Yamamoto K, Kodama K, Masuyama T, Hirayama A, Nanto S, Mishima M, Kitabatake A, Kamada T
Cardiovascular Division, Osaka Police Hospital, Japan.
Int J Cardiol. 1992 Feb;34(2):143-55. doi: 10.1016/0167-5273(92)90150-2.
We examined the response of ventriculo-arterial coupling to epinephrine in 19 patients with normal left ventricular function and with left ventricular dysfunction of various degrees using a conductance catheter. They were divided into three groups: group I, seven patients without left ventricular wall motion abnormality; group II, six patients with ejection fraction of 45-60%; group III, six patients with ejection fraction of 28-40%. Changes in the slope of the end-systolic pressure-volume relationship (end-systolic elastance), the effective arterial elastance, the ratio of effective arterial elastance to end-systolic elastance and the ventricular work efficiency during administration of two different doses of epinephrine (0.05 and 0.1 micrograms/kg/min) were compared among the three groups. At baseline there were no significant differences among the three groups in the ratio of effective arterial elastance to end-systolic elastance, or ventricular work efficiency. At the lower dose of epinephrine, the mean ratio of effective arterial elastance to end-systolic elastance decreased and the mean ventricular work efficiency increased in any groups. At the higher dose of epinephrine the mean ratio of effective arterial elastance to end-systolic elastance further decreased and the mean ventricular work efficiency further increased in groups I and II. However, the mean ratio of effective arterial elastance to end-systolic elastance did not decrease but the mean ventricular work efficiency even decreased in group III. Thus, in patients with advanced left ventricular dysfunction, even a high dose of epinephrine does not modulate the ventriculo-arterial coupling to increase ventricular work efficiency.
我们使用电导导管研究了19例左心室功能正常以及不同程度左心室功能障碍患者的心室动脉耦联对肾上腺素的反应。他们被分为三组：第一组，7例无左心室壁运动异常的患者；第二组，6例射血分数为45%-60%的患者；第三组，6例射血分数为28%-40%的患者。比较了三组在给予两种不同剂量肾上腺素（0.05和0.1微克/千克/分钟）期间，收缩末期压力-容积关系斜率（收缩末期弹性）、有效动脉弹性、有效动脉弹性与收缩末期弹性之比以及心室工作效率的变化。基线时，三组在有效动脉弹性与收缩末期弹性之比或心室工作效率方面无显著差异。在较低剂量的肾上腺素作用下，任何一组中有效动脉弹性与收缩末期弹性的平均比值均降低，平均心室工作效率均升高。在较高剂量的肾上腺素作用下，第一组和第二组中有效动脉弹性与收缩末期弹性的平均比值进一步降低，平均心室工作效率进一步升高。然而，第三组中有效动脉弹性与收缩末期弹性的平均比值并未降低，平均心室工作效率甚至降低了。因此，在晚期左心室功能障碍患者中，即使是高剂量肾上腺素也无法调节心室动脉耦联以提高心室工作效率。
