Keller N, Sykulski R, Larsen J
Department of Medicine, Hvidovre Hospital, Denmark.
Clin Physiol. 1991 May;11(3):199-210. doi: 10.1111/j.1475-097x.1991.tb00451.x.
The influence of two cardiac inotropic drugs, dobutamine and salbutamol, on plasma atrial natriuretic factor (ANF) was investigated in 20 patients with congestive heart failure. All were in New York Heart Association class-III or IV. The patients underwent right heart catheterization with determination of central pressures, cardiac output, and pulmonary arterial plasma ANF during incremental infusions with dobutamine or salbutamol. Fourteen patients completed the study. Both drugs induced comparable increases in cardiac index and decreases in total systemic vascular resistance (P less than 0.01) without significant changes in central pressures. Heart rate rose after salbutamol (P less than 0.05), but not after dobutamine. No changes in plasma ANF were observed after either of the drug infusions. ANF secretion rate was calculated from simultaneous measurements of ANF in right atrial and pulmonary arterial plasma before and after salbutamol infusion, and median values rose more than seven-fold (P less than 0.05). The results demonstrate that ANF secretion rate is augmented after beta-adrenergic agents, possibly by a direct beta 2-adrenergic stimulation, in patients with severe congestive heart failure, and that changes in plasma ANF are an insufficient measure of ANF release when patient samples are small.
在20例充血性心力衰竭患者中研究了两种强心药物多巴酚丁胺和沙丁胺醇对血浆心钠素（ANF）的影响。所有患者均为纽约心脏协会III级或IV级。患者在多巴酚丁胺或沙丁胺醇递增输注期间接受右心导管检查，测定中心静脉压、心输出量和肺动脉血浆ANF。14例患者完成了研究。两种药物均可使心脏指数显著升高，总全身血管阻力显著降低（P<0.01），而中心静脉压无明显变化。沙丁胺醇输注后心率升高（P<0.05），多巴酚丁胺输注后心率无变化。两种药物输注后血浆ANF均无变化。通过同时测量沙丁胺醇输注前后右心房和肺动脉血浆中的ANF来计算ANF分泌率，中位数升高超过7倍（P<0.05）。结果表明，在严重充血性心力衰竭患者中，β肾上腺素能药物可能通过直接的β2肾上腺素能刺激增加ANF分泌率，并且当患者样本量较小时，血浆ANF的变化不足以衡量ANF释放情况。
