Birnbaum D E, Preuner J G, Gieseke R, Trenk D, Jaehnchen E
Department of Cardiovascular Surgery, Rehabilitation Center, Bad Krozingen, FRG.
Cardiology. 1990;77 Suppl 3:34-41; discussion 62-7. doi: 10.1159/000174669.
The efficacy of acute haemodynamic support with intravenous enoximone (2 X bolus 0.5 mg/kg; infusion 5.0 micrograms/kg/min) versus dopamine (3.0-4.0 micrograms/kg/min), over an 18-hour period, was investigated in patients to be weaned from cardiopulmonary bypass (placebo-controlled trial). Under steady-state conditions, enoximone produced a substantial increase in cardiac index (20.6 +/- 1.7%), but no change in heart rate. The improvement in cardiac index with time until constant values were reached (6 h) was not directly paralleled by the plasma concentration of enoximone. Pharmacodynamically relevant concentrations were already present after 1 h of infusion (480 +/- 68 ng/ml) and comparable with the value determined after 6 h (442 +/- 37 ng/ml). After 18 h of infusion, plasma concentration had reached 742 +/- 47 ng/ml without a further improvement in cardiac function. The augmentation of stroke volume index (23.3 +/- 2.5%) occurred concomitantly with a decrease in systemic vascular resistance (-23.1 +/- 0.6%), obviously due to a decrease in diastolic arterial pressure (-12.0 +/- 3.8%). The pulmonary capillary wedge pressure remained unaffected. There was only a slight decrease in pulmonary vascular resistance (-9.3 +/- 3.2%). During both enoximone infusion and dopamine infusion, right atrial pressure increased (10.0 +/- 3.1 and 9.0 +/- 1.8%, respectively), in contrast to the untreated control group. This is contradictory to the drugs' described effect in patients suffering from congestive heart failure. At a concentration which would not normally cause cardiac acceleration, dopamine provided minor haemodynamic support in the period after cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)
在一项针对拟脱离体外循环的患者的研究中（安慰剂对照试验），对静脉注射依诺昔酮（2次推注，每次0.5mg/kg；输注速度5.0微克/千克/分钟）与多巴胺（3.0 - 4.0微克/千克/分钟）在18小时内的急性血流动力学支持效果进行了研究。在稳态条件下，依诺昔酮使心脏指数显著增加（20.6±1.7%），但心率无变化。在达到恒定值（6小时）之前，心脏指数随时间的改善与依诺昔酮的血浆浓度并无直接平行关系。输注1小时后（480±68纳克/毫升）就已出现与药效学相关的浓度，且与6小时后测定的值（442±37纳克/毫升）相当。输注18小时后，血浆浓度达到742±47纳克/毫升，但心脏功能并未进一步改善。每搏量指数增加（23.3±2.5%）的同时，体循环血管阻力下降（-23.1±0.6%），这显然是由于舒张压下降（-12.0±3.8%）所致。肺毛细血管楔压未受影响。肺血管阻力仅略有下降（-9.3±3.2%）。与未治疗的对照组相比，在依诺昔酮输注和多巴胺输注期间，右心房压力均升高（分别为10.0±3.1%和9.0±1.8%）。这与这些药物在充血性心力衰竭患者中所描述的作用相矛盾。在通常不会引起心率加快的浓度下，多巴胺在体外循环后的时期提供了轻微的血流动力学支持。（摘要截选至250字）
