Mäurer W, Tillmanns H, Kübler W
Z Kardiol. 1979 May;68(5):290-7.
In patients with severe heart failure there is increased sympathetic-adrenergic activity functioning as a compensatory mechanism. Despite of increased plasma catecholamine levels myocardial sensivity to catecholamines administered for therapeutic reasons is not diminished. The positive inotropic effect of catecholamines is more pronounced as compared to digitalis glycosides. The therapeutic efficacy of catecholamines, particularly their capability to increase cardiac output, is strongly dependent on their action on alpha- and beta2-receptors. In order to enhance cardiac performance, catecholamines are mainly used under three clinical settings: 1. severe heart failure and cardiogenic shock secondary to acute myocardial infarction, 2. 'Low cardiac output syndrome" following cardiac surgery, and 3. chronic congestive heart failure refractory to therapy with glycosides and diuretics. The use of catecholamines in the presence of acute myocardial infarction may be hazardous due to the accompanying increase of myocardial oxygen consumption. Among the available catecholamines, clinical interest recently focused on dopamine and dobutamine. Particularly with the primarily cardioselective beta-stimulating agent dobutamine a marked positive inotropic effect can be achieved in a range of dosage not significantly affecting heart rate and peripheral resistance. Positive inotropic agents may be even more effective when used in combination with vasodilators, which decrease impedance to left ventricular ejection.
在重度心力衰竭患者中，交感 - 肾上腺素能活性增强，作为一种代偿机制发挥作用。尽管血浆儿茶酚胺水平升高，但出于治疗目的给予儿茶酚胺时，心肌对其敏感性并未降低。与洋地黄苷相比，儿茶酚胺的正性肌力作用更为显著。儿茶酚胺的治疗效果，尤其是其增加心输出量的能力，很大程度上取决于它们对α受体和β2受体的作用。为增强心脏功能，儿茶酚胺主要用于以下三种临床情况：1. 急性心肌梗死继发的重度心力衰竭和心源性休克；2. 心脏手术后的“低心输出量综合征”；3. 对洋地黄苷和利尿剂治疗无效的慢性充血性心力衰竭。在急性心肌梗死情况下使用儿茶酚胺可能具有危险性，因为会伴随心肌耗氧量增加。在现有的儿茶酚胺中，临床兴趣最近集中在多巴胺和多巴酚丁胺上。特别是使用主要具有心脏选择性的β激动剂多巴酚丁胺时，在不显著影响心率和外周阻力的剂量范围内可实现明显的正性肌力作用。正性肌力药物与血管扩张剂联合使用时可能更有效，血管扩张剂可降低左心室射血阻抗。
