Fletcher D, Mainardi J L, Brun-Buisson C, Lemaire F, Brochard L
Medical Intensive Care Unit, Paris XII Université, Hôpital Henri-Mondor, Créteil, France.
Intensive Care Med. 1990;16(7):466-8. doi: 10.1007/BF01711229.
Epinephrine is a potent bronchodilator currently used to treat severe asthma, although there is no proven advantage of this drug over beta 2 adrenergic agonists. By contrast, as demonstrated here, the use of such a potent vasoconstrictor can worsen hemodynamic status when left ventricular dysfunction is associated with asthma or is the cause for dyspnea. We describe the case of a 60-year-old man with an history of chronic asthmatic bronchitis admitted for status asthmaticus. Bronchodilator therapy, including high dosages of intravenous epinephrine, failed to improve the patient and he was intubated and mechanically ventilated. Several hours later, a right heart catheterization revealed severe unexpected left heart dysfunction with a capillary wedge pressure of 45 mmHg and a cardiac index of 1.7 l/min/m2. Epinephrine was gradually stopped which resulted in a decrease in mean arterial blood pressure and an improvement of hemodynamic status. He was discharged on home mechanical ventilation. In this patient, ischemic left heart failure was revealed by a clinical picture mimicking status asthmaticus. Epinephrine, given as bronchodilator therapy on an empiric basis precipitated the patient into cardiogenic shock. Therefore this drug should not be recommended in face of the possibility of cardiac asthma or associated cardiac dysfunction.
肾上腺素是一种强效支气管扩张剂，目前用于治疗严重哮喘，尽管尚无证据表明该药物比β2肾上腺素能激动剂更具优势。相比之下，如此处所示，当左心室功能障碍与哮喘相关或为呼吸困难的病因时，使用这种强效血管收缩剂会使血流动力学状态恶化。我们描述了一名60岁男性的病例，该患者有慢性喘息性支气管炎病史，因哮喘持续状态入院。支气管扩张剂治疗，包括大剂量静脉注射肾上腺素，未能改善患者病情，随后患者接受插管并进行机械通气。数小时后，右心导管检查显示严重的意外左心功能障碍，毛细血管楔压为45 mmHg，心脏指数为1.7 l/min/m2。肾上腺素逐渐停用，这导致平均动脉血压下降，血流动力学状态改善。患者出院后接受家庭机械通气。在该患者中，缺血性左心衰竭通过类似哮喘持续状态的临床表现得以揭示。经验性给予肾上腺素作为支气管扩张剂治疗使患者陷入心源性休克。因此，鉴于存在心源性哮喘或相关心脏功能障碍的可能性，不应推荐使用该药物。
