Boldt J, Kling D, Schuhmann E, Dapper F, Hempelmann G
Abteilung Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.
Anaesthesist. 1989 May;38(5):238-44.
The new phosphodiesterase-III inhibitor (PDI) enoximone is a non-catecholamine, non-glycoside cardiotonic agent with concomitant vasodilating properties. It has proved beneficial in patients with severe chronic heart failure. The influence of enoximone i.v. on hemodynamics was investigated during cardiac surgery under various conditions. METHODS. A randomized series of 60 patients undergoing elective aorto-coronary bypass grafting were studied. The hemodynamic effects of 0.5 mg/kg enoximone given i.v. as a bolus (30 s) were investigated before anesthesia (n = 10), during anesthesia (n = 10), and during extracorporeal circulation (ECC, n = 10) and compared with those observed in corresponding control groups (n = 10 in each control) of patients who had received saline solution as placebo. Anesthesia was maintained with weight-dependent dosages of fentanyl, midazolam and pancuronium bromide. All patients were invasively monitored by means of a pulmonary artery catheter. Additionally, left ventricular pressure (LVP), left ventricular end-diastolic pressure (LVEDP) and dp/dtmax were measured before the initiation of ECC. During ECC direct vascular effects were investigated with measurement of perfusion pressure and the volume of the oxygenator. RESULTS. Before the induction of anesthesia no significant change in MAP and HR could be observed, whereas CI increased (+20%) and TSR decreased (-24%) significantly. During anesthesia, the injection of enoximone was followed by a significant decrease in MAP only in the 1st min (-17%); baseline level was reached again after 6 min; and HR was slightly increased (+8%). TSR (-31%) and LVEDP (-38%) decreased, whereas CI (+17%) and dp/dtmax (+45%) were increased significantly. During ECC perfusion pressure (-37%) and the volume of the oxygenator (-17%) were significantly decreased, demonstrating direct vasodilating effects on both the arteries and the vein. CONCLUSION. Arterial and venous vasodilation with an increase in myocardial performance (dp/dtmax) resulting in an increase in CI were the predominant hemodynamic effects of enoximone i.v. No arrhythmogenic effects or interactions with the anesthetics used were observed in this study.
新型磷酸二酯酶III抑制剂（PDI）依诺昔酮是一种具有血管舒张特性的非儿茶酚胺、非糖苷类强心剂。已证实其对严重慢性心力衰竭患者有益。研究了在不同条件下心脏手术期间静脉注射依诺昔酮对血流动力学的影响。方法：对60例行择期主动脉冠状动脉搭桥术的患者进行随机分组研究。在麻醉前（n = 10）、麻醉期间（n = 10）和体外循环期间（ECC，n = 10），静脉推注（30秒）0.5mg/kg依诺昔酮，研究其血流动力学效应，并与接受生理盐水作为安慰剂的相应对照组（每组n = 10）进行比较。采用依体重剂量的芬太尼、咪达唑仑和泮库溴铵维持麻醉。所有患者均通过肺动脉导管进行有创监测。此外，在体外循环开始前测量左心室压力（LVP）、左心室舒张末期压力（LVEDP）和dp/dtmax。在体外循环期间，通过测量灌注压力和氧合器容积来研究直接血管效应。结果：麻醉诱导前，MAP和HR无显著变化，而CI增加（+20%），TSR显著降低（-24%）。在麻醉期间，静脉注射依诺昔酮后仅在第1分钟MAP显著降低（-17%）；6分钟后恢复至基线水平；HR略有增加（+8%）。TSR（-31%）和LVEDP（-38%）降低，而CI（+17%）和dp/dtmax（+45%）显著增加。在体外循环期间，灌注压力（-37%）和氧合器容积（-17%）显著降低，表明对动脉和静脉均有直接血管舒张作用。结论：静脉注射依诺昔酮的主要血流动力学效应是动脉和静脉血管舒张，心肌性能（dp/dtmax）增加，导致CI增加。本研究未观察到致心律失常作用或与所用麻醉剂的相互作用。
