Treese N, Erbel R, Rhein S, Henrichs K J, Meyer J
Medical Clinic II, Johannes Gutenberg University, Mainz, West Germany.
Eur Heart J. 1989 Jun;10(6):484-92. doi: 10.1093/oxfordjournals.eurheartj.a059517.
In the present study, the safety and efficacy of the combined administration of intravenous nitroprusside and oral enoximone, an experimental compound with phosphodiesterase inhibitory properties, were evaluated. Ten patients with unstable chronic heart failure maintained on digitalis and diuretics were selected to receive enoximone because of their poor response to intravenous nitroprusside. For a mean peak dose of 115 micrograms min-1 nitroprusside, cardiac index increased from 1.8 +/- 0.4 to 2.0 +/- 0.4 l min-1 m-2, while pulmonary artery diastolic pressure and mean right atrial pressure decreased from 29 +/- 6 to 24 +/- 5 and from 15 +/- 6 to 11 +/- 3 mmHg respectively; mean arterial pressure and heart rate were unchanged. The addition of 1.6 mg kg-1 oral enoximone t.i.d. to nitroprusside resulted in a substantial improvement of cardiac function: cardiac index increased further to 2.8 +/- 0.5 l min-1 m-2 (P less than 0.001), pulmonary artery diastolic pressure and right atrial pressure decreased to 18 +/- 5 and 7 +/- 3 mmHg (P less than 0.01), respectively, while mean arterial pressure rose from 90 +/- 11 mmHg to 95 +/- 0 mmHg (P less than 0.05); heart rate was unchanged. The salutary haemodynamic response to combined nitroprusside-enoximone therapy persisted for more than 32 h, and cardiac performance remained improved on enoximone for a further 8 h despite the discontinuation of nitroprusside. No serious side-effects or changes in the arrhythmia profile were observed. The addition of oral enoximone to nitroprusside has beneficial haemodynamic effects in unstable chronic heart failure.
在本研究中，对静脉注射硝普钠与口服依诺昔酮（一种具有磷酸二酯酶抑制特性的实验性化合物）联合用药的安全性和有效性进行了评估。选择10例接受洋地黄和利尿剂治疗的不稳定型慢性心力衰竭患者，因其对静脉注射硝普钠反应不佳而接受依诺昔酮治疗。硝普钠平均峰值剂量为115微克/分钟时，心脏指数从1.8±0.4升至2.0±0.4升/分钟/平方米，而肺动脉舒张压和平均右心房压分别从29±6降至24±5以及从15±6降至11±3毫米汞柱；平均动脉压和心率未变。在硝普钠基础上加用1.6毫克/千克口服依诺昔酮，每日3次，可使心功能显著改善：心脏指数进一步升至2.8±0.5升/分钟/平方米（P<0.001），肺动脉舒张压和右心房压分别降至18±5和7±3毫米汞柱（P<0.01），而平均动脉压从90±11毫米汞柱升至95±10毫米汞柱（P<0.05）；心率未变。硝普钠-依诺昔酮联合治疗的有益血流动力学反应持续超过32小时，尽管停用了硝普钠，但在继续使用依诺昔酮的情况下，心脏功能在接下来的8小时内仍保持改善。未观察到严重副作用或心律失常情况的变化。在硝普钠基础上加用口服依诺昔酮对不稳定型慢性心力衰竭具有有益的血流动力学作用。
