Vincent J L, Madhoun P, Primo G, Kahn R J
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Intensive Care Med. 1989;15(8):530-1. doi: 10.1007/BF00273566.
Enoximone is a new inotropic agent, which acts by the inhibition of the type III phosphodiesterase (PDE) enzyme. The present report describes a 81-year-old female patient with severe heart failure following aortic valve replacement. Her cardiac activity was paced. The addition of enoximone (two doses of 0.5 mg/kg) to an intravenous infusion of dobutamine (8 mcg/kg/min) and sodium nitroprusside significantly increased cardiac output (CO) from 3.2 to 3.9 l/min and decreased pulmonary artery occlusive pressure (PAOP) from 22 to 16 mmHg. Another dose of enoximone 12 h later had similar effects. However, another 12 h later, after dobutamine had been discontinued, two successive injections of 0.5 mg/kg of enoximone were totally ineffective (CO from 2.6 to 2.5 l/min, PAOP 23 mmHg). When the dobutamine infusion was restarted (at 8 mcg/kg/min), the positive effects of 0.5 mg/kg of enoximone were again present (CO from 3.0 to 3.6 l/min, PAOP from 19 to 14 mmHg). This observation underscores the therapeutic value of the combination of PDE inhibitors such as enoximone with adrenergic agents such as dobutamine in the management of severe heart failure.
依诺昔酮是一种新型的强心剂，其作用机制是抑制Ⅲ型磷酸二酯酶（PDE）。本报告描述了一位81岁的女性患者，在进行主动脉瓣置换术后出现严重心力衰竭。对其心脏活动进行了起搏。在静脉输注多巴酚丁胺（8微克/千克/分钟）和硝普钠的基础上加用依诺昔酮（两剂，每剂0.5毫克/千克），可使心输出量（CO）从3.2升/分钟显著增加至3.9升/分钟，并使肺动脉闭塞压（PAOP）从22毫米汞柱降至16毫米汞柱。12小时后再给予一剂依诺昔酮也有类似效果。然而，又过了12小时，在停用多巴酚丁胺后，连续两次注射0.5毫克/千克的依诺昔酮完全无效（CO从2.6升/分钟降至2.5升/分钟，PAOP为23毫米汞柱）。当重新开始输注多巴酚丁胺（8微克/千克/分钟）时，0.5毫克/千克依诺昔酮的积极作用再次出现（CO从3.0升/分钟增加至3.6升/分钟，PAOP从19毫米汞柱降至14毫米汞柱）。这一观察结果强调了在严重心力衰竭的治疗中，依诺昔酮等PDE抑制剂与多巴酚丁胺等肾上腺素能药物联合使用的治疗价值。
