Uretsky B F
Postgrad Med J. 1986 Jun;62(728):585-92. doi: 10.1136/pgmj.62.728.585.
The appropriateness of inotropic therapy in chronic heart failure was examined by critically reviewing five assumptions upon which this form of therapy has been justified. Only the first, that cardiac performance can be acutely improved by inotropic therapy, has been empirically proven. That such acute improvement is sustained appears to be true with non-catecholamine agents whereas the chronic haemodynamic efficacy of oral catecholamines remains in doubt. That any inotropic agent can improve exercise tolerance, make the patient feel better, or effect a change without deleteriously affecting the myocyte is very much in doubt. Thus, although the prospect of using powerful inotropic therapy in the patient with heart failure is theoretically appealing, its utility remains to be proven.
通过严格审视支持慢性心力衰竭中使用正性肌力药物治疗的五个假设，来检验该治疗方式的合理性。只有第一个假设，即正性肌力药物治疗可急性改善心脏功能，已得到实证证明。对于非儿茶酚胺类药物，这种急性改善似乎能够持续，而口服儿茶酚胺类药物的慢性血流动力学疗效仍存疑问。任何正性肌力药物能否改善运动耐量、让患者感觉更好，或者在不损害心肌细胞的情况下产生效果，都非常值得怀疑。因此，尽管在心力衰竭患者中使用强效正性肌力药物治疗在理论上很有吸引力，但其效用仍有待证实。
