Leier C V
Am J Med. 1986 Oct 31;81(4C):40-5. doi: 10.1016/0002-9343(86)90944-7.
Advances in our understanding of the pathophysiology of cardiac-ventricular failure and the pharmacophysiology of adrenergic receptors have greatly improved the short-term therapy of the low-output, hypotensive-hypoperfused, cardiac failure states. Agents are now specifically selected for these conditions on the basis of their predominant effects on the heart (positive inotropy) and the peripheral vasculature (vasodilatation or vasoconstriction). With the addition of dobutamine therapy, the pharmacophysiologic spectrum now includes norepinephrine (predominant vasopressor), dopamine (combined vasopressor-positive inotrope), dobutamine (predominant positive inotrope), and isoproterenol (combined positive inotrope-vasodilator). Digitalis was introduced to the medical profession 200 years ago. In terms of chronically administered positive inotropic therapy, to date, this "old-timer" has not been replaced. The yet experimental phosphodiesterase inhibitors, enoximone and milrinone, appear promising as long-term nonparenteral inotropes; however, the precise role, clinical effectiveness, and safety profile of these agents remain to be determined.
我们对心室衰竭病理生理学以及肾上腺素能受体药物生理学认识的进展，极大地改善了低输出量、低血压-低灌注心力衰竭状态的短期治疗。现在根据药物对心脏（正性肌力作用）和外周血管系统（血管舒张或血管收缩）的主要作用，专门为这些病症选择药物。随着多巴酚丁胺治疗的加入，药物生理学范围现在包括去甲肾上腺素（主要是血管升压药）、多巴胺（兼具血管升压和正性肌力作用）、多巴酚丁胺（主要是正性肌力药）和异丙肾上腺素（兼具正性肌力和血管舒张作用）。洋地黄在200年前被引入医学领域。就长期给予的正性肌力治疗而言，迄今为止，这种“老药”尚未被取代。仍处于实验阶段的磷酸二酯酶抑制剂依诺昔酮和米力农，作为长期非肠道正性肌力药似乎很有前景；然而，这些药物的确切作用、临床疗效和安全性仍有待确定。
