Uretsky B F, Lawless C E, Verbalis J G, Valdes A M, Kolesar J A, Reddy P S
Department of Medicine, University of Pittsburgh.
Chest. 1987 Oct;92(4):657-62. doi: 10.1378/chest.92.4.657.
The hemodynamic and hormonal responses to dobutamine alone and with the addition of amrinone were studied in ten patients with severe heart failure. Dobutamine significantly increased heart rate, cardiac index, and stroke volume index and significantly decreased mean right atrial and systemic arterial pressures and systemic and pulmonary vascular resistance. The addition of amrinone further decreased significantly mean right atrial, pulmonary arterial, and pulmonary arterial wedge pressures and systemic vascular resistance, while heart rate rose. The response of the cardiac index was variable, increasing in seven and decreasing in three patients. Plasma renin activity rose significantly with dobutamine and further increased with amrinone. We conclude that in most patients with severe heart failure, amrinone, when combined with dobutamine, improves hemodynamics. The further increase in heart rate, variable effects on the cardiac index, and marked activation of the renin-angiotensin system suggest caution and potential limitations in the use of this combination.
在10例重度心力衰竭患者中研究了单独使用多巴酚丁胺以及加用氨力农时的血流动力学和激素反应。多巴酚丁胺显著增加心率、心脏指数和每搏量指数，并显著降低平均右心房压和体动脉压以及体循环和肺血管阻力。加用氨力农后，平均右心房压、肺动脉压和肺动脉楔压以及体循环血管阻力进一步显著降低，而心率升高。心脏指数的反应不一，7例患者升高，3例患者降低。多巴酚丁胺使血浆肾素活性显著升高，加用氨力农后进一步升高。我们得出结论，在大多数重度心力衰竭患者中，氨力农与多巴酚丁胺联合使用可改善血流动力学。心率进一步升高、对心脏指数的影响不一以及肾素-血管紧张素系统的显著激活提示在使用这种联合用药时需谨慎并可能存在局限性。
