Artman M, Parrish M D, Appleton S, Boucek R J, Graham T P
Am Heart J. 1987 Jan;113(1):144-50. doi: 10.1016/0002-8703(87)90022-6.
We evaluated the acute hemodynamic responses to hydralazine during cardiac catheterization in 13 infants with idiopathic dilated cardiomyopathy. Ages ranged from 2 to 13 months (6.7 +/- 4.0 months, mean +/- SD). Each infant had congestive heart failure and angiographic evidence of markedly depressed left ventricular ejection fraction (0.24 +/- 0.11; normal = 0.58-0.78) with left ventricular dilation (left ventricular end-diastolic volume = 349 +/- 125% of normal). Hydralazine (0.5 to 1.0 mg/kg administered intravenously) acutely decreased systemic arteriolar resistance from 21.1 +/- 3.3 to 12.0 +/- 2.7 U/m2 (p less than 0.001). This 41 +/- 14% decrease in systemic resistance was accompanied by a 45 +/- 16% increase in cardiac index (3.24 +/- 0.53 to 4.71 +/- 0.99 L/min/m2; p less than 0.001). Mean arterial blood pressure declined from 70 +/- 8 to 60 +/- 11 mm Hg (p less than 0.001). Hydralazine also increased heart rate (122 +/- 19 to 138 +/- 18 bpm; p less than 0.001), but this increase did not account entirely for the change in cardiac index as evidenced by a rise in stroke volume index (26.9 +/- 4.9 to 34.5 +/- 7.5 ml/beat/m2; p less than 0.001). Pulmonary arteriolar resistance and pulmonary capillary wedge pressure fell slightly in response to hydralazine. Subsequently, oral hydralazine was included in the treatment regimen of 10 infants followed for 3 to 38 months (mean = 15 months). Of these, eight demonstrated sustained clinical improvement. We conclude that hydralazine may be a beneficial adjunct to the management of congestive heart failure in young infants with a dilated cardiomyopathy.
我们评估了13例特发性扩张型心肌病婴儿在心脏导管插入术期间对肼屈嗪的急性血流动力学反应。年龄范围为2至13个月（平均±标准差为6.7±4.0个月）。每名婴儿均患有充血性心力衰竭，且血管造影显示左心室射血分数明显降低（0.24±0.11；正常为0.58 - 0.78），伴有左心室扩张（左心室舒张末期容积为正常的349±125%）。静脉注射肼屈嗪（0.5至1.0 mg/kg）后，全身小动脉阻力从21.1±3.3急剧降至12.0±2.7 U/m²（p < 0.001）。全身阻力下降41±14%的同时，心脏指数增加45±16%（从3.24±0.53升至4.71±0.99 L/min/m²；p < 0.001）。平均动脉血压从70±8降至60±11 mmHg（p < 0.001）。肼屈嗪还使心率增加（从122±19升至138±18次/分钟；p < 0.001），但正如每搏量指数升高所证明的那样（从26.9±4.9升至34.5±7.5 ml/搏/m²；p < 0.001），这种增加并不能完全解释心脏指数的变化。肺动脉小动脉阻力和肺毛细血管楔压对肼屈嗪的反应略有下降。随后，10例婴儿的治疗方案中加入了口服肼屈嗪，并随访3至38个月（平均为15个月）。其中8例显示出持续的临床改善。我们得出结论，肼屈嗪可能是治疗患有扩张型心肌病的幼儿充血性心力衰竭的有益辅助药物。
