Hwang M H, Pacold I, Piao Z E, Engelmeier R, Scanlon P J, Loeb H S
Am Heart J. 1986 Feb;111(2):312-6. doi: 10.1016/0002-8703(86)90145-6.
Patients with mitral stenosis often require supine exercise in order to increase their heart rate and cardiac output to assess the severity of their valvular obstruction during cardiac catheterization. We substituted dobutamine for exercise in 14 patients with suspected mitral stenosis. The dobutamine infusion was started at 5 micrograms/kg/min and was increased to 10, 15, and 20 micrograms/kg/min every 3 minutes as tolerated. The heart rate increased from 84 +/- 4 to 123 +/- 7 bpm (p less than 0.001), the cardiac index increased from 2.4 +/- 0.2 to 3.4 +/- 0.2 L/min/m2 (p less than 0.001), and the mean pulmonary artery pressure increased from 27 +/- 3 to 30 +/- 2 mm Hg (p less than 0.02). The pulmonary wedge pressure of 19 +/- 2 mm Hg and the mitral valve index of 0.8 +/- 0.1 cm2/m2 remained unchanged, but the left ventricular end-diastolic pressure decreased from 11 +/- 2 to 6 +/- 2 mm Hg (p less than 0.02). The hemodynamic response during the infusion of dobutamine identified a subgroup of patients with more severe mitral stenosis. Thus, the administration of dobutamine is useful in the evaluation of the severity of mitral valve obstruction during catheterization.
二尖瓣狭窄患者在心脏导管插入术期间，常需仰卧运动以提高心率和心输出量，从而评估瓣膜梗阻的严重程度。我们对14例疑似二尖瓣狭窄患者用多巴酚丁胺替代运动。多巴酚丁胺输注起始剂量为5微克/千克/分钟，视耐受情况每3分钟增加至10、15和20微克/千克/分钟。心率从84±4次/分钟增至123±7次/分钟（p<0.001），心脏指数从2.4±0.2升/分钟/平方米增至3.4±0.2升/分钟/平方米（p<0.001），平均肺动脉压从27±3毫米汞柱增至30±2毫米汞柱（p<0.02）。肺楔压19±2毫米汞柱和二尖瓣指数0.8±0.1平方厘米/平方米保持不变，但左心室舒张末期压力从11±2毫米汞柱降至6±2毫米汞柱（p<0.02）。多巴酚丁胺输注期间的血流动力学反应确定了一组二尖瓣狭窄更严重的患者亚组。因此，多巴酚丁胺给药在导管插入术期间评估二尖瓣梗阻严重程度方面是有用的。
