Kurland G, Williams J, Lewiston N J
J Allergy Clin Immunol. 1979 Jun;63(6):407-11. doi: 10.1016/0091-6749(79)90214-8.
We recently utilized continuous infusion intravenous isoproterenol in the treatment of respiratory failure in an 18-yr-old steroid-dependent asthmatic female. Aminophylline, hydrocortisone, aerosolized isoetharine, and oxygen were also administrered. The patient responded to this therapy, with PaCO2 falling from 70 torr to 33 torr in 18 hr. The maximum isoproterenol dosage administered was 0.32 microgram/kg/min. Thirty-six hours following the institution of therapy, while the isoproterenol was being tapered, the patient experienced an increase in respiratory distress followed by cardiac arrest. Postmortem examination revealed multiple small areas of myocardial necrosis. These findings, unusual in asthma, probably were related to the effects of isoproterenol or the combination of isoproterenol and aminophylline on the stressed myocardium. The vulnerability of the hypoxic myocardium to the effects of isoproterenol suggests that careful cardiac monitoring is essential in the management of patients receiving this medication for treatment of respiratory failure secondary to severe asthma.
我们最近使用持续静脉输注异丙肾上腺素治疗一名18岁依赖类固醇的哮喘女性患者的呼吸衰竭。同时还给予了氨茶碱、氢化可的松、雾化异丙喘宁和氧气。患者对该治疗有反应，动脉血二氧化碳分压（PaCO2）在18小时内从70托降至33托。异丙肾上腺素的最大给药剂量为0.32微克/千克/分钟。治疗开始36小时后，在逐渐减少异丙肾上腺素用量时，患者呼吸窘迫加重，随后发生心脏骤停。尸检发现多处小面积心肌坏死。这些在哮喘中不常见的发现，可能与异丙肾上腺素或异丙肾上腺素与氨茶碱联合对应激心肌的作用有关。缺氧心肌对异丙肾上腺素作用的易感性表明，在治疗严重哮喘继发呼吸衰竭而接受此药治疗的患者时，仔细的心脏监测至关重要。
