Loeb H S, Ostrenga J P, Gaul W, Witt J, Freeman G, Scanlon P, Gunnar R M
Circulation. 1983 Oct;68(4):813-20. doi: 10.1161/01.cir.68.4.813.
Hemodynamic effects of dopamine and intravenous nitroglycerin alone, and in combination, were studied in 27 patients with severe left ventricular failure. Dopamine alone increased cardiac index from 1.8 to 2.5 l/min/m2 but also increased wedge pressure from 24 to 30 mm Hg and heart rate from 88 to 101 beats/min. Arterial oxygen saturation fell from 92% to 87% (p less than .001). Nitroglycerin alone had a lesser effect on cardiac index (1.8 to 2.2 l/min/m2) but decreased wedge pressure from 26 to 16 mm Hg and heart rate from 91 to 86 beats/min. Arterial oxygen saturation fell from 91% to 90% (NS). Combined dopamine and nitroglycerin administration resulted in optimal hemodynamics, with cardiac index of 2.9 l/min/m2, wedge pressure of 17 mm Hg, and heart rate of 96 beats/min. Arterial oxygen saturation remained low at 88% in spite of the reduction in left ventricular filling pressure, which probably reflects increased intrapulmonary right-to-left shunting coupled with increased pulmonary blood flow. These results suggest that the combination of dopamine with intravenous nitroglycerin should be considered for patients with severe left ventricular dysfunction who require temporary pharmacologic support.
对27例严重左心室衰竭患者研究了多巴胺、静脉注射硝酸甘油单独及联合应用时的血流动力学效应。单独使用多巴胺使心脏指数从1.8升/分钟/平方米增加到2.5升/分钟/平方米，但同时使楔压从24毫米汞柱升高到30毫米汞柱，心率从88次/分钟增加到101次/分钟。动脉血氧饱和度从92%降至87%（p<0.001）。单独使用硝酸甘油对心脏指数的影响较小（从1.8升/分钟/平方米增加到2.2升/分钟/平方米），但使楔压从26毫米汞柱降至16毫米汞柱，心率从91次/分钟降至86次/分钟。动脉血氧饱和度从91%降至90%（无显著性差异）。联合使用多巴胺和硝酸甘油可产生最佳血流动力学效果，心脏指数为2.9升/分钟/平方米，楔压为17毫米汞柱，心率为96次/分钟。尽管左心室充盈压降低，但动脉血氧饱和度仍低至88%，这可能反映了肺内右向左分流增加以及肺血流量增加。这些结果表明，对于需要临时药物支持的严重左心室功能不全患者，应考虑多巴胺与静脉注射硝酸甘油联合应用。
