Beekman R H, Rocchini A P, Rosenthal A
Circulation. 1982 Mar;65(3):523-8. doi: 10.1161/01.cir.65.3.523.
To evaluate the effects of acute afterload reduction, hydralazine, 0.2 mg/kg, was administered at cardiac catheterization to seven infants who had a large ventricular septal defect (VSD). The infants were 2.5 - 11 months old (mean 5.1 months). Before and 5, 15, 25 and 35 minutes after hydralazine, aortic, pulmonary capillary wedge, pulmonary artery, right atrial and superior vena caval pressures and saturations, heart rate and oxygen consumption were measured. Hemodynamic effects were noted after 5 minutes but were most pronounced 35 minutes after hydralazine. Prehydralazine baseline data were therefore compared with values 35 minutes after hydralazine. Pulmonary flow did not changes, but systemic flow increased significantly (4.5 +/- 0.2 to 6.7 +/- 0.5 liters/min/m2 [mean +/- SEM], p less than 0.001). The pulmonary-to-systemic flow ratio decreased by 32% (3.4 +/- 0.4 to 2.3 +/- 0.2, p less than 0.001) and the absolute left-to-right shunt decreased by 24% (10.8 +/- 1.3 to 8.2 +/- 1.2 liters/min/m2, p less than 0.01). Hydralazine caused a significant decrease in systemic resistance (13.9 +/- 0.7 to 9.5 +/- 0.7 U, p less than 0.001). Pulmonary resistance, aortic, pulmonary artery and pulmonary capillary wedge pressures, heart rate and oxygen consumption did not change after hydralazine. Right atrial pressure decreased slightly (4.0 +/- 0.6 to 2.4 +/- 0.6 mm Hg, p less than 0.05). In conclusion, hydralazine caused a significant increase in systemic blood flow and a significant decrease in both pulmonary-to-systemic flow ratio and absolute left-to-right shunt in seven infants with a large VSD. These effects appear to be related to the decrease in systemic resistance that occurred with hydralazine. Although limited to the acute setting, these findings suggest that hydralazine may be beneficial in the management of infants with a large VSD.
为评估急性后负荷降低的效果，在心脏导管插入术时给7名患有大型室间隔缺损（VSD）的婴儿静脉注射了0.2 mg/kg的肼屈嗪。这些婴儿年龄在2.5至11个月之间（平均5.1个月）。在注射肼屈嗪之前以及之后5、15、25和35分钟，测量了主动脉、肺毛细血管楔压、肺动脉、右心房和上腔静脉压力及饱和度、心率和氧耗量。5分钟后观察到血流动力学效应，但在注射肼屈嗪后35分钟最为明显。因此，将注射肼屈嗪前的基线数据与注射后35分钟的值进行了比较。肺血流量未发生变化，但体循环血流量显著增加（从4.5±0.2升至6.7±0.5升/分钟/平方米[平均值±标准误]，p<0.001）。肺循环与体循环血流量之比下降了32%（从3.4±0.4降至2.3±0.2，p<0.001），绝对左向右分流减少了24%（从10.8±1.3降至8.2±1.2升/分钟/平方米，p<0.01）。肼屈嗪使体循环阻力显著降低（从13.9±0.7降至9.5±0.7 U，p<0.001）。注射肼屈嗪后，肺循环阻力、主动脉、肺动脉和肺毛细血管楔压、心率和氧耗量均未改变。右心房压力略有下降（从4.0±0.6降至2.4±0.6 mmHg，p<0.05）。总之，肼屈嗪使7名患有大型VSD的婴儿的体循环血流量显著增加，肺循环与体循环血流量之比以及绝对左向右分流均显著降低。这些效应似乎与肼屈嗪引起的体循环阻力降低有关。尽管仅限于急性情况，但这些发现表明肼屈嗪可能对患有大型VSD婴儿的治疗有益。
