Lotto A, Finzi A, Massari F M, Pagnoni F, Valentini R, Ambrosini F, Lo Masto M
G Ital Cardiol. 1984 Oct;14(10):762-7.
The hemodynamic effects induced by an i.v. administration of Amiodarone (5 mg/Kg in 10 min + continuous infusion of 0.6 mg/min for 4-40 hrs), Propafenone (1-2 mg/Kg in 5 min + continuous infusion of 10-15 mcg/Kg/min for 24 hrs) and Mexiletine (250 mg in 15 min + 250 mg in 1 hr) have been evaluated in patients with acute myocardial infarction complicated by sinus tachycardia and hyperdynamic pattern, ventricular or supraventricular arrhythmias. The hemodynamic serial determinations have been comprehensive of: heart rate; systolic, diastolic and mean pressure; central venous pressure; arterial and wedge pulmonary pressure; cardiac output and cardiac index; vascular systemic resistences; left ventricular stroke work index; left ventricular mean ejection rate; double and triple product. In all of the three groups we observed: a reduction of cardiac index associated with an increase of left and right ventricular filling pressure and a reduction either of left ventricular stroke work index and left ventricular mean ejection rate; these hemodynamic changes were less significant after Mexiletine than after Amiodarone or Propafenone. These data confirm the negative inotropic effect of the three drugs; anyhow, these changes are usually well tolerated by patients affected by AMI with a sufficiently preserved ventricular function. The authors, however, reccommend an accurate hemodynamic monitoring of the effects of the drugs also to identify patients with a not overt ventricular failure which may become manifest after drug administration.
静脉注射胺碘酮（10分钟内注射5mg/kg，随后以0.6mg/分钟的速度持续输注4 - 40小时）、普罗帕酮（5分钟内注射1 - 2mg/kg，随后以10 - 15μg/kg/分钟的速度持续输注24小时）和美西律（15分钟内注射250mg，1小时后再注射250mg）对急性心肌梗死合并窦性心动过速和高动力型、室性或室上性心律失常患者的血流动力学影响已得到评估。血流动力学的系列测定包括：心率；收缩压、舒张压和平均压；中心静脉压；动脉压和肺楔压；心输出量和心脏指数；体循环阻力；左心室每搏功指数；左心室平均射血率；双乘积和三乘积。在所有三组中我们都观察到：心脏指数降低，同时左、右心室充盈压升高，左心室每搏功指数和左心室平均射血率降低；美西律给药后这些血流动力学变化比胺碘酮或普罗帕酮给药后不那么显著。这些数据证实了这三种药物的负性肌力作用；然而，对于心室功能足够保留的急性心肌梗死患者，这些变化通常耐受性良好。不过，作者建议对药物作用进行精确的血流动力学监测，以识别那些在给药后可能出现明显心室功能不全的隐性心室功能不全患者。
