Timmis A D, Bergman G, Walker L, Monaghan M J, Jewitt D E
Int J Cardiol. 1984 Mar;5(3):327-38. doi: 10.1016/0167-5273(84)90110-4.
This study was designed to investigate and compare the haemodynamic and metabolic responses to pirbuterol and salbutamol in patients with congestive heart failure and coronary artery disease. Attention was directed towards the effects these beta 2-adrenoceptor agonists have on left ventricular systolic function, systemic and coronary haemodynamics and myocardial substrate metabolism. Sixteen patients were randomly allocated to treatment with either pirbuterol 20 mg or salbutamol 6 mg. Since no statistically significant differences between the responses to these drugs were observed, combined data for both agents are presented. Ninety minutes after the drug intervention cardiac index increased from 2.2 +/- 0.1 to 2.9 +/- 0.2 1/min per m2 (P less than 0.001) in association with marked reductions in systemic vascular resistance (from 22 +/- 1 to 15 +/- 1 units, P less than 0.001) and increments in left ventricular dp/dtmax (from 1074 +/- 85 to 1422 +/- 133 mm Hg/sec, P less than 0.05). Modest reductions in left ventricular end-diastolic pressure (from 21 +/- 1 to 15 +/- 1 mm Hg, P less than 0.01) were observed. Heart rate increased from 82 +/- 5 to 91 +/- 4 beats/min (P less than 0.01) but the small fall in mean arterial pressure (from 86 +/- 3 to 78 +/- 3 mm Hg) was not significant. Drug-induced coronary vasodilatation reduced coronary coronary vascular resistance from 0.65 +/- 0.06 to 0.47 +/- 0.04 units (P less than 0.01) and led to a marked increase in coronary sinus blood flow (from 124 +/- 9 to 155 +/- 9 ml/min, P less than 0.05). Arterial levels of free fatty acids increased from 0.78 +/- 0.13 to 1.05 +/- 0.18 mmol/l (P less than 0.05) resulting in the preferential utilization of this substrate as a myocardial energy source. Despite the substantial haemodynamic improvement, however, no significant increase in myocardial oxygen uptake or lactate production was observed. Thus, in patients with coronary artery disease and congestive heart failure pirbuterol and salbutamol improve left ventricular function by a combination of afterload reduction and positive inotropism such that no appreciable deterioration in myocardial energetics occurs.
本研究旨在调查和比较吡布特罗与沙丁胺醇对充血性心力衰竭和冠状动脉疾病患者的血流动力学及代谢反应。重点关注这些β2肾上腺素能激动剂对左心室收缩功能、全身和冠状动脉血流动力学以及心肌底物代谢的影响。16例患者被随机分为两组，分别接受20mg吡布特罗或6mg沙丁胺醇治疗。由于未观察到这两种药物反应之间存在统计学显著差异，因此呈现了两种药物的综合数据。药物干预90分钟后，心脏指数从2.2±0.1增至2.9±0.2L/min per m2（P<0.001），同时全身血管阻力显著降低（从22±1降至15±1单位，P<0.001），左心室dp/dtmax增加（从1074±85增至1422±133mmHg/秒，P<0.05）。观察到左心室舒张末期压力适度降低（从21±1降至15±1mmHg，P<0.01）。心率从82±5增至91±4次/分钟（P<0.01），但平均动脉压小幅下降（从86±3降至78±3mmHg）无统计学意义。药物诱导的冠状动脉血管扩张使冠状动脉血管阻力从0.65±0.06降至0.47±0.04单位（P<0.01），并导致冠状窦血流量显著增加（从124±9增至155±9ml/分钟，P<0.05）。动脉血中游离脂肪酸水平从0.78±0.13增至1.05±0.18mmol/L（P<0.05），导致该底物被优先用作心肌能量来源。然而，尽管血流动力学有显著改善，但未观察到心肌氧摄取或乳酸生成显著增加。因此，对于冠状动脉疾病和充血性心力衰竭患者，吡布特罗和沙丁胺醇通过降低后负荷和正性肌力作用的联合改善左心室功能，使得心肌能量代谢无明显恶化。
