Maskin C S, Forman R, Sonnenblick E H, Frishman W H, LeJemtel T H
Am J Cardiol. 1983 Jan 1;51(1):177-82. doi: 10.1016/s0002-9149(83)80032-0.
The acute hemodynamic and metabolic effects of dobutamine administered during exercise were studied in 8 patients with severe chronic heart failure. Exercise was performed on an upright bicycle ergometer using a graded protocol. During exercise performed without administration of dobutamine, exhaustion occurred after 4.5 +/- 1.2 minutes of exercise. The cardiac index increased from 1.61 +/- 0.25 to 2.67 +/- 0.59 liters/min/m2 (p less than 0.001), the arteriovenous oxygen difference from 7.8 +/- 1.7 to 12.5 +/- 2.4 ml/100 ml (p less than 0.001), and oxygen uptake from 7.9 +/- 3.0 to 41.2 +/- 15.7 mg/100 ml (p less than 0.001). During exercise performed with the administration of dobutamine, the cardiac index was significantly greater than during the control state, 3.23 +/- 0.78 versus 2.67 +/- 0.59 liters/min/m2 (p less than 0.001), while the arteriovenous oxygen difference was significantly lower, 11.2 +/- 2.1 vs 12.5 +/- 2.4 ml/100 ml (p less than 0.01). The arterial lactate level was not significantly changed, 45.3 +/- 17.6 versus 41.2 +/- 15.7 mg/100 ml. Although the dobutamine level tended to increase maximal oxygen uptake compared with the control period of exercise, 9.1 +/- 1.2 versus 8.5 +/- 1.4 ml/kg/min (p less than 0.05), it did not significantly increase exercise capacity, 4.8 +/- 1.5 versus 4.5 +/- 1.2 min. Thus administration of dobutamine in patients with severe chronic heart failure increased the cardiac index during maximal exercise but failed to increase exercise capacity. Since arteriovenous oxygen difference is reduced, dobutamine probably increases blood flow to the nonexercising tissues and not to the actively metabolizing muscles.
对8例严重慢性心力衰竭患者进行了研究，观察运动期间给予多巴酚丁胺后的急性血流动力学和代谢效应。采用分级方案在直立式自行车测力计上进行运动。在不给予多巴酚丁胺的运动过程中，运动4.5±1.2分钟后出现疲劳。心脏指数从1.61±0.25升/分钟/平方米增加到2.67±0.59升/分钟/平方米（p<0.001），动静脉氧差从7.8±1.7毫升/100毫升增加到12.5±2.4毫升/100毫升（p<0.001），摄氧量从7.9±3.0毫克/100毫升增加到41.2±15.7毫克/100毫升（p<0.001）。在给予多巴酚丁胺的运动过程中，心脏指数显著高于对照状态，分别为3.23±0.78升/分钟/平方米和2.67±0.59升/分钟/平方米（p<0.001），而动静脉氧差显著降低，分别为11.2±2.1毫升/100毫升和12.5±2.4毫升/100毫升（p<0.01）。动脉乳酸水平无显著变化，分别为45.3±17.6毫克/100毫升和41.2±15.7毫克/100毫升。尽管与运动对照期相比，多巴酚丁胺倾向于增加最大摄氧量，分别为9.1±1.2毫升/千克/分钟和8.5±1.4毫升/千克/分钟（p<0.05），但并未显著增加运动能力，分别为4.8±1.5分钟和4.5±1.2分钟。因此，在严重慢性心力衰竭患者中给予多巴酚丁胺可增加最大运动时的心脏指数，但未能增加运动能力。由于动静脉氧差降低，多巴酚丁胺可能增加了流向非运动组织的血流量，而不是流向活跃代谢肌肉的血流量。
