Stemple D R, Kleiman J H, Harrison D C
Am J Cardiol. 1978 Aug;42(2):267-75. doi: 10.1016/0002-9149(78)90909-8.
To assess the circulatory effects of afterload reduction and inotropism individually and in combination as rational therapy for refractory heart failure, nitroprusside and dopamine were administered to 13 patients with severe cardiac decompensation. Dopamine at average doses of 3 and 7 microgram/kg per min produced increases in cardiac output and reductions in peripheral resistance. At doses of 15 microgram/kg per min, dopamine increased heart rate, peripheral arterial pressure and side effects. Nitroprusside alone decreased left-sided filling pressures and increased cardiac output. When the agents were administered together, the increases in cardiac output were significantly greater than with either agent alone and there was physiologic improvement in overall circulatory function. The relations among changes in afterload (systemic impedence), preload (filling pressures) and cardiac index help to explain the salutary effects of combined therapy in patients with refractory heart failure.
为了单独评估降低后负荷和增强心肌收缩力以及联合使用这两种方法作为难治性心力衰竭合理治疗手段时对循环系统的影响，对13例严重心功能不全患者使用了硝普钠和多巴胺。平均剂量为每分钟3和7微克/千克的多巴胺可使心输出量增加，外周阻力降低。剂量为每分钟15微克/千克时，多巴胺会使心率、外周动脉压升高并产生副作用。单独使用硝普钠可降低左心充盈压并增加心输出量。当两种药物联合使用时，心输出量的增加显著大于单独使用任何一种药物时，并且整体循环功能有生理改善。后负荷（体循环阻力）、前负荷（充盈压）和心脏指数的变化之间的关系有助于解释联合治疗对难治性心力衰竭患者的有益作用。
