Unverferth D V, Magorien R D, Altschuld R, Kolibash A J, Lewis R P, Leier C V
Am Heart J. 1983 Jul;106(1 Pt 1):29-34. doi: 10.1016/0002-8703(83)90434-9.
Most patients with nonischemic congestive cardiomyopathy (COCM) derive subjective benefit from a 3-day intravenous infusion of dobutamine. The mechanism of this improvement was evaluated by the measurement of metabolic factors (serum sodium and blood urea nitrogen [BUN]) during the infusion in 23 group I patients. In addition, six patients (group II) had an endomyocardial biopsy procedure before and after 3 days of bed rest and then after 3 days of dobutamine. The tissue was analyzed for adenosine triphosphate (ATP) and creatine. The eight group III patients had cardiac output, coronary sinus blood flow, and arterial and coronary sinus oxygen saturation measurements before and during two dose increments of dobutamine (5 and 10 micrograms/kg/min). The results demonstrated that the mean sodium of group I patients rose from 135 +/- 3 (means +/- SD) to 137 +/- 4 mEq/L (p less than 0.05) and the BUN fell from 21 +/- 7 to 15 +/- 6 mg/100 ml (p less than 0.001). The ATP/creatine of the endomyocardial biopsies from group II did not change from control with bed rest (0.36 +/- 0.24 to 0.37 +/- 0.24), but rose to 0.62 +/- 0.26 (p less than 0.05) after dobutamine. In group III, the cardiac output and coronary blood flow increased proportionately with increasing doses of dobutamine. These data suggest that there are both metabolic and hemodynamic advantages gained during a 3-day infusion of dobutamine, and that either or both could contribute to the clinical improvement noted in patients with COCM.
大多数非缺血性充血性心肌病（COCM）患者在接受为期3天的多巴酚丁胺静脉输注后，主观感觉症状有所改善。通过在输注过程中测量23例I组患者的代谢因子（血清钠和血尿素氮[BUN]）来评估这种改善的机制。此外，6例患者（II组）在卧床休息3天前后以及多巴酚丁胺治疗3天后接受了心内膜心肌活检。对组织进行三磷酸腺苷（ATP）和肌酸分析。8例III组患者在多巴酚丁胺剂量增加两次（5和10微克/千克/分钟）之前和期间测量心输出量、冠状窦血流量以及动脉和冠状窦血氧饱和度。结果表明，I组患者的平均血清钠从135±3（均值±标准差）升至137±4 mEq/L（p<0.05），BUN从21±7降至15±6 mg/100 ml（p<0.001）。II组心内膜心肌活检的ATP/肌酸在卧床休息时与对照组相比没有变化（从0.36±0.24至0.37±0.24），但在多巴酚丁胺治疗后升至0.62±0.26（p<0.05）。在III组中，心输出量和冠状动脉血流量随着多巴酚丁胺剂量的增加而成比例增加。这些数据表明，在为期3天的多巴酚丁胺输注过程中，患者在代谢和血流动力学方面均有获益，且其中之一或两者都可能是COCM患者临床症状改善的原因。
