Rouleau J L, Warnica J W, Burgess J H
Am J Med. 1981 Jul;71(1):147-52. doi: 10.1016/0002-9343(81)90282-5.
Reviewed here are the data from 34 patients given prazosin for chronic intractable heart failure. In 13 patients in whom hemodynamics were measured after the fifth 3 mg dose of prazosin was given, no attenuation was found. The cardiac index increased from 1.77 +/- 0.13 to 2.5 +/- 0.13 liters/min/m2 (p less than 0.001), and the pulmonary capillary wedge pressure decreased from 31,46 +/- 1.56 to 23.54 +/- 1.11 mg Hg (p less than 0.001). During long-term follow-up (15.9 +/- 1.5 months) the administration of spironolactone proved to be very useful. Within three months of starting prazosin therapy, none of the 15 patients discharged on a regimen of spironolactone needed readmission for edema, but 11 of the 13 patients discharged without a spironolactone regimen did. The addition of spironolactone or an increase in furosemide to the therapeutic regimen was helpful but a change to hydralazine was not. We concluded that prazosin causes short-term hemodynamic and long-term clinical improvement in patients with intractable heart failure; that spironolactone helps to prevent clinical attenuation but that more detailed studies are required to better characterize the attenuation to vasodilators seen in patients with congestive heart failure.
本文回顾了34例接受哌唑嗪治疗慢性顽固性心力衰竭患者的数据。在13例患者中，给予第5次3mg剂量的哌唑嗪后测量了血流动力学，未发现衰减。心脏指数从1.77±0.13升/分钟/平方米增加到2.5±0.13升/分钟/平方米（p＜0.001），肺毛细血管楔压从31.46±1.56mmHg降至23.54±1.11mmHg（p＜0.001）。在长期随访（15.9±1.5个月）期间，螺内酯的应用被证明非常有用。在开始哌唑嗪治疗的三个月内，15例接受螺内酯治疗方案出院的患者中，没有一人因水肿需要再次入院，但13例未接受螺内酯治疗方案出院的患者中有11人需要再次入院。在治疗方案中添加螺内酯或增加呋塞米是有帮助的，但改用肼屈嗪则没有帮助。我们得出结论，哌唑嗪可使顽固性心力衰竭患者短期内血流动力学改善，长期临床症状改善；螺内酯有助于预防临床症状衰减，但需要更详细的研究来更好地描述充血性心力衰竭患者对血管扩张剂的衰减情况。
