Hindman M C, Slosky D A, Peter R H, Newman G E, Jones R H, Wallace A G
Circulation. 1980 Apr;61(4):751-8. doi: 10.1161/01.cir.61.4.751.
To determine the hemodynamic effects of afterload reduction at rest and during upright exercise in patients with coronary artery disease and left ventricular dysfunction, 12 patients were studied before and after taking 50-75 mg of oral hydralazine every 6 hours for 48 hours. Oxygen consumption and heart rate were unchanged from control both at rest and during two work loads on a bicycle ergometer. Cardiac output was significantly increased at rest and during both workloads. The arteriovenous oxygen difference was significantly reduced at rest and during exercise. Pulmonary capillary wedge pressure was also significantly lower at rest and during exercise. Systemic vascular resistance was reduced at rest, and exercise-induced vasodilation was augmented by the administration of hydralazine. Left ventricular end-diastolic volume and ejection fraction assessed by radionuclide angiocardiography were not significantly changed at rest or during exercise after hydralazine. Seven of the 12 patients have maintained clinical improvement during a follow-up of 6-12 months. Hemodynamic improvement provided by oral hydralazine at rest is maintained during moderate exertion in patients with coronary artery disease and left ventricular dysfunction. In selected patients, chronic afterload reduction with oral hydralazine may result in increased cardiac reserve, decreased pulmonary congestion or decreased myocardial oxygen demands, thereby improving or abolishing resting or exertional dyspnea or angina.
为了确定后负荷降低对冠心病合并左心室功能不全患者静息及直立运动时血流动力学的影响，对12例患者在每6小时口服50 - 75 mg肼屈嗪，共48小时前后进行了研究。静息及在自行车测力计上的两种工作负荷状态下，耗氧量和心率与对照相比均无变化。静息及两种工作负荷状态下的心输出量均显著增加。静息及运动时动静脉氧差均显著降低。静息及运动时肺毛细血管楔压也显著降低。静息时全身血管阻力降低，服用肼屈嗪后运动诱导的血管舒张增强。经放射性核素心血管造影评估，静息或运动时，肼屈嗪治疗后左心室舒张末期容积和射血分数均无显著变化。12例患者中有7例在6 - 12个月的随访期间病情持续改善。冠心病合并左心室功能不全患者静息时口服肼屈嗪所带来的血流动力学改善在中等强度运动时得以维持。在部分患者中，口服肼屈嗪持续降低后负荷可能会增加心脏储备，减轻肺淤血或降低心肌需氧量，从而改善或消除静息或运动时的呼吸困难或心绞痛。
