Störk T, Möckel M, Störk S, Piske G, Danne O, Bodemann T, Müller R, Eichstädt H, Hochrein H
Kardiologie/Intensivmedizin, Universitätsklinikum Rudolf Virchow, FU Berlin.
Z Kardiol. 1993 May;82(5):293-301.
Objective of the present study was to investigate the hemodynamic response to molsidomine in nitrate tolerance state. In 13 out of 16 patients (5 women, 11 men, 62 [53/71] years [median, 25%/75%-percentiles]) with chronic heart failure (NYHA stage II-III; median angiographic ejection fraction (EF) 55%) and coronary artery disease (stenosis of at least 75%) the development of tolerance under the continuous infusion of high doses of nitroglycerin (10 mg/h) was observed. Tolerance was defined as a benefit loss of at least 50% of the initial nitroglycerin effect with respect to the pulmonary capillary wedge pressure. Compared to the state of tolerance to nitroglycerin the infusion of 10 mg molsidomine over 15 minutes resulted in significant changes of the median values (25%/75%-percentiles) of mean right atrial pressure from 16 (12/21) to 9 (5/12) mmHg (p < 0.01), mean pulmonary artery pressure from 37 (30/40) to 24 (20/30) mmHg (p < 0.001), mean pulmonary capillary wedge pressure from 22 (18/25) to 15 (10/22) mmHg (p < 0.01) and cardiac output from 4.1 (3.5/4.7) to 5.2 (4.2/5.6) l/min (p < 0.01). This action of molsidomine corresponded to a complete overcoming (> 100%) of the benefit loss observed during the development of nitrate tolerance with respect to all above-mentioned hemodynamic parameters. Under parallel maintainance of nitroglycerin infusion (10 mg/h) these hemodynamic effects of molsidomine, i.e. at least 90% of the peak effect, lasted for 147 (130/182) minutes (median, 25%/75%-percentiles). Baseline values, i.e. a loss of at least 75% of the molsidomine effect, were only reached after 363 (319/412) minutes (median, 25%/75%-percentiles).(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是调查在硝酸盐耐受状态下对吗多明的血流动力学反应。在16例慢性心力衰竭（纽约心脏协会II - III级；血管造影术测定的射血分数（EF）中位数为55%）和冠状动脉疾病（至少75%狭窄）患者（5名女性，11名男性，62[53/71]岁[中位数，第25/75百分位数]）中的13例中，观察到在持续输注高剂量硝酸甘油（10mg/h）时耐受性的发展。耐受性定义为相对于肺毛细血管楔压，初始硝酸甘油效应的益处损失至少50%。与硝酸甘油耐受状态相比，在15分钟内输注10mg吗多明导致平均右心房压力的中位数（第25/75百分位数）从16（12/21）显著变化至9（5/12）mmHg（p<0.01），平均肺动脉压力从37（30/40）降至24（20/30）mmHg（p<0.001），平均肺毛细血管楔压从22（18/25）降至15（10/22）mmHg（p<0.01），心输出量从4.1（3.5/4.7）升至5.2（4.2/5.6）l/min（p<0.01）。吗多明的这一作用相当于在所有上述血流动力学参数方面完全克服（>100%）了在硝酸盐耐受发展过程中观察到的益处损失。在并行维持硝酸甘油输注（10mg/h）的情况下，吗多明的这些血流动力学效应，即至少90%的峰值效应，持续了147（130/182）分钟（中位数，第25/75百分位数）。基线值，即吗多明效应损失至少75%，仅在363（319/412）分钟后达到（中位数，第25/75百分位数）。（摘要截断于250字）
