Berti S, Palmieri C, Ravani M, Bonini R, Iascone M R, Clerico A, Manfredi C, Iervasi G, Ferrazzi P, Biagini A
CNR, Clinical Physiology Institute, Pisa, Italy.
Cardiovasc Drugs Ther. 1996 Mar;10(1):81-7. doi: 10.1007/BF00051134.
Patients with heart failure generally show improvement in their clinical condition after enoximone infusion over the period of treatment; this effect cannot be ascribed only to the known hemodynamic action of this drug. Thirty-six patients (age range 44-82 years) with heart failure (NYHA class II-IV) underwent 48-hour enoximone infusion to study whether this prolonged improvement might depend on changes in systemic or renal hemodynamics or in neurohormonal balance. All patients underwent Swan-Ganz hemodynamic monitoring; renal plasma flow, glomerular filtration rate, plasma atrial natriuretic factor (ANF), and plasma renin activity (PRA) were all measured at baseline, at the peak of the enoximone action, and 48 hours after drug discontinuation. The main hemodynamic parameters were significantly improved during enoximone infusion and after drug discontinuation. The cardiac index basal value of 2.2 +/- 0.1 l/min/m2 increased to 3.1 +/- 0.1 l/min/m2 after 24-hour therapy (p < 0.01); similarly, pulmonary wedge pressure, mean pulmonary arterial pressure, and right atrial pressure decreased markedly (p < 0.01). Beneficial effects were also observed in renal hemodynamics; indeed, renal plasma flow (basal value 485 +/- 39 ml/min) increased significantly after 24-hour enoximone infusion (575 +/- 35 ml/min; p < 0.01), and this tendency was also observed 48 hours after drug discontinuation. No significant modifications were observed in plasma hormone data; however, the PRA plasma level had a tendency to decrease. We conclude that in patients with heart failure, enoximone infusion has a less marked effect on renal hemodynamics, but this is more lasting than systemic hemodynamic effects. The tendency of PRA to decrease (although not statistically significant), still detectable 2 days after treatment in the presence of steady high plasma ANF concentrations, may also contribute to the paradoxical longlasting benefit despite the short-lived improvement in systemic hemodynamics after brief cycles of enoximone infusion.
心力衰竭患者在接受依诺昔酮输注治疗期间，其临床状况通常会有所改善；这种效果不能仅归因于该药物已知的血流动力学作用。36例年龄在44至82岁之间的心力衰竭（纽约心脏协会II-IV级）患者接受了48小时的依诺昔酮输注，以研究这种持续改善是否可能取决于全身或肾脏血流动力学或神经激素平衡的变化。所有患者均接受了Swan-Ganz血流动力学监测；在基线、依诺昔酮作用峰值以及停药后48小时均测量了肾血浆流量、肾小球滤过率、血浆心钠素（ANF）和血浆肾素活性（PRA）。在依诺昔酮输注期间和停药后，主要血流动力学参数均有显著改善。心脏指数的基础值2.2±(0.1)l/min/m²在24小时治疗后增至3.1±(0.1)l/min/m²（p＜0.01）；同样，肺楔压、平均肺动脉压和右心房压均显著降低（p＜0.01）。在肾脏血流动力学方面也观察到了有益效果；实际上，肾血浆流量（基础值485±(39)ml/min）在依诺昔酮输注24小时后显著增加（575±(35)ml/min；p＜0.01），并且在停药后48小时也观察到了这种趋势。血浆激素数据未观察到显著变化；然而，PRA血浆水平有下降趋势。我们得出结论，在心力衰竭患者中，依诺昔酮输注对肾脏血流动力学的影响较小，但比全身血流动力学影响更持久。尽管依诺昔酮输注短暂周期后全身血流动力学改善短暂，但在治疗2天后，在血浆ANF浓度持续较高的情况下，PRA仍有下降趋势（尽管无统计学意义），这也可能是长期获益的原因之一。
