多巴酚丁胺和依诺昔酮对冠状动脉搭桥术后左心室功能不全患者二尖瓣和肺静脉血流特征的影响。

Effects of dobutamine and enoximone on transmitral and pulmonary venous flow characteristics in patients with left ventricular dysfunction after coronary artery bypass grafting.

作者信息

Vroom M B, van Wezel H B, vd Brink R B, vd Lee R, Eijsman L, Visser C A, van Zwieten P A

机构信息

Department of Anesthesia, Academic Medical Center, Amsterdam, The Netherlands.

出版信息

J Cardiothorac Vasc Anesth. 1996 Oct;10(6):756-63. doi: 10.1016/S1053-0770(96)80201-1.

DOI:10.1016/S1053-0770(96)80201-1

PMID:8910155

Abstract

OBJECTIVES

To assess the effects of dobutamine and enoximone on transmitral (TMF) and pulmonary venous flow (PVF) characteristics.

DESIGN

Prospective and randomized.

SETTING

A university hospital intensive care unit.

PARTICIPANTS

Thirty patients with moderate left ventricular dysfunction after coronary artery bypass grafting (CABG).

INTERVENTIONS

Patients received either dobutamine, 10 micrograms/kg/min, or enoximone, 20 micrograms/kg/min, for the treatment of a low cardiac index (CI) (< 2.2 L/min/m2).

MEASUREMENTS AND MAIN RESULTS

Both drugs significantly (p < 0.05) increased CI from 1.91 +/- 0.17 (dobutamine) and 1.97 +/- 0.17 (enoximone) at baseline to 2.86 +/- 0.70 and 2.84 +/- 0.39 L/min/m2, respectively. Compared with the enoximone (enox)-treated group, the administration of dobutamine (dob) resulted in significantly (p < 0.05) greater increases in mean arterial pressure (dob: 18 +/- 9% v enox: -2 +/- 7%), heart rate (dob: 24 +/- 13% v enox: 3 +/- 5%) and pulmonary artery pressure (dob: 5 +/- 10% v enox: -4 +/- 9%). In contrast, the increase in stroke volume index was significantly less in the dobutamine-treated group (dob: 22 +/- 27% v enox: 41 +/- 21%). The TMF indices, peak E, and peak A wave increased significantly (p < 0.05) after both dobutamine (baseline: 37.3 +/- 6.7 and 41.1 +/- 9.3; max dose: 42.4 +/- 4.3 and 49.0 +/- 10.2 cm/s) and enoximone (baseline: 36.2 +/- 7.5 and 44.2 +/- 10.9; max dose: 40.5 +/- 5.0 and 49.4 +/- 12.1 cm/s) without significantly altering the E/A ratio. Only dobutamine significantly (p < 0.05) decreased isovolumic relaxation time from 109 +/- 24 to 94 +/- 21 ms. There was no significant change in isovolumic relaxation time between the dobutamine (-12% +/- 17%)- and the enoximone (-4% +/- 21%)- treated group. PVF recordings demonstrated a significant increase in time velocity integrals of the S wave with both dobutamine (12.2 +/- 3.1 v 13.7 +/- 3.2 cm) and enoximone (11.0 +/- 3.0 v 12.2 +/- 3.2 cm). No changes in the systolic fraction of the PVF were noted.

CONCLUSIONS

There were no major differences in parameters reflecting diastolic function between the dobutamine- and the enoximone-treated groups.

摘要

目的

评估多巴酚丁胺和依诺昔酮对二尖瓣血流（TMF）和肺静脉血流（PVF）特征的影响。

设计

前瞻性随机研究。

地点

大学医院重症监护病房。

参与者

30例冠状动脉旁路移植术（CABG）后出现中度左心室功能不全的患者。

干预措施

患者接受多巴酚丁胺（10微克/千克/分钟）或依诺昔酮（20微克/千克/分钟）治疗低心指数（CI）（<2.2升/分钟/平方米）。

测量指标及主要结果

两种药物均显著（p<0.05）提高CI，多巴酚丁胺组从基线时的1.91±0.17提高到2.86±0.70升/分钟/平方米，依诺昔酮组从1.97±0.17提高到2.84±0.39升/分钟/平方米。与依诺昔酮治疗组相比，多巴酚丁胺治疗组平均动脉压（多巴酚丁胺组：18±9%，依诺昔酮组：-2±7%）、心率（多巴酚丁胺组：24±13%，依诺昔酮组：3±5%）和肺动脉压（多巴酚丁胺组：5±10%，依诺昔酮组：-4±9%）显著（p<0.05）升高。相反，多巴酚丁胺治疗组的每搏量指数增加显著低于依诺昔酮组（多巴酚丁胺组：22±27%，依诺昔酮组：41±21%）。多巴酚丁胺（基线：37.3±6.7和41.1±9.3；最大剂量：42.4±4.3和49.0±10.2厘米/秒）和依诺昔酮（基线：36.2±7.5和44.2±10.9；最大剂量：40.5±5.0和49.4±12.1厘米/秒）治疗后，TMF指数、E峰和A峰均显著（p<0.05）增加，且E/A比值无显著改变。仅多巴酚丁胺显著（p<0.05）缩短等容舒张时间，从109±24毫秒降至94±21毫秒。多巴酚丁胺治疗组（-12%±17%）和依诺昔酮治疗组（-4%±21%）之间等容舒张时间无显著变化。PVF记录显示，多巴酚丁胺（12.2±3.1对13.7±3.2厘米）和依诺昔酮（11.0±3.0对12.2±3.2厘米）治疗后S波时间速度积分均显著增加。PVF的收缩分数无变化。