Meissner A, Schmelzle T, Simon R
Klinik für Kardiologie, Christian-Albrechts-Universität Kiel.
Z Kardiol. 1996 Nov;85(11):839-46.
In cardiogenic shock, combined pharmacotherapy with dopamine/dobutamine was being used as a standard regimen and was compared to dopamine/milrinone in this study. In a total of 20 patients with persistent hemodynamic depression despite mechanical ventilation plus dopamine (10-12 micrograms/kg/min) and nitroglycerin (33 micrograms/min) infusions additional therapy with dobutamine (maximal dose: 9 micrograms/kg/min; n = 10) or milrinone (0.5 microgram/kg/min; n = 10) was started. Dobutamine induced an increase of cardiac index (2.0 +/- 0.1 to 2.9 +/- 0.21/min/m2; p < 0.01; mean +/- SEM) and heart rate (96 +/- 6 to 117 +/- 5 min-1; p < 0.05) while mean arterial pressure (75 +/- 2 to 71 +/- 4 mm Hg) and pulmonary capillary wedge pressure (21 +/- 2 to 19 +/- 2 mm Hg) hardly changed. The rate-pressure product rose from 10790 +/- 684 to 13234 +/- 678 mm Hg/ min (p < 0.05). Milrinone had a comparable effect on cardiac index (2.0 +/- 0.1 to 2.6 +/- 0.1 I/min/m2; p < 0.01) but induced a minor change in heart rate (94 +/- 6 to 104 +/- 8 min-1; p < 0.05) and a more pronounced decrease in mean arterial pressure (77 +/- 2 to 65 +/- 2 mm Hg; p < 0.01) and pulmonary capillary wedge pressure (24 +/- 2 to 17 +/- 1 mm Hg; p < 0.01). The rate-pressure product declined (11033 +/- 711 to 10555 +/- 929 mm Hg/min). In comparison, dopamine/milrinone appeared to be advantageous in terms of pre- and afterload reduction and myocardial oxygen demand. However, the concomitant decline in arterial pressure might impair end-organ perfusion.
在心源性休克中，多巴胺/多巴酚丁胺联合药物治疗被用作标准方案，在本研究中与多巴胺/米力农进行了比较。共有20例患者，尽管接受了机械通气、多巴胺（10 - 12微克/千克/分钟）和硝酸甘油（33微克/分钟）输注，但仍存在持续性血流动力学抑制，随后开始使用多巴酚丁胺（最大剂量：9微克/千克/分钟；n = 10）或米力农（0.5微克/千克/分钟；n = 10）进行额外治疗。多巴酚丁胺使心脏指数升高（从2.0±0.1升至2.9±0.2升/分钟/平方米；p < 0.01；平均值±标准误），心率升高（从96±6升至117±5次/分钟；p < 0.05），而平均动脉压（从75±2降至71±4毫米汞柱）和肺毛细血管楔压（从21±2降至19±2毫米汞柱）几乎没有变化。心率 - 血压乘积从10790±684升至13234±678毫米汞柱/分钟（p < 0.05）。米力农对心脏指数有类似作用（从2.0±0.1升至2.6±0.1升/分钟/平方米；p < 0.01），但引起心率的轻微变化（从94±6升至104±8次/分钟；p < 0.05），平均动脉压更明显下降（从77±2降至65±2毫米汞柱；p < 0.01），肺毛细血管楔压下降（从24±2降至17±1毫米汞柱；p < 0.01）。心率 - 血压乘积下降（从11033±711降至10555±929毫米汞柱/分钟）。相比之下，多巴胺/米力农在降低前负荷和后负荷以及心肌氧需求方面似乎更具优势。然而，动脉压的随之下降可能会损害终末器官灌注。
