Hsueh C W, Lee W L, Chen C K, Ho H Y, Chen C P, Huang J L, Huang D S, Chen Y T, Ting C T
Department of Medicine, Taichung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Apr;61(4):199-209.
Autonomic dysfunction plays an important role in the pathogenesis, treatment and prognosis of congestive heart failure (CHF). Sympathomimetic amines have been widely used in the treatment of CHF, but reports on their autonomic effects in CHF are rare. This study was designed to evaluate the effects of dopamine and dobutamine on cardiac autonomic function as assessed by heart rate variability (HRV).
Twenty patients with symptomatic CHF (systolic dysfunction) were enrolled. After recording one-hour baseline electrocardiographs (ECGs), patients were randomly selected for either dopamine (4 micrograms/kg/minute, Group A) or dobutamine (4 micrograms/kg/minute, Group B) treatment for three days. On the third day, a 24-hour ambulatory ECG was recorded and a tilt-table test was performed. Only furosemide and nitrates were allowed for adjunctive therapy. HRV was measured before and after treatment in both time and frequency domains. Frequency-domain HRV was also measured during head-up tilt.
After treatment, all patients improved [New York Heart Association fraction (NYHA Fc) 3.7 to 2.0]. Group A patients had higher post-treatment 24-hour HRV than those in Group B. SDNN (standard deviation of the average normal RR intervals in the entire ECG recording), SDANN (standard deviation of the average normal RR intervals for all five minute segments of an entire ECG recording) and SDNN indices in Group A were significantly higher than in Group B (90 +/- 33 ms vs 41 +/- 12 ms, 78 +/- 32 ms vs 36 +/- 11 ms, and 37 +/- 19 ms vs 16 +/- 7 ms, respectively, all p < 0.05). rMSSD (the square root of the mean of the squared differences between adjacent normal RR intervals over the entire ECG recording) and pNN50 (percentage of differences between adjacent normal RR intervals that are greater than 50 ms computed over the entire ECG recording) were also higher in Group A patients, with borderline significance. All measurements of total frequency and low-frequency and high-frequency components tended to be higher in Group A than Group B, but this was only significant for total frequency amplitude (22.9 +/- 13.4 ms vs 10.9 +/- 6.1 ms, p < 0.05). Dopamine but not dobutamine treatment seems to restore the depressed circadian change in frequency-domain HRV classically seen in patients with CHF. The HRV change during head-up tilting did not differ between the two groups. Three patients in Group B showed non-sustained ventricular tachycardia on ambulatory ECG during the treatment period.
Dopamine and dobutamine have comparable therapeutic effects in patients with CHF, but low-dose dopamine more favorably affects cardiac autonomic function.
自主神经功能障碍在充血性心力衰竭（CHF）的发病机制、治疗及预后中起重要作用。拟交感胺已广泛用于CHF的治疗，但关于其在CHF中自主神经效应的报道较少。本研究旨在评估多巴胺和多巴酚丁胺对通过心率变异性（HRV）评估的心脏自主神经功能的影响。
纳入20例有症状的CHF（收缩功能障碍）患者。记录1小时基线心电图（ECG）后，患者被随机分为多巴胺组（4微克/千克/分钟，A组）或多巴酚丁胺组（4微克/千克/分钟，B组），治疗3天。在第3天，记录24小时动态心电图并进行倾斜试验。仅允许使用速尿和硝酸盐作为辅助治疗。在治疗前后的时域和频域测量HRV。在头高位倾斜期间也测量频域HRV。
治疗后，所有患者均有改善[纽约心脏协会分级（NYHA Fc）从3.7降至2.0]。A组患者治疗后的24小时HRV高于B组。A组的SDNN（整个心电图记录中正常RR间期平均值的标准差）、SDANN（整个心电图记录中所有5分钟段正常RR间期平均值的标准差）和SDNN指数显著高于B组（分别为90±33毫秒对41±12毫秒、78±32毫秒对36±11毫秒、37±19毫秒对16±7毫秒，均p<0.05）。A组患者的rMSSD（整个心电图记录中相邻正常RR间期平方差平均值的平方根）和pNN50（整个心电图记录中相邻正常RR间期差值大于50毫秒的百分比）也较高，具有临界显著性。A组的总频率及低频和高频成分的所有测量值均倾向于高于B组，但仅总频率幅度有显著性差异（22.9±13.4毫秒对10.9±6.1毫秒，p<0.05）。多巴胺而非多巴酚丁胺治疗似乎恢复了CHF患者中经典所见的频域HRV昼夜变化的降低。两组间头高位倾斜期间的HRV变化无差异。B组有3例患者在治疗期间动态心电图显示非持续性室性心动过速。
多巴胺和多巴酚丁胺对CHF患者有相似的治疗效果，但低剂量多巴胺对心脏自主神经功能的影响更有利。
