SEPARATION OF THE DIRECT MYOCARDIAL AND VASODILATOR ACTIONS OF MILRINONE ADMINISTERED BY AN INTRACORONARY INFUSION TECHNIQUE
SEPARATION OF THE DIRECT MYOCARDIAL AND VASODILATOR ACTIONS OF MILRINONE ADMINISTERED BY AN INTRACORONARY INFUSION TECHNIQUE
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DOI：
10.1161/01.cir.73.1.130
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发表时间：
1986-01-01
期刊：
影响因子：
37.8
通讯作者：
COLUCCI, WS
中科院分区：
文献类型：
--
作者：
LUDMER, PL;WRIGHT, RF;COLUCCI, WS
为了确定米力农的正性肌力作用和血管扩张作用对严重充血性心力衰竭患者的相对贡献，将该药物通过持续输注直接注入11名患有纽约心脏协会功能III级或IV级心力衰竭的患者的左冠状动脉。以高达50 μ g/min的速率冠状动脉内输注米力农对平均动脉压或全身血管阻力没有影响，但导致峰值正dP/dt（+21%）、每搏输出量指数（+18%）和每搏作功指数（+21%）的剂量相关增加，以及心率（-3%）、平均右心房压（-25%）、左室舒张末期压（-17%）。在8名患者中，冠状动脉内输注后静脉内给药（75 μ g/kg）导致平均动脉压（-14%）和全身血管阻力（-40%）显著降低，与冠状动脉内给药相比心搏量指数进一步增加，并且与冠状动脉内给药相比平均右心房和左心室舒张末期压进一步降低。这些数据表明，米力农发挥正性肌力作用和血管扩张作用，对药物的总体血流动力学效应有显著贡献。
To determine the relative contributions of milrinone''s positive inotropic and vasodilator actions in patients with severe congestive heart failure, the drug was administered by constant infusion directly into the left main coronary artery of 11 patients with New York Heart Association functional class III or IV heart failure. Intracoronary infusion of milrinone at rates up to 50 .mu.g/min had no effect on mean arterial pressure or systemic vascular resistance but resulted in dose-related increases in peak positive dP/dt (+21%), stroke volume index (+18%), and stroke work index (+21%) and decreases in heart rate (-3%), mean right atrial pressure (-25%), and left ventricular end-diastolic pressure (-17%). In eight patients, intravenous administration (75 .mu.g/kg) after the intracoronary infusion resulted in significant decreases in mean arterial pressure (-14%) and systemic vascular resistance (-40%), further increase in stroke volume index compared with intracoronary administration, and further decreases in mean right atrial and left ventricular end-diastolic pressures compared with intracoronary administration. These data indicate that milrinone exerts both positive inotropic and vasodilator actions that contribute significantly to the drug''s overall hemodynamic effect.