Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure.
Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure.
复制标题
长期卡托普利治疗严重慢性心力衰竭期间的血流动力学反应模式。
作者：
M. Packer;N. Medina;M. Yushak;J. Meller
为了确定卡托普利对严重心力衰竭患者早期和晚期血流动力学影响之间的关系，我们对51例接受该药治疗2至8周的患者进行了连续的右心导管插入术。观察到四种血流动力学反应模式。9例患者最初反应最小（I型）；6例在长期治疗中未能改善，但3例显示延迟的血流动力学益处。28名患者在48小时和2至8周后持续了最初的有益药物作用（II型）。在7例患者中，首次剂量的卡托普利产生了明显的有益反应，但这些反应在48小时后迅速减弱；然而，持续治疗2至8周后，首次给药的血流动力学效应自发恢复，即三期反应（III型）。在其余7例患者中，延长卡托普利治疗不能逆转初始反应的衰减；2 ~ 8周后血流动力学指标恢复到预处理值，即药物耐受性（IV型）。最小反应患者的血浆肾素活性（0.6 +/- 0.2 ng/ml/hr）较低，而三期反应患者的血浆肾素活性（9.4 +/- 2.5 ng/ml/hr）高于II型和IV型反应患者（分别为4.4 +/- 0.7和2.8 +/- 0.5 ng/ml/hr， p均小于0.05）。虽然卡托普利的首剂量效应经常持续，但延迟、减弱和三相反应的发生表明，在严重心力衰竭患者中，血管扩张药物的早期和晚期血流动力学效应之间可能存在复杂和可变的关系。
To determine the relationship between the early and late hemodynamic effects of captopril in patients with severe heart failure, we performed serial right heart catheterizations in 51 such patients who were treated with the drug for 2 to 8 weeks. Four hemodynamic patterns of response were observed. Nine patients had minimal responses initially (type I); six failed to improve during long-term treatment, but three showed delayed hemodynamic benefits. Twenty-eight patients had initial beneficial drug effects that were sustained after 48 hr and after 2 to 8 weeks (type II). In seven patients, first doses of captopril produced marked beneficial responses, but these became rapidly attenuated after 48 hr; nevertheless, continued therapy for 2 to 8 weeks was accompanied by spontaneous restoration of the hemodynamic effects of first doses of the drug, i.e., triphasic response (type III). In the remaining seven patients, attenuation of initial response was not reversed by prolonged captopril therapy; hemodynamic variables after 2 to 8 weeks had returned to their pretreatment values, i.e., drug tolerance (type IV). Plasma renin activity was lower in patients with minimal responses (0.6 +/- 0.2 ng/ml/hr) and was higher in patients with triphasic responses (9.4 +/- 2.5 ng/ml/hr) than in patients with types II and IV response patterns (4.4 +/- 0.7 and 2.8 +/- 0.5 ng/ml/hr, respectively; both p less than .05). Although first-dose effects of captopril are frequently sustained, the occurrence of delayed, attenuated, and triphasic responses indicates that a complex and variable relationship may exist between the early and late hemodynamic effects of vasodilator drugs in patients with severe heart failure.