L-NMMA (a nitric oxide synthase inhibitor) is effective in the treatment of cardiogenic shock
L-NMMA (a nitric oxide synthase inhibitor) is effective in the treatment of cardiogenic shock
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DOI：
10.1161/01.cir.101.12.1358
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发表时间：
2000-03-28
期刊：
影响因子：
37.8
通讯作者：
Golik, A
中科院分区：
文献类型：
--
作者：
Cotter, G;Kaluski, E;Golik, A
目的是评估L-NMMA治疗心源性休克的安全性和有效性。方法：我们连续招募了11例入院后持续24小时以上的心源性休克患者，尽管在可行的情况下进行了冠状动脉导管插入术和直接经皮冠状动脉腔内血运重建术，并进行了机械通气、主动脉内球囊反搏（IABP）和高剂量儿茶酚胺治疗。L-NMMA以1 mg/kg的IV推注和1 mg的连续滴注给药。kg（-1）。结果-在L-NMMA给药的10分钟内，平均动脉血压（MAP）从76+/-9上升到109 +/-32 mmHg（+43%），5小时内尿量从63+/-25增加至156+/-63 cc/h（+ 148%）。在MAP从2.0+/-0.5升/分急剧增加到1.7+/-0.4升/分的过程中，心脏指数下降。m（2））（-15%）;然而，它逐渐增加到1.85+/-0.4 L/（min . m（2））。心率和楔压保持稳定。停用L-NMMA后24小时，MAP（+36%）和尿量（+189%）仍增加;但心脏指数恢复至治疗前水平。未检测到不良事件。11例患者中，10例可脱离机械通气和IABP，8例患者从冠心病重症监护室出院，7例（64%）在1个月随访时存活。结论L-NMMA用于心源性休克患者是安全的，具有良好的临床和血流动力学效果。
Background-The objective was to assess the safety and efficacy of L-NMMA in the treatment of cardiogenic shock,Methods-We enrolled 11 consecutive patients with cardiogenic shock that persisted after >24 hours from admission, despite coronary catheterization and primary percutaneous transluminal coronary revascularization, when feasible, and treatment with mechanical ventilation, intraaortic balloon pump (IABP), and high doses of catecholamines. L-NMMA was administered as an IV bolus of 1 mg/kg and continuous drip of 1 mg . kg(-1) . h(-1) for 5 hours, Treatment with catecholamines, mechanical ventilation, and IABP was kept constant throughout the study.Results-Within 10 minutes of L-NMMA administration, mean arterial blood pressure (MAP) increased from 76+/-9 to 109 +/- 32 mm Hg (+43%), Urine output increased within 5 hours from 63+/-25 to 156+/-63 cc/h (+ 148%). Cardiac index decreased during the steep increase in MAP from 2.0+/-0.5 to 1.7+/-0.4 L/(min . m(2)) (-15%); however, it gradually increased to 1.85+/-0.4 L/(min . m(2)) after 5 hours. The heart rate and the wedge pressure remained stable, Twenty-four hours after L-NMMA discontinuation, MAP (+36%) and urine output (+189%) remained increased; however, cardiac index returned to pretreatment level. No adverse events were detected. Ten out of eleven patients could be weaned off mechanical ventilation and IABP, Eight patients were discharged from the coronary intensive care unit, and seven (64%) were alive at 1-month follow-up,Conclusions-L-NMMA administration in patients with cardiogenic shock is safe and has favorable clinical and hemodynamic effects.