地高辛、硝酸甘油与多巴酚丁胺对风湿性心脏瓣膜病患者的血液动力学效应

HEMODYNAMIC EFFECTS OF DIGOXIN, NITROGLYCERIN, AND DOBUTAMINE IN PATIENTS WITH RHEUMATIC VALVULAR DISEASE

对１５例以二尖瓣损害为主心功能ＩＩＩ～ＩＶ级的风湿性心脏瓣膜病患者分别在使用地高辛、硝酸甘油和多巴酚丁胺时血液动力学效应进行研究。结果显示，服用地高辛和利尿剂时，患者的心输出量（ＣＯ）正常或亚临床降低，但右室压（ＲＶＰ）、肺动脉压（ＰＡＰ）和肺小动脉楔压（ＰＣＷＰ）明显高于正常，大多数患者仍表现中度肺充血。静脉加用硝酸甘油后，平均动脉压下降１３％，心率（ＨＲ）、每搏量（ＳＶ）和ＣＯ无明显改变，升高的ＲＶＰ、ＰＡＰ和ＰＣＷＰ则显著下降。加用多巴酚丁胺后，平均动脉压下降４％，ＨＲ和ＳＶ适度增加，ＣＯ显著增加，伴随ＲＶＰ、ＰＡＰ和ＰＣＷＰ进一步下降，血波动力学异常基本纠正。３种药物联合应用取得了良好的血液动力学效应。

Hemodynamic effects of 15 cases of rheumatic mitral valvular disease of III～IV (NYHA), among them 9 had only mild aortic valve involvement, were studied during administrating digoxin, nitroglycerin (NG), and dobutamine (DT). Digoxin and diuretic therapy could only maintain cardiac output (CO) at normal or subnormal level, but right ventricular pressure (RVP) and pulmonary capillary wedge pressure (PCWP) were still significantly higher than normal. After adding NG (iv), blood pressure was decreased by 13 %, heart rate (HR) ,stroke volume (SV), and CO were not obviously changed. But RVP, PAP, and PCWP were significantly lowered. After adding both NG and DT, the degree of blood pressure lowering was decreased from 13% to 4%. HR and SV were moderately increased ,CO was significantly increased, PAP and PCWP were much lowered. The hemodynamic abnormality was basically corrected. Both NG and DT could prevent blood pressure from dropping too much, and have favorable effects on the hemodynamics.