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題 名 | Dopamine and Dobutamine Have Different Effects on Heart Rate Variability in Patients with Congestive Heart Failure=多巴胺及多保他命對於鬱血性心衰竭患者的心率變異度有不同的效果 |
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作 者 | 謝宗輝; 李文領; 陳政康; 何鴻鋆; 陳清埤; 黃金隆; 黃達三; 陳穎從; 丁紀臺; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:4 1998.04[民87.04] |
頁 次 | 頁199-209 |
分類號 | 415.319 |
關鍵詞 | 多保他命; 多巴胺; 心臟衰竭; 心率變異度; Dobutamine; Dopamine; Heart failure; Heart rate variability; |
語 文 | 英文(English) |
中文摘要 | 背景 自主神經系統失調,在鬱血性心衰竭患者的致病機轉、治療考慮及預後, 都扮演重要角色。類交感神經性胺類藥品,已被廣泛應用於治療心衰竭患者的鬱血症狀,然 而這些藥劑對心衰竭患者自主神經系統的影響卻很少有人報告,本篇研究主要在於評估鬱血 性心衰竭患者使用多巴胺(dopamine)及多保他命(dobutamine)後其心率變異度的變化, 以間接探討其對於自主神經系統的影響。 方法 我們收集了20位因鬱血性心衰竭症狀而住院的病人,這些病人的致病原因都是左心 室收縮功能失調(平均左心室射出比率33��10﹪)。共有l8位男性、2位女性患者,平均 年齡66��11歲。在治療前先記錄一小時心電圖,隨後病患經隨機分配,接受多巴胺(4μ g/kg/min, A組),或多保他命吋(4μg/kg/min,B組)靜脈持續滴注三天。在治療後第三 天,我們記錄病人24小時心電圖,同時記錄病人接受傾斜床測試時的心電圖,這些心電圖 記錄隨後用於演算其心率變異度。 結果 兩組病人的基本臨床數據及治療前心率變異度並無顯著差異。經治療後,兩組病人的 症狀皆有顯著改善。A組病人其心率變異度有顯著提高的情形,且心率變異度出現有如正常 人般生理性日夜變化的現象。在A組病人中,有三位患者記錄到短期心室快速收縮的心律不 整;而B組病人則沒有這種情形。 結論 低劑量多巴胺及多保他命對於鬱血性心臟衰竭的治療效果相當,但多巴胺對心臟的自 主神經功能有較好的影響。 |
英文摘要 | Background. Autonomic dystunction 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 doparnine and dobutamine on cardiac autonomic function as assessed by heart rate variability (HRV). Methods. Twenty patients with symptomatic CHF (systolic dysfunction) were enrolled. After recording one-hour baseline electrocardiographs (ECCs), patients were randomly selected for either dopamine (4μg/kg/minute, Croup A) or dobutamine (4μ g/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. Results. After treatment, all patients improved [New York Heart Association fraction (NYHA Fc) 3.7 to 2.0]. Croup A patients had higher post-treatment 24-hour HRV than those in Croup B. SDNN (standard deviation of the average normal RR intervals in the entire ECC recording), SDANN (standard deviation of the average normal RR intervals for all five -minute segments of an entire ECC 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 ECC 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 Croup A patients, with borderline significance. All measurements of total frequency and low-frequency and high-frequency components tended to be higher in Croup A than Croup 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. Conclusions. Doparnine and dobutamine have comparable therapeutic effects in patients with CHF, but low-dose dopamine more favorably affects cardiac autonomic function. |
本系統中英文摘要資訊取自各篇刊載內容。