多巴酚丁胺联合硝酸甘油、速尿在治疗顽固性心衰中的疗效

目的：探讨临床上采用多巴酚丁胺联合硝酸甘油、速尿在治疗顽固性心衰中的疗效。方法回顾性分析该院2009年11月—2014年11月收治的顽固性心衰患者的临床资料。治疗组采用多巴酚丁胺联合硝酸甘油和速尿用药治疗,对照组采用洋地黄制剂进行治疗。比较分析两组患者治疗前后的心率、血压和临床疗效。结果治疗组患者治疗前后心率、收缩压和舒张压差异有统计学意义(<0.05);而对照组患者治疗前后心率、收缩压和舒张压差异无统计学意义(>0.05);治疗组患者总有效率明显高对照组,总有效分别为94.1%和89.1%,差异有统计学意义(<0.05)。结论多巴酚丁胺联合硝酸甘油、速尿联合治疗能够快速控制心率和血压,总的疗效较好,有临床应用和推广价值。     

Clinical outcomes of levosimendan versus dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function

To assess the clinical outcomes of levosimendan and dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function in Indian scenario. Cardiac, renal, electrolytes and hepatic parameters as well as the clinical outcomes were assessed. Levosimendan and dobutamine improved ejection fraction significantly. Levosimendan in comparison to dobutamine, increased cardiac output (0.76 vs. ?0.38 at 48 h, 1.15 vs. ?0.31 day 7, -2.02 vs. ?1.51 day 30), cardiac index (0.89 vs.-0.13 at 48 h, 1.16 vs. ?0.07 at day 7 and 1.05 vs. ?0.25 at day 30) and eGFR (?1.4 vs. ?0.75 at day 30) significantly. Levosimendan reduced ICU stay (p = 0.038) significantly whereas dobutamine decreased the hospital stay duration (p = 0.015). There was no major difference in re-hospitalization and mortality between groups. Ventricular tachyarrhythmia was the main adverse event noted in Levosimendan arm. Levosimendan showed improved cardiac as well as renal outcomes within a month when compared to dobutamine and it is the first study to determine the renal parameters of Levosimendan in an Indian setting.     

小剂量多巴酚丁胺负荷评价缺血性二尖瓣反流患者二尖瓣复合结构变化特点的超声研究

目的采用经食管三维超声心动图(RT 3D-TEE)技术结合小剂量多巴酚丁胺,分析缺血性二尖瓣反流患者和正常对照者的二尖瓣几何形态学参数在静息及负荷状态时的变化特点。方法采用MVQ技术对25例缺血性心二尖瓣反流组患者及20名正常对照者组进行检查,应用MVQ软件测量并分析对照组及缺血性二尖瓣反流组患者在静息及使用小剂量多巴酚丁胺后二尖瓣环及瓣叶几何形态学参数变化特点。结果正常对照组二尖瓣环及瓣叶结构相对稳定,并不随小剂量多巴酚丁胺的使用而发生明显变化;对缺血性二尖瓣反流组患者使用多巴酚丁胺,二尖瓣环及瓣叶空间结构变化主要体现在瓣环结构的构型变化及由其产生的二尖瓣瓣叶对合参数的变化;小剂量多巴酚丁胺的使用后二尖瓣环构型相对朝向正常"鞍状"结构的回归。结论小剂量负荷时缺血性二尖瓣反流程度的减少依赖于左心功能相对增加后二尖瓣环构型相对朝向正常"鞍状"结构的回归,二尖瓣的帆状穹窿构型变化在保证二尖瓣环及瓣叶结构稳定性中起着至关重要的作用。     

Acute changes in N-terminal pro-brain natriuretic peptide induced by dobutamine stress echocardiography.

AIMS: Aim of the study was to determine the effect of dobutamine stress echocardiography (DSE)-induced ischemia on circulating levels of N-terminal fragment of B-type natriuretic peptide (NT-pro-BNP). METHODS AND RESULTS: One hundred and twenty-eight patients underwent DSE for the evaluation of known or suspected coronary artery disease. NT-pro-BNP levels were measured before and 1h after completion of DSE. NT-pro-BNP levels were similar before and after DSE regardless of whether patients had (123+/-101.8 vs. 124.2+/-108.3, p=NS) or did not have inducible ischemia (96.5+/-70.5 vs. 100.5+/-71.1, p=NS). Patients with inducible myocardial ischemia had no different NT-pro-BNP levels compared to patients without inducible ischemia both before (123+/-101.8 vs. 96.5+/-70pg/ml, p=0.37) and after DSE (124.2+/-108.3 vs. 100.5+/-71.1pg/ml, p=0.55). Patients with severe inducible ischemia had significantly higher NT-pro-BNP levels compared to patients with mild or moderate inducible ischemia and patients without inducible ischemia, both before (208.5+/-125.5 vs. 96+/-78.9 vs. 96.5+/-70pg/ml, p=0.017 and p=0.025, respectively) and after DSE (212.5+/-138.1 vs. 94.8+/-81.1 vs. 100.5+/-71.1pg/ml, p=0.015 and p=0.023, respectively). NT-pro-BNP levels before DSE could be independently predicted by age (p<0.0001), presence of diabetes mellitus (p=0.002), and ejection fraction (p=0.005), but not DSE inducible ischemia. CONCLUSION: NT-pro-BNP is not affected by DSE-induced ischemia and cannot be used in clinical practice to improve diagnostic accuracy of DSE.     

彩色室壁动态技术在多巴酚丁胺超声心动图负荷试验诊断冠心病中的价值

目的　将彩色室壁动态 (CK)技术用于多巴酚丁胺超声心动图负荷试验 (DSE) ,并与二维超声心动图 (2 DE)目测法比较 ,评价其实用价值和优越性。方法　 30例冠心病 (CAD)患者和 2 6例正常对照组先后于冠状动脉造影后一个月内完成 DSE。(1)分别用 2 DE和 CK技术判断室壁运动状况 ,比较诊断冠心病的敏感性 ,特异性和准确性。(2 )用 SPECT作为金标准 ,采用 CK技术定量分析室壁运动。结果　 (1) CK技术诊断冠心病的敏感性和准确性分别是 89.6 %和 90 .7% ,均高于 2 DE法 ,P<0 .0 5 .尤其对单支 ,二支病变诊断敏感性更高 ,特异性无显著差异 ,分别为 92 % ,88% ,P>0 .0 5 .(2 ) DSE后冠心病非受累部位心内膜移动幅度增加 ,受累部位则明显减少。结论　 CK技术诊断冠心病的敏感性和准确性均高于 2 DE法 .CK技术定量分析法有一定价值     

Impaired cardiac reserve in asymptomatic patients with moderate pulmonary restenosis late after relief of severe pulmonary stenosis: Evidence for diastolic dysfunction

Background

Patients with moderate pulmonary valve restenosis late after relief of severe pulmonary stenosis (PS) may show decreased exercise tolerance. To elucidate the mechanism of decreased exercise tolerance, we evaluated cardiac response to physical and pharmacological stress in these patients and compared results with those of patients with native moderate PS.

Methods

Twenty asymptomatic patients with moderate PS were divided into 2 groups: Group I (late after relief of severe PS, n = 9), and Group II (no previous intervention, n = 11). All patients underwent an exercise test, dobutamine stress (DS) MRI, and delayed contrast enhanced MRI. The response to physical and pharmacological stress was compared between both groups.

Results

Group I showed impaired exercise capacity compared to Group II (VO₂max = 72.8% ± 3.5% vs. 102.5% ± 16.3%, p < 0.001). During DS-MRI, RV-SV increased in Group II, but not in Group I (+ 13 ± 8 ml, − 5 ± 8 ml, p < 0.001). RV end‐diastolic volume decreased significantly in Group I patients (p = 0.006) while it did not significantly change in Group II patients. The amount of RV-SV increase (? RV-SV) correlated negatively with the period of moderate PS existence and the current PG in Group I (r = − 0.82, p = 0.007, and r = − 0.68, p = 0.04, respectively) but not in Group II (r = 0.45, p = 0.1, and r = 0.40, p = 0.2, respectively). Furthermore, ? RV-SV correlated negatively with the PG before valvuloplasty (r = − 0.76, p = 0.02).

Conclusion

Impaired exercise capacity in patients with moderate pulmonary restenosis after relief of severe PS is probably caused by inability to increase RV-SV. Disturbed RV filling properties, worsening in time, might play a role.     

Intravenously administered pharmaceuticals impact biofilm formation and detachment of Staphylococcus lugdunensis and other staphylococci

Coagulase-negative staphylococci and Staphylococcus aureus are major causes of catheter-related infections because of their ability to form biofilms on indwelling polymeric devices. Staphylococcus lugdunensis is a particularly virulent coagulase-negative species responsible for several types of biofilm-related infections, but factors that influence biofilm formation by this species remain undetermined. Heparin and catecholamine inotropes are common intravenously administered drugs reported to stimulate biofilm formation of some staphylococci. This study assessed the effects of catecholamines and heparin on biofilm formation of a collection of S. lugdunensis isolates and other Staphylococcus species. Dopamine stimulated biofilm formation in two-thirds of S. lugdunensis isolates, whereas dobutamine prevented nearly all S. lugdunensis isolates from adhering to polystyrene. Heparin markedly reduced biofilm formation by 87% of S. lugdunensis isolates. Preformed biofilms of S. lugdunensis and other Staphylococcus species detached from polystyrene after exposure to heparin at concentrations used in catheter locks. Our data suggest that intravenous pharmaceuticals may influence staphylococcal biofilm formation on and detachment from intravascular catheters.     

Effects of levosimendan and dobutamine on experimental acute lung injury in rats

The effects of levosimendan on acute lung injury induced by peritonitis and abdominal hypertension in the early stages of sepsis in rats were investigated. Twenty-four adult male Wistar rats were randomized into: (1) sham, (2) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by dobutamine, (3) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by levosimendan, and (4) controls subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture with no treatment. In the control and levosimendan groups, cecal ligation and puncture resulted in moderate IL-1β immunolabelling in lung tissue; marked IL-1β immunolabelling was demonstrated in the dobutamine group. TNF-α immunolabelling was negative in both the sham and levosimendan groups, but moderate and weak immunoreactivities were observed in the dobutamine and control groups, respectively. There were almost no TUNEL positive cells in the sham, but they were prominent in the control. TUNEL positive cells were significantly less in the levosimendan treated lungs when compared to control and dobutamine groups. Immunoreactivity of eNOS was stronger in the dobutamine group when compared with the levosimendan group. In addition, iNOS immunoreactivity was strongly detected in the control group; this immunoreactivity was less in the levosimendan group than the dobutamine group. In this experimental sepsis model, treatment with levosimendan had a marked effect on attenuating or decreasing apoptosis and inflammation in the lung.     

小剂量多巴酚丁胺负荷超声心动图试验对急性心肌梗塞后患者梗塞相关动脉残存狭窄的诊断

目的 将小剂量多巴酚丁胺负荷超声心动图试验用于急性心肌梗塞后两周患者的研究。方法 根据美国超声协会推荐的心室壁１６节段划分法，推断引起室壁运动异常区域血流灌注异常的梗塞相关动脉，并与金标准冠状动脉造影结果结果相比较。结果 该试验对梗塞相关动脉残存狭窄诊断的敏感性及特异性分别为８０％、７８．８％。结论 小剂量ＤＳＥ试验对梗塞相关动脉残存狭窄也有较好的诊断价值。