Hämodynamische Wirkung von Dobutamin bei Patienten mit Herzinsuffizienz

Abstract

Dobutamine, a new catecholamine with a positive inotropic action, was given by infusion to 9 patients with cardiac failure in a dosage of 5 and 7.5 mug/kg-min over a period of 15 minutes. An improvement of left ventricular function was proven by an increase of cardiac output by 33%, a reduction of end-diastolic pressure from 21 to 14 mm Hg, an improvement of left ventricular ejection fraction from 29 to 39% and of the mean circumferential fibre contraction velocity from 0.4 to 0.8 circ/s. The systolic aortic pressure increased by a mean of 14% (5 mug/kg-min) and 23% (7.5 mug/kg-min). However, the resistance of the systemic circulation decreased from 1858 to 1439 and 1444 dyn-s-cm-5. Cardiac frequency remained unchanged with a dosage of 5 mug/kg-min and increased by a mere 7 beats/min with a dosage of 7.5 mug/kg-min. There was no increased tendency for arrhythmia. Dobutamine thus appears to act relatively selectively on myocardial beta-1 receptors. Results so far indicate therapeutic success in patients with severe cardiac failure, particularly in the low-output syndrome.

Hemodynamic Effects of Dobutamine and Epinephrine in Patients during Coronary Surgery

“…When using comparable doses of dobutamine, in conscious patients only a minimal tendency towards rising heart rate, as compared to a related increase in contractility, could be found (2,4,6,11,15,26,28,29,31,33,36). Our investigations in patients during anesthesia are in contrast with the above-mentioned studies: Heart rate increased by 14.2% and by 24%.…”

“…With dobutamine a dose-related decrease in left ven tricular filling pressure has been reported (2,6,11,17,29,32,42,48) which was in part related to its positive inotropic effects (23,29). Furthermore, a decrease in preload can be facilitated by a reduc tion in afterload (29).…”

“…The newly synthesized catecholamine dobutamine (Dobutrex®) has been introduced as a sympathomi metic inotropic agent with less chronotropic, vascu lar and arrhythmogenic effects than most of the other catecholamines. Therapeutic advantages and limitations of this drug were demonstrated by inves tigations in isolated hearts (21), in heart muscle pre parations (51), in animal experiments (23,24,25,35,40,52,53,54,55,56,57) and in patients with various forms of myocardial insufficiency (2,6,11,26,27,29,30,31,37,38,39,48). In patients with myocardial infarction, dobutamine increased cardiac output as well as systolic blood pressure and de creased pulmonary capillary pressure without en largement of the ischemic area (17).…”

Hemodynamic effects of dobutamine in children with cardiovascular failure

“…In adults the following hemodynamic effects of dobutamine were observed: Increase of myocardial contractility with little chronotropic effect and little effect on the pulmonary and systemic vascular resistances [1,4,5,8,9]. Although dobutamine has been studied extensively in adults, little is known about its effect in children [2,6,7,11].…”

Effects of dobutamine on left ventricular performance in newborns as determined by systolic time intervals

“…In an attempt to find a sympathomimetic amine with a selective positive inotropic activity, the agent dobutamine (Dobutrex, Lilly, Windles, England) has been synthesized [40]. Although dobutamine has been studied extensively in adults [1,2,9,17,18,21,24,29,41,43,45], experience with this agent in newborns is limited [28, 36,]. Confirmation of the efficacy of dobutamine in newborns seems to be necessary since there are well-known differences in the performance of the myocardium between newborns and adults [3,7,8,12,26,[31][32][33]43].…”