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首页> 外文期刊>Expert opinion on pharmacotherapy >Combined use of ultra-short acting beta-blocker esmolol and intravenous phosphodiesterase 3 inhibitor enoximone
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Combined use of ultra-short acting beta-blocker esmolol and intravenous phosphodiesterase 3 inhibitor enoximone

机译:超短效β受体阻滞剂艾司洛尔和静脉内磷酸二酯酶3抑制剂依诺酮的组合使用

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摘要

In patients with impaired myocardial contractility associated with down-regulation of the p-receptors, compounds inhibiting phosphodiesterase (PDE) 3 may be useful to increase contractility. The PDE3 inhibitor enoximone has been shown to improve pump-function independent from the p-receptor pathway. A simultaneous decrease in ventricular preload and afterioad by vasodilation has led to the term 'inodilator'. Esmolol is the only available ultra-short acting intravenous beta-blocking agent. Due to its half-life of ~ 9 min, beta-blockade, and thus, heart rate, can easily be titrated. Esmolol appears to be a helpful tool to avoid myocardial ischemia (e.g., in the perioperative setting). As with all other beta-blockers, it has dose-dependent negative inotropic effects, and this limits its use in patients with severe heart failure showing low cardiac output. It seems reasonable that an intravenous combination of both approaches, enoximone-induced positive inotropy and esnaolol-associated protection from myocardial ischemia, might offer advantages by producing beneficial hemodynamic effects and by compensating each other's limitations in a complementary way. In spite of some promising results, the place of a combination of enoximone and esmolol in the process of treating patients with (acute) heart failure showing low output is still not entirely clear, and needs further confirmation.
机译:在与p受体下调相关的心肌收缩力受损的患者中,抑制磷酸二酯酶(PDE)3的化合物可能有助于增加收缩力。已显示PDE3抑制剂依诺昔酮可独立于p受体途径改善泵功能。血管舒张同时使心室前负荷和继发减少导致了术语“扩张剂”。艾司洛尔是唯一可用的超短效静脉内β受体阻滞剂。由于其约9分钟的半衰期,β受体阻滞剂(因此心率)可以轻松确定。艾司洛尔似乎是避免心肌缺血(例如在围手术期中)的有用工具。与所有其他β受体阻滞剂一样,它具有剂量依赖性的负性肌力作用,这限制了其在显示低心输出量的严重心力衰竭患者中的​​使用。两种方法的静脉内组合,即依诺酮引起的正性肌力和依那洛尔相关的心肌缺血保护作用,似乎可以通过产生有益的血流动力学作用并通过补充性地补偿彼此的局限性来提供优势。尽管取得了一些令人鼓舞的结果,但是在治疗输出量低的(急性)心力衰竭患者的过程中,依诺酮和艾司洛尔的组合位置尚不完全清楚,需要进一步证实。

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