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Kokyu to Junkan Volume 34, Issue 6 （June 1986）

呼吸と循環 34巻6号（1986年6月発行）

Japanese English

研究

急性心筋梗塞に伴う心不全に対するamrinone（Win 40680）一回静注の効果—dopamine，dobutamineとの比較 Effects of intravenous amrinone (Win 40680) on heart failure complicated by acute myocardial infarction: Comparative study with dopamine and dobutamine 田中啓治 ¹ , 高野照夫 ¹ , 島井新一郎 ¹ , 高田加寿子 ¹ , 洪基哲 ¹ , 清野精彦 ¹ , 加藤貴雄 ¹ , 子島潤 ² , 宗像一雄 ² , 早川弘一 ² Keiji Tanaka ¹ , Teruo Takano ¹ , Shinichiro Shimai ¹ , Kazuko Takada ¹ , Mototetsu Koh ¹ , Yoshihiko Seino ¹ , Takao Katoh ¹ , Jun Nejima ² , Kazuo Munakata ² , Hirokazu Hayakawa ² ¹日本医科大学集中治療室 ²日本医科大学第一内科 ¹Division of CCU and ICU, Nippon Medical School ²1st Department of Internal Medicine, Nippon Medical School pp.651-657

発行日 1986年6月15日 Published Date 1986/6/15

DOI https://doi.org/10.11477/mf.1404204886

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Abstract 文献概要
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　うっ血性心不全に対する治療薬として，従来よりdigitalis剤，catecholamine剤などの陽性変力剤が用いられてきたが，近年新たにいくつかの陽性変力剤が開発され，その有用性が報告されている^1〜3）。

　bipyridine誘導体であるamrinone（Win 40680：5-amino-3,4’-bipyridin-6（1H）-one：図1）は，1978年FarahとAlousi^4）によってはじめて紹介された新しい陽性変力剤であり，上記薬剤のいずれとも異なった機序によって心筋収縮力を増大させるという。すなわち，digitalisのごとくNa，K-ATPaseを抑制することはなく，またcatecholamineのように交感神経β受容体を介することもないとされ，平はPDE（phosphodiesterase）阻害によって細胞内cyclic AMP濃度を増加せしめ，強心作用を発現する可能性が高いと述べている^5,6）。

The hemodynamic effects of a newly developed inotropic agent, amrinone (AMN) were studied and compared with those of dopamine (DA) and dobutamine (DB) in forty patients with pump failure due to acute myocardial infarction. Hemodynamic measurements were done using a Swan-Ganz thermodilution catheter before and 5, 10, 15, 30, 60, 90 and 120 minutes after the intravenous injection of AMN (1-2mg/kg) for 3 minutes in eight patients, and also before and during the drip infusion (3-7,μg/kg/min) of DA fifteen patients and DB in seventeen patients. AMN caused maximal increases in CI, SVI and SWI, and maximal lowering in CVP and SVR 5 minutes after the intravenous injection, while maximal lowering in PCWP occurred 10 minutes after the injection. These significant hemodynamic changes were lasting for 60 minutes after the injection. Simultaneous measurements of serum concentration of AMN revealed a significant and extremely high negative correlation between CVP and serum concentration of AMN (r=0.923). Comparing the maximal hemodynamic effects occurred 3 minutes after the injection of AMN with those of DA and DB, it was evidenced that AMN increased CI almost same as DA, and lowered CVP and PCWP much more compared to DB. These results suggest that AMN possesses dominant vasodilating effect besides the inotropic effect, and which would be of marked benefit for the treatment of refractory heartfailure because of the characteristic cardiovascular hemodynamic effects as if catecholamine and a vasodilator were combined.