重症心不全に対するNifedipine（Adalat®）の急性効果（第3報）—Ergometer運動負荷時の血行動態および代謝に及ぼす影響についての検討

Effects of sublingual Nifedipine on hemodynamic and metabolic responsee to exercise (Ergometer, 25W, 5min.) in patients with severe congestive heart failure

　心不全に対する心室負荷軽減療法として，Nifedipineの血行動態に及ぼす急性効果は種々報告されているが^1〜9），代謝および交感神経系に及ぼす影響は報告が少なく^4），まして運動負荷時の血行動態^1,5,8,9），代謝および交感神経系に及ぼす影響となると極めて報告が少ない。

　以前より，我々は重症心不全患者に対するNifedipineの急性効果として後負荷並びに前負荷軽減効果と共に代謝およびGas分析面における改善も期待できる事を報告してきた^2,4）。

　Rest and exercise systemic hemodynamic and metabolic parameters were assessed before and lhr after the sublingual administration of 10mg of Nifedipine in 7 patients with congestive heart failure.

　When compared with control, Nifedipine increased rest and exercise cardiac index by 15% and 14% (p< 0.05), Noradrenaline by 58% (p<0.05). exercise stroke volume index by 26% (p<0.051, decreased rest and exercise pulmonary capillary wedge pressure by 23% and 21% (p<0.05, p<0.02), rest and exercise mean pulmonary aterial pressure by 19% ( p < 0.05) and 17% (p< 0.021), mean right aterial pressure by 30% (p<0.05), systemic vascular resistance index by 20% (p<0.05). exercise double products by 21% (p < O. 021, respectively whereas there was no significant change in rest and exercise heart rate, mean blood pressure, renin activity, aldosterone, adrenaline, lactate/pyruvate and exercise noradrenaline.

　Therefore Nifedipine seemed to be a potent vasodilator with both acting as afterload and preload reduction and so to be useful for the treatment of severe heart failure as a deloading agent at rest and during exercise.