塩酸コルホルシンダロパート（アデール®）少量併用投与により著明な改善を認めた難治性心不全の2例

Remarkable Effect of Additional Low-dose Colforsin Daropate Hydrochloride Administration in Two Cases of Refractory Congestive Heart Failure

　他剤不応性のうっ血性心不全に対して塩酸コルホルシンダロパートを少量追加投与し著明な改善を認めた2症例を経験した．第1例は心房細動，心拡大，僧帽弁逆流症に下壁の急性心筋梗塞を合併した症例で，カテコラミン，利尿剤の点滴下で本剤0.1〜0.025μg/kg/minとジギタリスの投与にて著明な利尿作用と自覚症状，肺うっ血の改善を認めた．第2例は左冠動脈主幹部の完全閉塞による急性心筋梗塞であり，血行再建後もショック状態と呼吸不全が続いた．カテコラミン，利尿剤の点滴下に0.1〜0.05μg/kg/min投与にて著明な利尿作用と，肺うっ血，人工呼吸器管理下での吸入酸素濃度必要量の減少を認めた．両例とも心拍数上昇，出現不整脈は軽微であった．塩酸コルホルシンダロパートはうっ血性心不全の他剤無効例に対する強心剤として登場したが，他剤使用例に少用量を併用することでも著明な効果が期待できる．

　Colforsin daropate hydrochloride (CDH) has been approved as a new inotropic agent. It is reported to be effective at a dose of O.1~0.05μg/kg/min in cases refractory to other inotoropic agents. This report describes two cases of refractory congestive heart failure that were successfully treated by addition of low-dose colforsin daropate hydrochloride to catecholamines and diuretics. The first patient was a 63-year-old male with rheumatoid arthritis, membraous nephropathy, atrial fibrillation and severe mitral regurgitation with moderate left atrial and left ventricular dilatation. After inferior myocardial infarction was successfuly revascularized by coronary angioplasty, the patient developed refractory congestive heart failure despite treatment with catecholamines, digitoxin and diuretics. After additional low-dose (at 0.10~0.025μg/ kg/min) CDH, a remarkable increase in urine volume, and improvement of symptoms and pulmonary congestion were observed.

　The second case was a 67-year-old male, who was admitted with acute myocardial infarction of that left main trunk that was successfuly revascularized by primary coronary angioplasty and stent implantation. This patient also developed refractory congestive heart failure and hypotension despite treatment with catecholamines and diuretics, as well as intraaortic balloon pumping and controlled ventilation. After addition of low-dose (at 0.10~0.05μg/kg/min) CDH, a remarkable increase in urine volume was seen and we could decrease the fraction of inspiratory oxygen under controlled ventilation.

　Additional low dose CDH had a remarkable diuretic effect in refractory congestive heart failure, which could suggest a new protocol using CDH as an inotropic agent for the management of congestive heart failure.