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Kardiovaskuläre Effekte von Dobutamin

Cardiovascular effects of dobutamine

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Summary

The cardiovascular effects of dobutamine, a derivative of dopamine have been investigated in seven patients with chronic left ventricular dysfunction. The patients were either suffering from coronary heart disease or from cardiomyopathy.

Dobutamine was administered at doses of 2.5–5.0–7.5–10.0 and 15.0 µg/kg/min. The following parameters were measured: aortic pressure, left ventricular pressure (LVEDP, LVdp/dtmax) by using a Millar tip manometer, pulmonary artery pressure and cardiac output (dy-dilution technique).

The positive chronotropic effect of dobutamine was small in the lower dosage range and reached significance only with the highest dose of 15.0 µg/kg/min. Systolic aortic pressure was increased moderately over the whole dosage range (p<0.05). However the increment of mean aortic pressure (+11 mm Hg), of stroke volume (+22%) and of stroke work (+49%) was already maximum (p<0.05) at a dose of 5.0 µg/kg/min.

The positive inotropic action of dobutamine caused a dose related increase of cardiac index and of LVdp/dtmax of +53% and of +193% respectively. This effect was accompanied by a continuous and significant decrease of LVEDP and of peripheral resistance. Dobutamine induced arrhythmias have not been observed. 15 min after infusion stop, no dobutamine effect could be detected. These findings demonstrate that the actions of dobutamine are not merely cardioselective. However, in the dose range between 2.5 and 15.0 µg/kg/min a positive inotropic effect is predominant. Further clinical trials with dobutamine on patients with severe myocardial dysfunction and low output syndrome may yield promising results.

Zusammenfassung

Die kardiovaskulären Effekte von Dobutamin, einem Derivat des Dopamin, wurden an 7 Patienten mit chronischer Funktionsstörung der linken Kammer bei koronarer und myokardialer Herzerkrankung untersucht.

Dobutamin wurde in steigenden Dosen von 2,5–5,0–7,5–10,0 und 15,0 µg/kg/min infundiert. Gemessen wurden der Druck in der zentralen Aorta, im linken Ventrikel (Kathetertipmanometer; LVEDP, LVdp/dtmax) und in der Pulmonalarterie sowie das Herzminutenvolumen (Farbstoffverdünnungsmethode).

Der positiv chronotrope Effekt von Dobutamin war gering und erst bei 15,0 µg/kg/min statistisch auffällig. Der systolische Aortendruck nahm im gesamten Dosisbereich mäßig stark zu. Dagegen war die Zunahme des mittleren Aortendruckes mit 11 mm Hg, die des Schlagvolumens mit 22% und der Schlagarbeit mit 49% bei 5,0 µg/kg/min am größten (p<0,05).

Die positiv inotrope Wirkung von Dobutamin führte dosisabhängig zu einer Zunahme des Herzindex und von LVdp/dtmax um maximal 63 bzw. 193% (p<0,01). Dabei sanken der LVEDP und der periphere Widerstand signifikant ab. Arrhythmien traten unter Dobutamin nicht auf. Nach 15 min war die Wirkung der Substanz abgeklungen.

Die Befunde zeigen, daß Dobutamin keine streng kardioselektive Wirkung besitzt. Jedoch überwiegt im Dosisbereich von 2,5–15,0 µg/kg/min die positiv inotrope Wirkung. Weitere klinische Untersuchungen mit dieser Substanz an Patienten mit schwerer Herzinsuffizienz und low output Syndrom erscheinen erfolgversprechend.

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  1. II. Medizinische Klinik und Poliklinik der Universität Mainz, Germany

    P. Limbourg, H. Just, F. Kersting & K. F. Lang

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  1. P. Limbourg
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  2. H. Just
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  3. F. Kersting
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  4. K. F. Lang
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Limbourg, P., Just, H., Kersting, F. et al. Kardiovaskuläre Effekte von Dobutamin. Klin Wochenschr 56, 551–557 (1978). https://doi.org/10.1007/BF01477251

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