循環器ジャーナル66巻1号

2018年01月発行

特集 循環器診療　薬のギモン—エキスパートに学ぶ薬物治療のテクニック Ⅰ．心不全診療でのギモン

急性心不全の強心薬は，ドパミン？ドブタミン？それともPDEⅢ阻害薬？いつ始めたほうがいいの？

著者： 佐藤直樹¹²

所属機関： ¹日本医科大学武蔵小杉病院循環器内科 ²日本医科大学武蔵小杉病院集中治療室

ページ範囲：P.14 - P.19

Point
・低心拍出・低灌流をしっかり評価し，不確定な場合は確実な血行動態評価法により評価を行う．
・必要と判断したらすぐに開始する．
・低用量から開始し時間単位で効果判定して増減する．

参考文献

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3) Jewitt D, Birkhead J, Mitchell A, et al:Clinical cardiovascular pharmacology of dobutamine. A selective inotropic catecholamine. Lancet 2:363-367, 1974

4) 佐藤直樹：急性心不全を診る．日本医科大学雑誌71:426-429, 2004

5) Kajimoto K, Sato N, Keida T, et al:Low admission heart rate is a marker rather than a mediator of increased in-hospital mortality for patients with acute heart failure syndromes in sinus rhythm. Int J Cardiol 171:98-100, 2014

6) Gheorghiade M, Abraham WT, Albert NM, et al:Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 296:2217-2226, 2006

7) Kajimoto K, Sato N, Sakata Y, et al:Relationship between systolic blood pressure and preserved or reduced ejection fraction at admission in patients hospitalized for acute heart failure syndromes. Int J Cardiol 168:4790-4795, 2013

8) Cecconi M, De Becker D, Antonelli M, et al:Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795-1815, 2014

9) Sato N, Gheorghiade M, Kajimoto K, et al:Hyponatremia and in-hospital mortality in patients admitted for heart failure（from the ATTEND registry）. Am J Cardiol 111:1019-1025, 2013

10) Kajimoto K, Minami Y, Sato N, et al:Serum sodium concentration, blood urea nitrogen, and outcomes in patients hospitalized for acute decompensated heart failure. Int J Cardiol 222:195-201, 2016

11) Sotomi Y, Sato N, Kajimoto K, et al:Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes:from the ATTEND Registry. Int J Cardiol 172:165-172, 2014

12) De Backer D, Biston P, Devriendt J, et al:Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 362:779-789, 2010

13) Elkayam U, Ng TM, Hatamizadeh P, et al:Renal vasodilatory action of dopamine in patients with heart failure:magnitude of effect and site of action. Circulation 117:200-205, 2008

14) Kamiya M, Sato N, Nozaki A, et al:Renal effects of added low-dose dopamine in acute heart failure patients with diuretic resistance to natriuretic peptide. J Cardiovasc Pharmacol 65:282-288, 2015

15) Peacock WF, Emerman C, Costanzo MR, et al:Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail 15:256-264, 2009

16) Mebazaa A, Tolppanen H, Mueller C, et al:Acute heart failure and cardiogenic shock:a multidisciplinary practical guidance. Intensive Care Med 42:147-163, 2016

17) 日本循環器学会：急性心不全治療ガイドライン（2011年改訂版）http://www.j-circ.or.jp/guideline/pdf/JCS2011_izumi_h.pdf（2017年1月5日アクセス確認）