心血管活性药物讲义.pptVIP

ISOPROTERENOL异丙肾上腺素 Synthetic catecholamine人工合成的儿茶酚胺 Non-specific beta agonist with minimal alpha-adrenergic effects.主要激动β受体，对β1和β2受体选择性很低，对α受体几乎无作用 Causes inotropy, chronotropy, and systemic and pulmonary vasodilatation.正性肌力、正性频率、全身和肺血管舒张 Indications: bradycardia心动过缓, decreased cardiac output心输出量减少, bronchospasm支气管痉挛 (bronchodilator). ISOPROTERENOL Occasionally used to maintain heart rate following heart transplantation. Dose starts at 0.01 mcg/kg/min and is increased to 1.0 mcg/kg/min for desired effect. INHALED NITRIC OXIDE吸入一氧化氮 Selective Pulmonary vasodilator Dilates only pulmonary capillaries毛细血管 to alveoli肺泡 participating in gas exchange Decreases intrapulmonary shunt and improves V/Q matching减少肺内分流和增加通气/血流比例 Rapidly inactivated灭活 by Hgb in pulm. cap. so no systemic side effects (eg hypotension) INHALED NITRIC OXIDE Potential for use in ARDS and Pulmonary Hypertension Currently only approved for use in neonatal Pulmonary Hypertension Expensive Special monitoring equipment required Dose: Concentration of 0.5-60 ppm（parts per million） in inhaled gas Additional considerations Mechanical ventilation and oxygen therapy (to conserve CO) Analgesia, anxiolysis and sedation镇痛，抗焦虑和镇静 Electrolyte homeostasis esp Ca and Mg电解质稳态（钙、镁） Nutrition - avoid hypoglycemia营养支持，避免低血糖 Anemia is an “unconstitutional surcharge” Last but not the least: Maintain appropriate intravascular volume保证适当的血容量 Selecting inotropic and vasopressor agents for specific hemodynamic disturbances in children Hemodynamic pattern Normal Deceased Elevated Blood pressure or SVR Septic Shock Stroke index High Stroke Index low to N None or dopamine Dobutamine or dopamine Norepinephrine Dopamine or epinephrine (or dobutamine plus norephinephrine) None Dobutamine plus nitroprusside Cardiogenic shock Dobutamine or amrinone or dopamine Epinephrine or dopamine -- Myocardial dysfunction (complicating critical illness) Dobutamine or dopamine or amrinone Epinephrine or dopamine (or dobutamine plu