其他扩血管药物

除硝酸酯、硝普钠和酚妥拉明外，尚有一些其他血管扩张药，如乌拉地尔、奈西利肽等。

乌拉地尔具有独特的双重扩血管作用，其外周作用是选择性地阻断血管平滑肌的α1受体；中枢作用是兴奋延髓的5-羟色胺-1A受体，抑制延髓心血管中枢的反馈调节而降低外周血管阻力，并使心率保持相对稳定。乌拉地尔主要扩张动脉，冠状动脉内也有α受体，近来不断有研究证实乌拉地尔具有冠状动脉的扩张作用。相较于硝酸酯类与硝普钠而言，乌拉地尔对心率的影响较小，减少了反射性引起心率过快的不良反应；且硝普钠和硝酸酯均可增加肺内右向左的分流，导致动脉血氧分压下降，而乌拉地尔则无上述不良影响，故对心力衰竭患者更为有益。

奈西立肽（nesiritide）是最近研制成功的一种新型血管扩张药，是重组人脑钠肽（BNP），已用于AHF的治疗。BNP是在心室壁张力增加、心肌肥大、容量负荷过重时心肌细胞产生的一种内源性激素物质。奈西立肽可以扩张静脉、动脉、冠状动脉，从而降低心脏前负荷和后负荷，在无直接正性肌力作用的情况下增加心输出量。慢性心力衰竭病人应用奈西立肽可产生有益的血流动力学作用，增加钠排泄，抑制肾素-血管紧张素-醛固酮和交感神经系统。与静脉硝酸甘油相比，能更有效地改善血流动力学，且不良反应更少。新近研究表明，奈西立肽能够明显改善扩张型心肌病患者的血流动力学障碍。尽管如此，目前对奈西立肽的临床研究仍然很有限，有些病人可能对治疗无反应，目前尚不能证明其有助于改善临床结果，其疗效有待进一步验证。

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