可卡因对左心室功能的影响. 与增加的壁面应力和治疗后持久性的关系
P M Mehta1, T A Grainger, R M Lust
1Department of Internal Medicine, East Carolina University School of Medicine, Greenville, NC 27858-4354, USA.
对狗的可卡因输注通过增加壁应力而减少左心室 (LV) 功能,而不是通过减少心肌收缩性. 这些对LV功能的影响在可卡因服用停止后持续了两个多小时.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 由于可卡因已知的心血管风险,调查可卡因对心脏的影响至关重要.
- 了解可卡因是否通过直接心肌毒性或改变负载条件损害左心室 (LV) 功能,对于临床管理至关重要.
研究的目的:
- 要区分可卡因对心肌收缩率的影响与负载条件对LV功能的影响.
- 为了确定可卡因在输液停止后对LV功能影响的时间进程.
主要方法:
- 使用心声回声和血液动力学在 30 个闭胸狗在吗啡镇静下.
- 服用不同剂量的可卡因 (10,30,100μg/kg/min) 或盐水,监测 LV 功能,动脉压和心率.
- 使用末缩壁应力和分数缩短之间的关系来评估收缩性.
主要成果:
- 可卡因在30和100微克/公斤/分钟的剂量显著降低了喷射分数和分数缩短.
- 这些剂量还急剧增加了动脉压和心率,导致末缩壁应激升高.
- 分析表明, LV 功能的降低主要是由于壁面应力增加,而不是心肌收缩能力降低.
结论:
- 在这种狗模型中,可卡因降低了喷射阶段的LV功能,这是由于后负荷增加 (壁应力),而不是直接的心肌抑郁.
- 观察到的功能性改变在输注后至少持续了2小时,突出显示了可卡因对心脏血液动力学的持续影响.
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