Mayumi H, Toshima Y, Tokunaga K
Division of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Cardiovasc Surg (Torino). 1992 Nov-Dec;33(6):738-45.
An antagonist to H1 histamine receptor and one to H2 histamine receptor were used to prevent protamine-induced hypotension in 126 Japanese patients undergoing open heart surgery. In a study comparing an H1 antagonist "diphenhydramine" and an H2 antagonist "famotidine", 103 patients were divided into four groups: 31 patients were given no drugs (Group 1), 25 patients were given 0.4 mg/kg of diphenhydramine (Group 2), 33 patients were given 0.4 mg/kg of famotidine (Group 3), and 14 patients were given both the drugs (Group 4) before protamine administration. Although the systolic arterial pressure decreased significantly after protamine administration in all groups, famotidine was found to be effective in reducing protamine-induced hypotension, whereas diphenhydramine was not effective. In order to further investigate the hemodynamic changes in a double-blinded fashion, 12 patients were given normal saline (Group 5), while 11 patients were given 0.4 mg/kg of famotidine (Group 6) before protamine administration. Again, the minimal systolic and mean arterial pressures after protamine injection were significantly higher in Group 6 than in Group 5, while left atrial pressure, central venous pressure, heart rate, and cardiac index were almost the same and remained constant in the two groups. These results strongly suggest that the H2 antagonist "famotidine" is beneficial in reducing protamine-induced hypotension after cardiopulmonary bypass, while the H1 antagonist "diphenhydramine" is not.
使用一种H1组胺受体拮抗剂和一种H2组胺受体拮抗剂，来预防126例接受心脏直视手术的日本患者出现鱼精蛋白诱导的低血压。在一项比较H1拮抗剂“苯海拉明”和H2拮抗剂“法莫替丁”的研究中，103例患者被分为四组：31例患者未用药（第1组），25例患者给予0.4mg/kg苯海拉明（第2组），33例患者给予0.4mg/kg法莫替丁（第3组），14例患者在给予鱼精蛋白前同时给予这两种药物（第4组）。尽管所有组在给予鱼精蛋白后收缩压均显著下降，但发现法莫替丁在减轻鱼精蛋白诱导的低血压方面有效，而苯海拉明无效。为了以双盲方式进一步研究血流动力学变化，12例患者在给予鱼精蛋白前给予生理盐水（第5组），而11例患者给予0.4mg/kg法莫替丁（第6组）。同样，第6组鱼精蛋白注射后的最低收缩压和平均动脉压显著高于第5组，而两组的左心房压、中心静脉压、心率和心脏指数几乎相同且保持稳定。这些结果强烈表明，H2拮抗剂“法莫替丁”有助于减轻体外循环后鱼精蛋白诱导的低血压，而H1拮抗剂“苯海拉明”则无效。
