可乐定对左心室功能不全患者动脉压力反射敏感性及交感神经活动心肺压力反射控制的影响。

The effects of clonidine on arterial baroreflex sensitivity and cardiopulmonary baroreflex control of sympathetic nerve activity in patients with left ventricular dysfunction.

作者信息

Yuasa Fumio, Kawamura Akihiro, Yokoe Hiroshi, Yoshida Susumu, Murakawa Kousuke, Sugiura Tetsuro, Iwasaka Toshiji

机构信息

Second Department of Internal Medicine, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka, Japan.

出版信息

Clin Physiol Funct Imaging. 2011 Mar;31(2):94-100. doi: 10.1111/j.1475-097X.2010.00983.x. Epub 2010 Oct 24.

DOI:10.1111/j.1475-097X.2010.00983.x

PMID:20969725

Abstract

BACKGROUND

Clonidine is a potent sympatholytic drug with central neural effects. The aim of this study was to evaluate the effects of clonidine on arterial baroreflex sensitivity (BRS) and cardiopulmonary (CP) baroreflex control of muscle sympathetic nerve activity (MSNA) in patients with left ventricular (LV) dysfunction.

METHOD

Twenty patients were randomly assigned to either clonidine or placebo groups (10 in each group). BRS (by phenylephrine method) and CP baroreflex (by lower body negative pressure) effects on sympathetic nerve activity (circulating norepinephrine and MSNA recordings) were measured before and after a 4-week treatment period.

RESULTS

Clonidine lowered blood pressure and heart rate. Clonidine was accompanied not only by a decrease in plasma noradrenaline (from 444±196 to 260±144 pg ml(-1) ) but also by a reduction in directly measured MSNA (from 47±16 to 36±16 bursts min(-1) ). BRS increased significantly from 3·01±1·19 to 6·86±2·84 ms mmHg(-1) after clonidine. When expressed as per cent change in MSNA during CP baroreceptor stimulation, CP baroreflex control of MSNA was significantly increased from 9·26±8·93% to 28·83±11·96% after clonidine. However, there were no significant changes in the measured variables in the control group.

CONCLUSION

Clonidine enhanced BRS and CP baroreflex control of MSNA while reducing baseline sympathetic activity in patients with LV dysfunction.

摘要

背景

可乐定是一种具有中枢神经效应的强效抗交感神经药物。本研究的目的是评估可乐定对左心室（LV）功能障碍患者动脉压力反射敏感性（BRS）和心肺（CP）压力反射对肌肉交感神经活动（MSNA）的控制作用。

方法

20例患者被随机分为可乐定组或安慰剂组（每组10例）。在为期4周的治疗期前后，测量BRS（用去氧肾上腺素法）和CP压力反射（用下体负压法）对交感神经活动（循环去甲肾上腺素和MSNA记录）的影响。

结果

可乐定降低了血压和心率。可乐定不仅伴随着血浆去甲肾上腺素的降低（从444±196降至260±144 pg/ml），还伴随着直接测量的MSNA的减少（从47±16降至36±16次/分钟）。可乐定治疗后，BRS从3.01±1.19显著增加至6.86±2.84 ms/mmHg。当以CP压力感受器刺激期间MSNA的变化百分比表示时，可乐定治疗后CP压力反射对MSNA的控制从9.26±8.93%显著增加至28.83±11.96%。然而，对照组的测量变量没有显著变化。