咀嚼烟草对全身、肺和冠状动脉循环的急性影响。

Acute effects of tobacco chewing on the systemic, pulmonary and coronary circulation.

机构信息

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Am J Cardiovasc Drugs. 2011;11(2):109-14. doi: 10.2165/11586750-000000000-00000.

DOI:10.2165/11586750-000000000-00000

PMID:21446777

Abstract

BACKGROUND

Tobacco use is highly prevalent in India, with almost half of adult men consuming tobacco in either smoke or smokeless forms (particularly chewing). Although cigarette smoking is known to produce acute hemodynamic effects, there is a lack of data concerning such effects of chewing tobacco.

OBJECTIVE

The aim of this study was to determine the acute hemodynamic and coronary vasomotor effects of chewing tobacco.

METHODS

Twelve habitual tobacco chewers (mean ± SD age 51.3 ± 6.9 years) undergoing elective coronary angiography were included in the study. Following coronary angiography, a 7F thermodilution Swan Ganz continuous cardiac output pulmonary artery catheter was used to continuously measure the right heart pressures and cardiac output. Having obtained baseline hemodynamic data, 1g of tobacco was given to be chewed. Subsequently, hemodynamic data were obtained periodically over a period of 60 minutes. A repeat left coronary injection was performed, 10 minutes after giving the tobacco, in the right anterior oblique view to estimate the diameter of the left anterior descending (LAD) artery by quantitative coronary angiography.

RESULTS

Chewing tobacco led to a significant acute increase in heart rate (from 68.3 ± 12.4 beats/min to 80.6 ± 14.6 beats/min, peaking at 10 minutes) and cardiac output (from 3.8 ± 0.45 L/min to 4.7 ± 0.64 L/min, peaking at 15 minutes). There were no significant changes in the right atrial, pulmonary artery, or wedge pressures and hence no change in the pulmonary vascular resistance. More importantly, chewing tobacco was associated with coronary vasoconstriction (proximal LAD diameter change from 3.17 ± 0.43 mm to 2.79 ± 0.37 mm; p-value 0.02; mid LAD diameter change from 2.75 ± 0.36 mm to 2.40 ± 0.22 mm; p-value 0.03).

CONCLUSION

Chewing smokeless tobacco leads to coronary vasoconstriction and also produces significant hemodynamic alterations. These changes may have a bearing on excess vascular disease.

摘要

背景

在印度，烟草使用非常普遍，近一半的成年男性以吸烟或无烟形式（特别是咀嚼）消费烟草。虽然已知吸烟会产生急性血液动力学效应，但关于咀嚼烟草的此类效应的数据却很少。

目的

本研究旨在确定咀嚼烟草的急性血液动力学和冠状动脉血管舒缩效应。

方法

本研究纳入了 12 名习惯性烟草咀嚼者（平均年龄 51.3 ± 6.9 岁），他们正在接受选择性冠状动脉造影。在冠状动脉造影后，使用 7F 热稀释 Swan Ganz 连续心输出量肺动脉导管连续测量右心压力和心输出量。获得基线血液动力学数据后，给予 1g 烟草咀嚼。随后，在 60 分钟的时间内定期获取血液动力学数据。在给予烟草 10 分钟后，在右前斜位重复进行左冠状动脉注射，通过定量冠状动脉造影估计左前降支（LAD）的直径。

结果

咀嚼烟草导致心率显著急性增加（从 68.3 ± 12.4 次/分增加到 80.6 ± 14.6 次/分，在 10 分钟时达到峰值）和心输出量（从 3.8 ± 0.45 L/min 增加到 4.7 ± 0.64 L/min，在 15 分钟时达到峰值）。右心房、肺动脉或楔形压均无显著变化，因此肺血管阻力无变化。更重要的是，咀嚼烟草与冠状动脉收缩有关（近端 LAD 直径从 3.17 ± 0.43mm 变为 2.79 ± 0.37mm；p 值 0.02；中段 LAD 直径从 2.75 ± 0.36mm 变为 2.40 ± 0.22mm；p 值 0.03）。