Josephson M A, Schwab M, Coyle K, Singh B N
Am Heart J. 1987 Apr;113(4):952-7. doi: 10.1016/0002-8703(87)90056-1.
N-acetylprocainamide (NAPA) is the active metabolite of procainamide currently undergoing evaluation for its antiarrhythmic properties. Its effects on hemodynamic variables and on ventricular function in man are poorly defined. The effects of intravenously administered NAPA (18 mg/kg over 30 minutes; mean plasma level 40.2 +/- 6.2 micrograms/ml) on hemodynamics and left ventricular ejection fraction (LVEF) assessed by radionuclide ventriculography were therefore determined in 14 patients undergoing diagnostic cardiac catheterization. The peak effects of the drug with respect to most measured variables were seen at 30 minutes and were still apparent at 60 minutes. NAPA increased heart rate (3% at 10 minutes; p less than 0.01), decreased mean pulmonary arterial pressure (14%; p less than 0.05) and capillary wedge pressure (27%; p less than 0.01), decreased mean arterial pressure (12%; p less than 0.01), cardiac index (8%; p less than 0.01), LV dp/dtmax (9%; p less than 0.05), and stroke work index (17%; p less than 0.01). The LVEF increased 5% (p less than 0.05). There was a trend for the systemic vascular resistance to decrease, but this did not reach statistical significance. The data show that NAPA exerts relatively weak peripheral arteriolar and venodilator effects associated with a mild reduction in contractility and cardiac output but an increase in LVEF in patients with preserved ventricular function.
N-乙酰普鲁卡因胺（NAPA）是普鲁卡因胺的活性代谢产物，目前正在对其抗心律失常特性进行评估。其对人体血流动力学变量和心室功能的影响尚不明确。因此，在14例接受诊断性心导管检查的患者中，测定了静脉注射NAPA（30分钟内注射18mg/kg；平均血浆水平为40.2±6.2μg/ml）对血流动力学和通过放射性核素心室造影评估的左心室射血分数（LVEF）的影响。药物对大多数测量变量的峰值效应在30分钟时出现，60分钟时仍很明显。NAPA使心率增加（10分钟时增加3%；p<0.01），平均肺动脉压降低（14%；p<0.05）和肺毛细血管楔压降低（27%；p<0.01），平均动脉压降低（12%；p<0.01），心脏指数降低（8%；p<0.01），左心室dp/dtmax降低（9%；p<0.05），每搏功指数降低（17%；p<0.01）。LVEF增加了5%（p<0.05）。全身血管阻力有下降趋势，但未达到统计学意义。数据表明，NAPA具有相对较弱的外周小动脉和静脉扩张作用，伴有收缩力和心输出量轻度降低，但心室功能保留的患者LVEF增加。
