Kobayashi K, Hakuta T
Second Department of Internal Medicine, Yokohama City University School of Medicine, Japan.
J Cardiovasc Pharmacol. 1987;10 Suppl 8:S109-15.
Effects of nicorandil (NC), a newly synthesized nicotinamide derivative (2 mg i.v.), nitroglycerin (TNG, 0.3 mg sublingual), nifedipine (NF, 10 mg sublingual), and propranolol (PR, 0.1 mg/kg i.v.) on coronary hemodynamics were evaluated in 41 patients with ischemic heart disease. Coronary sinus flow (CSF) was measured using a continuous thermodilution method. NC decreased arterial pressure, cardiac output (CO), and pulmonary artery pressure without changing heart rate. Rate-pressure product tended to decrease. Resting CSF was increased by NC (117-148 ml/min, p less than 0.01) and NF. TNG and PR caused no significant changes. Furthermore, NC revealed the highest CSF/CO ratio among four agents and decreased coronary resistance. During rapid atrial pacing, CSF was slightly increased by TNG, but remained unchanged after NC and NF. Myocardial norepinephrine release was markedly increased by TNG (1.5-6.2 ng/min, p less than 0.01) and slightly increased by NF. No changes were noted after NC and PR. Myocardial lactate extraction varied insignificantly in all agents. NC is a potent coronary vasodilator and seems to reduce both preload and afterload; however, in contrast to TNG and NF, NC did not cause reflex tachycardia or an increase of myocardial sympathetic tone.
在41例缺血性心脏病患者中评估了新合成的烟酰胺衍生物尼可地尔（NC，静脉注射2毫克）、硝酸甘油（TNG，舌下含服0.3毫克）、硝苯地平（NF，舌下含服10毫克）和普萘洛尔（PR，静脉注射0.1毫克/千克）对冠状动脉血流动力学的影响。使用连续热稀释法测量冠状窦血流（CSF）。尼可地尔降低动脉压、心输出量（CO）和肺动脉压，而心率不变。心率-血压乘积有下降趋势。静息状态下，尼可地尔（117 - 148毫升/分钟，p < 0.01）和硝苯地平可增加CSF。硝酸甘油和普萘洛尔无显著变化。此外，尼可地尔在四种药物中显示出最高的CSF/CO比值，并降低冠状动脉阻力。在快速心房起搏期间，硝酸甘油使CSF略有增加，但尼可地尔和硝苯地平后CSF保持不变。硝酸甘油使心肌去甲肾上腺素释放显著增加（1.5 - 6.2纳克/分钟，p < 0.01），硝苯地平使其略有增加。尼可地尔和普萘洛尔后无变化。所有药物对心肌乳酸摄取的影响无明显差异。尼可地尔是一种有效的冠状动脉扩张剂，似乎能降低前负荷和后负荷；然而，与硝酸甘油和硝苯地平不同，尼可地尔不会引起反射性心动过速或心肌交感神经张力增加。
