Department of Anesthesiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Am J Cardiovasc Drugs. 2021 Jan;21(1):35-49. doi: 10.1007/s40256-020-00410-4.
Calcium channel blockers (CCBs) exert profound hemodynamic effects via blockage of calcium flux through voltage-gated calcium channels. CCBs are widely used in acute care to treat concerning, debilitating, or life-threatening hemodynamic changes in many patients. The overall literature suggests that, for systemic hemodynamics, although CCBs decrease blood pressure, they normally increase cardiac output; for regional hemodynamics, although they impair pressure autoregulation, they normally increase organ blood flow and tissue oxygenation. In acute care, CCBs exert therapeutic efficacy or improve outcomes in patients with aneurysmal subarachnoid hemorrhage, acute myocardial infarction and unstable angina, hypertensive crisis, perioperative hypertension, and atrial tachyarrhythmia. However, despite the clear links, there are missing links between the known hemodynamic effects and the reported outcome evidence, suggesting that further studies are needed for clarification. In this narrative review, we aim to discuss the hemodynamic effects and outcome evidence for CCBs, the links and missing links between these two domains, and the directions that merit future investigations.
钙通道阻滞剂 (CCB) 通过阻断电压门控钙通道的钙离子流，产生深远的血液动力学效应。CCB 在急性护理中被广泛用于治疗许多患者令人担忧、虚弱或危及生命的血液动力学变化。总体文献表明，对于全身血液动力学，虽然 CCB 会降低血压，但通常会增加心输出量；对于局部血液动力学，尽管它们会损害压力自动调节，但通常会增加器官血流量和组织氧合。在急性护理中，CCB 在蛛网膜下腔出血、急性心肌梗死和不稳定型心绞痛、高血压危象、围手术期高血压和心房性心动过速患者中发挥治疗效果或改善结局。然而，尽管存在明确的关联，但已知的血液动力学效应和报告的结果证据之间存在缺失的环节，表明需要进一步研究以澄清这些问题。在这篇叙述性综述中，我们旨在讨论 CCB 的血液动力学效应和结果证据、这两个领域之间的联系和缺失环节，以及值得未来研究的方向。
