Kiowski W, Frei A
Arch Intern Med. 1987 Jan;147(1):153-6.
Incidence and mechanisms of cimetidine-induced hypotension were investigated during the first intravenous injection of cimetidine (200 mg over three minutes) in 68 consecutive patients in the intensive care unit. Systolic pressure decreased more than 5 mm Hg (average, 14 mm Hg) in 50 patients, exceeding 30 mm Hg in nine (13%), while heart rate and pulmonary artery pressure (seven patients) did not change. Blood pressure decreased significantly more in patients requiring vasoconstrictor drug support. The arterial vasodilator properties of cimetidine were demonstrated in 12 normal volunteers in whom brachial artery cimetidine infusions caused a significant decrease of forearm vascular resistance. This effect was more pronounced when forearm vessels were preconstricted with dopamine hydrochloride (n = 6) or norepinephrine (n = 6), pointing toward an interference of cimetidine with sympathetically mediated vasoconstriction. Thus, intravenous injection of cimetidine in critically ill patients, presumably through arterial vasodilatation, is frequently associated with decreases of blood pressure, particularly in patients requiring vasoconstrictor drug support.
在重症监护病房对68例连续患者首次静脉注射西咪替丁（3分钟内注射200毫克）期间，研究了西咪替丁诱发低血压的发生率及机制。50例患者收缩压下降超过5毫米汞柱（平均14毫米汞柱），9例（13%）超过30毫米汞柱，而心率和肺动脉压（7例患者）未改变。需要血管收缩剂药物支持的患者血压下降更为显著。在12名正常志愿者中证实了西咪替丁的动脉血管舒张特性，其中对肱动脉输注西咪替丁导致前臂血管阻力显著降低。当用盐酸多巴胺（n = 6）或去甲肾上腺素（n = 6）预先收缩前臂血管时，这种作用更为明显，表明西咪替丁干扰了交感神经介导的血管收缩。因此，在重症患者中静脉注射西咪替丁，可能通过动脉血管舒张，常伴有血压下降，尤其是在需要血管收缩剂药物支持的患者中。
