Wilson R F, White C W
Circulation. 1986 Mar;73(3):444-51. doi: 10.1161/01.cir.73.3.444.
An ideal coronary vasodilator for studying coronary flow reserve in humans would rapidly produce maximal coronary vasodilation, be short acting to permit repeated measurements, and not alter systemic hemodynamics. The two commonly used vasodilators (dipyridamole and meglumine diatrizoate) do not satisfy these criteria; meglumine diatrizoate does not produce maximal hyperemia and dipyridamole has a long duration of effect (greater than 30 min). In this study we used a subselective coronary Doppler catheter to measure the dose-response kinetics of a shorter acting vasodilator, intracoronary papaverine. In 10 patients with normal coronary vessels, the maximal vasodilator response to papaverine was compared with that to intravenous dipyridamole (0.56 mg/kg infused over 4 min) and intracoronary meglumine diatrizoate. The increase in coronary blood flow velocity after the maximal dose of papaverine (4.8 +/- 0.4 peak/resting velocity ratio, mean +/- SEM) was nearly identical to that seen after infusion of dipyridamole (4.8 +/- 0.6) and was significantly greater than that after meglumine diatrizoate (3.1 +/- 0.2, p less than .01). At maximal hyperemia, mean arterial blood pressure fell 9 +/- 2% (mean +/- SEM) after intracoronary papaverine, 8 +/- 4% after dipyridamole, and 3 +/- 3% after meglumine diatrizoate. The dose-response kinetics of intracoronary papaverine were studied in 13 patients with normal coronary arteries. In the left coronary artery, maximal vasodilation (5.4 +/- 0.6) was achieved with 8 mg in six of eight patients and with 12 mg in all patients. In the right coronary artery, maximal vasodilation (4.8 +/- 0.7) was achieved with 6 mg in four or five patients and with 8 mg in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
一种用于研究人体冠状动脉血流储备的理想冠状动脉血管扩张剂应能迅速产生最大程度的冠状动脉扩张，作用时间短以便进行重复测量，且不改变全身血流动力学。两种常用的血管扩张剂（双嘧达莫和泛影葡胺）并不满足这些标准；泛影葡胺不能产生最大程度的充血，而双嘧达莫作用时间长（超过30分钟）。在本研究中，我们使用了一种亚选择性冠状动脉多普勒导管来测量一种作用时间较短的血管扩张剂——冠状动脉内罂粟碱的剂量反应动力学。在十名冠状动脉正常的患者中，比较了罂粟碱、静脉注射双嘧达莫（4分钟内输注0.56毫克/千克）和冠状动脉内泛影葡胺的最大血管扩张剂反应。罂粟碱最大剂量后的冠状动脉血流速度增加（峰值/静息速度比为4.8±0.4，平均值±标准误）与输注双嘧达莫后（4.8±0.6）几乎相同，且显著大于泛影葡胺后的增加（3.1±0.2，p<0.01）。在最大充血时，冠状动脉内注射罂粟碱后平均动脉血压下降9±2%（平均值±标准误），双嘧达莫后下降8±4%，泛影葡胺后下降3±3%。在13名冠状动脉正常的患者中研究了冠状动脉内罂粟碱的剂量反应动力学。在左冠状动脉中，八名患者中有六名使用8毫克达到最大扩张（5.4±0.6），所有患者使用12毫克均达到最大扩张。在右冠状动脉中，四五名患者使用6毫克达到最大扩张（4.8±0.7），所有患者使用8毫克均达到最大扩张。（摘要截短于250字）
