Meyer J S, Miyakawa Y, Welch K M, Itoh Y, Ishihara N, Chabi E, Nell J, Bartosh K, Ericsson A D
Stroke. 1976 Mar-Apr;7(2):158-67. doi: 10.1161/01.str.7.2.158.
Cerebral hemispheric blood flow and metabolism were measured before and after therapy with intracarotid infusion of combined PBZ and PPL in 15 patients with recent cerebral infarction. HBF was unaltered despite decrease in cerebral perfusion pressure. Cerebral hemispheric oxygen comsumption and carbon dioxide production decreased while cerebral hemispheric lactate production increased. Biphasic cerebral uptake of tyrosine was observed during and immediately after PBZ and PPL infusion. CSF HVA increased, indicating altered DA turnover. CSF 5HIAA levels also increased, suggesting altered 5HT turnover after PBZ and PPL. Release of cyclic AMP from ischemic brain into cerebral venous blood seen in the steady state was abolished after therapy. Cerebral hemodynamic studies suggest a functional balance between monaminergic neurogenic influences in the control of cerebral circulation. Imbalance of such controlling factors in ischemic brain may lead to paradoxical vascular responses to induced hypertension and hypotension. PBZ and PPL enhance such responses perhaps by increasing central neurotransmitter turnover and release. Further shift toward cerebral anaerobic metabolism may occur in ischemic brain following the use of phenoxybenzamine and propranolol. Worsening of neurological deficit occurred in four cases. Combined therapy with PBZ and PPL does not appear beneficial in the therapy of patients with recent stroke.
对15例近期脑梗死患者在颈内动脉输注苯苄胺（PBZ）和普萘洛尔（PPL）联合治疗前后进行了脑半球血流和代谢测量。尽管脑灌注压降低，但脑血流量未改变。脑半球氧耗量和二氧化碳生成量减少，而脑半球乳酸生成量增加。在输注PBZ和PPL期间及之后立即观察到酪氨酸的双相脑摄取。脑脊液高香草酸（HVA）增加，表明多巴胺（DA）代谢改变。脑脊液5-羟吲哚乙酸（5HIAA）水平也增加，提示PBZ和PPL后5-羟色胺（5HT）代谢改变。治疗后稳态下缺血性脑向脑静脉血中释放的环磷酸腺苷（cAMP）被消除。脑血流动力学研究表明，单胺能神经源性影响在脑循环控制中存在功能平衡。缺血性脑中此类控制因素的失衡可能导致对诱导性高血压和低血压的反常血管反应。PBZ和PPL可能通过增加中枢神经递质的代谢和释放来增强此类反应。使用苯氧苄胺和普萘洛尔后，缺血性脑可能会进一步向脑无氧代谢转变。4例患者神经功能缺损加重。PBZ和PPL联合治疗对近期中风患者的治疗似乎并无益处。
