吸烟对冠心病的急性冠状动脉血管收缩作用。

Acute coronary vasoconstrictive effects of cigarette smoking in coronary heart disease.

作者信息

Martin J L, Wilson J R, Ferraro N, Laskey W K, Kleaveland J P, Hirshfeld J W

出版信息

Am J Cardiol. 1984 Jul 1;54(1):56-60. doi: 10.1016/0002-9149(84)90303-5.

Abstract

To investigate the effect of cigarette smoking on the coronary vasculature, coronary sinus flow and myocardial oxygen delivery were measured at rest and during incremental atrial pacing in 10 patients with coronary artery disease. Measurements were then repeated while the patients smoked 2 unfiltered, high-nicotine cigarettes. Although smoking significantly increased the heart rate at rest and double product, coronary sinus flow did not change significantly (141 +/- 32 vs 146 +/- 28 ml/min). At the lowest equivalent pacing rate before and during smoking, the double products were comparable. However, coronary sinus flow was reduced by smoking (146 +/- 28 vs 159 +/- 28 ml/min, p less than 0.01) and coronary vascular resistance was increased (0.96 +/- 0.15 vs 0.83 +/- 0.13 mm Hg ml-1 min, p less than 0.02). The double products were also comparable at the peak pacing rate before and during smoking. Nonetheless, the coronary sinus flow was again lower (167 +/- 23 vs 227 +/- 41 ml/min, p = 0.02) and the coronary vascular resistance was higher (0.77 +/- 0.10 vs 0.63 +/- 0.09 mm Hg ml-1 min, p less than 0.01) during smoking. The transmyocardial arteriovenous oxygen difference was unchanged by smoking; therefore, myocardial oxygen delivery was reduced in proportion to the reductions in coronary sinus flow. Thus, cigarette smoking appears to acutely alter the ability of the coronary vasculature to regulate flow in accordance with the oxygen requirements of the myocardium.

摘要

为研究吸烟对冠状动脉血管系统的影响，对10例冠心病患者在静息状态和递增心房起搏过程中测量了冠状窦血流量和心肌氧输送量。然后在患者吸两支未过滤的高尼古丁香烟时重复测量。尽管吸烟显著增加了静息心率和双乘积，但冠状窦血流量没有显著变化（141±32 vs 146±28 ml/分钟）。在吸烟前和吸烟过程中最低等效起搏率时，双乘积相当。然而，吸烟使冠状窦血流量减少（146±28 vs 159±28 ml/分钟，p<0.01），冠状血管阻力增加（0.96±0.15 vs 0.83±0.13 mmHg ml-1分钟，p<0.02）。在吸烟前和吸烟过程中的起搏峰值率时，双乘积也相当。尽管如此，吸烟过程中冠状窦血流量再次降低（167±23 vs 227±41 ml/分钟，p = 0.02），冠状血管阻力更高（0.77±0.10 vs 0.63±0.09 mmHg ml-1分钟，p<0.01）。吸烟未改变心肌动静脉氧差；因此，心肌氧输送量与冠状窦血流量的减少成比例降低。因此，吸烟似乎会急性改变冠状动脉血管系统根据心肌氧需求调节血流量的能力。