可卡因、乙醇或其组合对人体心外膜冠状动脉尺寸的影响。

Influence of cocaine, ethanol, or their combination on epicardial coronary arterial dimensions in humans.

作者信息

Pirwitz M J, Willard J E, Landau C, Lange R A, Glamann D B, Kessler D J, Foerster E H, Todd E, Hillis L D

机构信息

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.

出版信息

Arch Intern Med. 1995 Jun 12;155(11):1186-91.

PMID:7763124

Abstract

BACKGROUND

Cocaine and ethanol are often abused concomitantly, and this combination may be more lethal than either substance alone. Although previous studies showed that cocaine causes coronary arterial vasoconstriction, the combined effect of cocaine and ethanol on the coronary vasculature in humans is unknown. Thus, we assessed the effects of intranasal cocaine, intravenous ethanol, or a cocaine-ethanol combination on heart rate, systemic arterial pressure, and coronary arterial dimensions in humans.

METHODS

Thirty-four subjects with chest pain (27 men and seven women, aged 34 to 67 years) who were referred for catheterization received one of the following pharmacologic interventions: (1) intranasal (2 mL) and intravenous (5 mL/kg) saline (n = 8 [group A]); (2) intranasal cocaine (2 mg/kg) and intravenous saline (5 mL/kg) (n = 9 [group B]); (3) intranasal saline (2 mL) and intravenous 10% ethanol (5 mL/kg) (n = 9 [group C]); or (4) intranasal cocaine (2 mg/kg) and intravenous 10% ethanol (5 mL/kg) (n = 8 [group D]). Heart rate, systemic arterial pressure, left coronary arterial dimensions (by computer-assisted quantitative angiography), as well as blood cocaine, ethanol, and cocaine metabolite concentrations were measured before and 30, 60, and 90 minutes after initiation of the intravenous infusions.

RESULTS

No hemodynamic or angiographic changes were observed in the group A (saline) subjects. In the group B (cocaine) subjects, the heart rate-systolic arterial pressure product increased by 5% and 10% at 30 and 90 minutes, respectively, and coronary arterial diameter decreased by 14% at these times. In the group C (ethanol) subjects, no hemodynamic changes were noted, but coronary arterial diameters increased by 12%, 11%, and 12% at 30, 60, and 90 minutes, respectively. In the group D (cocaine-ethanol) patients, rate-pressure product increased by 17%, 10%, and 16%, and coronary arterial diameters increased by 7%, 12%, and 13%, at 30, 60, and 90 minutes, respectively.

CONCLUSION

The combination of intranasal cocaine and intravenous ethanol causes an increase in the determinants of myocardial oxygen demand. However, it also causes a concomitant increase in epicardial coronary arterial diameter.

摘要

背景

可卡因和乙醇常被同时滥用，这种组合可能比单独使用任何一种物质更具致命性。尽管先前的研究表明可卡因会导致冠状动脉血管收缩，但可卡因和乙醇对人体冠状动脉血管系统的联合作用尚不清楚。因此，我们评估了鼻内给予可卡因、静脉注射乙醇或可卡因 - 乙醇组合对人体心率、体动脉压和冠状动脉尺寸的影响。

方法

34名因胸痛而被转诊进行导管插入术的受试者（27名男性和7名女性，年龄34至67岁）接受了以下药物干预之一：（1）鼻内（2 mL）和静脉内（5 mL/kg）生理盐水（n = 8 [A组]）；（2）鼻内可卡因（2 mg/kg）和静脉内生理盐水（5 mL/kg）（n = 9 [B组]）；（3）鼻内生理盐水（2 mL）和静脉内10%乙醇（5 mL/kg）（n = 9 [C组]）；或（4）鼻内可卡因（2 mg/kg）和静脉内10%乙醇（5 mL/kg）（n = 8 [D组]）。在静脉输注开始前以及开始后30、60和90分钟测量心率、体动脉压、左冠状动脉尺寸（通过计算机辅助定量血管造影）以及血液中可卡因、乙醇和可卡因代谢物浓度。

结果

A组（生理盐水）受试者未观察到血流动力学或血管造影变化。B组（可卡因）受试者的心率 - 收缩压乘积在30分钟和90分钟时分别增加了5%和10%，此时冠状动脉直径减小了14%。C组（乙醇）受试者未观察到血流动力学变化，但冠状动脉直径在30、60和90分钟时分别增加了12%、11%和12%。D组（可卡因 - 乙醇）患者的心率 - 血压乘积在30、60和90分钟时分别增加了17%、10%和16%，冠状动脉直径分别增加了7%、12%和13%。