β受体阻滞剂对心脏移植受者动态运动时神经体液及心肺反应的影响。

Effect of beta blockade on the neurohumoral and cardiopulmonary response to dynamic exercise in cardiac transplant recipients.

作者信息

Kushwaha S S, Banner N R, Patel N, Cox A, Patton H, Yacoub M H

机构信息

Department of Cardiology, Harefield Hospital, Middlesex.

出版信息

Br Heart J. 1994 May;71(5):431-6. doi: 10.1136/hrt.71.5.431.

DOI:10.1136/hrt.71.5.431

PMID:7912095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC483718/

Abstract

OBJECTIVE

To determine the effects of a small dose of beta blocker on neurohumoral and cardiopulmonary responses after cardiac transplantation.

BACKGROUND

Cardiac transplant recipients have a reduced exercise capacity and abnormal cardiovascular responses to exercise. The sympathoadrenal response to exercise has been shown to be abnormal with high venous noradrenaline. The effect of beta blockade on these neurohumoral mechanisms has not been defined.

METHODS

10 non-rejecting cardiac transplant recipients were studied. Patients carried out graded exercise to a symptom limited maximum. Blood samples were taken during exercise. Concentrations of noradrenaline, adrenaline, and atrial natriuretic peptide and plasma renin activity were measured. The next day, the exercise and sampling procedure were repeated after an oral dose of propranolol (40 mg).

RESULTS

Patients tolerated exercise poorly after beta blockade, which was reflected in the maximum workload reached. Heart rate and blood pressure were significantly higher at rest and during exercise before beta blockade. Although there was no significant difference when resting, mean (SEM) noradrenaline concentrations during peak exercise were higher after beta blockade (16.2 (2) v 23.6 (2.9) nmol/l, p = 0.001). Adrenaline concentrations at peak exercise were also greater after beta blockade (0.89 (0.31) v 1.18 (0.38) nmol/l, p = 0.055). Atrial natriuretic peptide concentrations tended to be higher after beta blockade (118.75 (50.2) v 169.79 (39.3) pmol/l, p = 0.36). There was no significant change in plasma renin activity.

CONCLUSIONS

A small oral dose of a competitive beta blocker such as propranolol has an adverse effect on exercise tolerance and cardiovascular response to exercise in cardiac transplant recipients. There are also increased concentrations of circulating noradrenaline and therefore, sympathetic activity during exercise. beta blockers should be used with caution in cardiac transplant recipients.

摘要

目的

确定小剂量β受体阻滞剂对心脏移植后神经体液及心肺反应的影响。

背景

心脏移植受者运动能力下降，且运动时心血管反应异常。运动时交感肾上腺反应已显示异常，静脉去甲肾上腺素水平较高。β受体阻滞剂对这些神经体液机制的影响尚未明确。

方法

对10名无排斥反应的心脏移植受者进行研究。患者进行分级运动至症状限制的最大运动量。运动期间采集血样。测量去甲肾上腺素、肾上腺素、心房利钠肽浓度及血浆肾素活性。次日，口服普萘洛尔（40毫克）后重复运动及采样程序。

结果

β受体阻滞剂治疗后患者运动耐受性差，这反映在达到的最大工作量上。β受体阻滞剂治疗前静息及运动时心率和血压显著更高。尽管静息时无显著差异，但β受体阻滞剂治疗后运动高峰时平均（标准误）去甲肾上腺素浓度更高（16.2（2）对23.6（2.9）纳摩尔/升，p = 0.001）。β受体阻滞剂治疗后运动高峰时肾上腺素浓度也更高（0.89（0.31）对1.18（0.38）纳摩尔/升，p = 0.055）。β受体阻滞剂治疗后心房利钠肽浓度有升高趋势（118.75（50.2）对169.79（39.3）皮摩尔/升，p = 0.36）。血浆肾素活性无显著变化。