Mitrovic V, Oehm E, Minge C, Thürmann P, Schlepper M
Abteilung für Klinische Pharmakologie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main.
Z Kardiol. 1994 Jun;83(6):431-8.
To compare the hemodynamic, antiischemic, metabolic, and neurohumoral effects of intravenous esmolol (beta 1 blocking agent) and gallopamil (verapamil-like calcium channel blocker), 14 patients with angiographically proven CAD and reproducible ST segment depression were studied at rest and during exercise under control conditions and after an intravenous bolus injection of esmolol (0.5 mg/kg/1 min, followed by an infusion with 0.2 mg/kg/min) or gallopamil (0.025 mg/kg/3 min). In contrast to gallopamil, esmolol significantly reduced systolic blood pressure (175.7 vs. 160 mm Hg) and heart rate (107.4 vs. 96.9 min-1) during exercise as well as cardiac output (11.57 vs. 9.38 l/min) and significantly enhanced systemic vascular resistance both at rest (1241 vs. 1479 dynes.s.cm-5) and during exercise (805 vs. 947 dynes.s.cm-5). On the other hand, exercise filling pressures and lactate levels (3.66 vs. 3.05 mmol/l) were significantly reduced by gallopamil only. Thus, the significant improvement of exercise tolerance by both esmolol and gallopamil is based on different mechanisms of action: esmolol improves myocardial ischemia by appreciably reducing myocardial oxygen consumption, whereas gallopamil primarily improves oxygen supply and ventricular performance. Plasma catecholamines, atrial natriuretic factor, and aldosterone levels as well as plasma renin activity were identically influenced by esmolol and gallopamil, respectively. A reflex activation of the sympathetic system did not occur.
为比较静脉注射艾司洛尔（β1阻滞剂）和加洛帕米（维拉帕米样钙通道阻滞剂）的血流动力学、抗缺血、代谢及神经体液效应，对14例经血管造影证实患有冠心病且静息和运动时可再现ST段压低的患者，在对照条件下以及静脉推注艾司洛尔（0.5mg/kg/1分钟，随后以0.2mg/kg/分钟输注）或加洛帕米（0.025mg/kg/3分钟）后进行了研究。与加洛帕米相反，艾司洛尔在运动期间显著降低收缩压（175.7对160mmHg）、心率（107.4对96.9次/分钟）以及心输出量（11.57对9.38升/分钟），并在静息时（1241对1479达因·秒/厘米⁻⁵）和运动期间（805对947达因·秒/厘米⁻⁵）显著增强全身血管阻力。另一方面，仅加洛帕米显著降低运动充盈压和乳酸水平（3.66对3.05mmol/L）。因此，艾司洛尔和加洛帕米对运动耐量的显著改善基于不同的作用机制：艾司洛尔通过明显降低心肌耗氧量改善心肌缺血，而加洛帕米主要改善氧供应和心室功能。血浆儿茶酚胺、心房利钠因子以及醛固酮水平以及血浆肾素活性分别受到艾司洛尔和加洛帕米相同的影响。未发生交感神经系统的反射性激活。
