Schrumpf J D, Sheps D S, Wolfson S, Aronson A L, Cohen L S
Am J Cardiol. 1977 Jul;40(1):76-82. doi: 10.1016/0002-9149(77)90104-7.
Pharmacologic agents that alter hemoglobin affinity for oxygen may affect systemic or myocardial oxygen delivery. In vitro, and in normal man propranolol shifts the oxyhemoglobin equilibrium curve to the right, thus increasing the partial pressure of oxygen at which hemoglobin is 50% saturated (P50) and enhancing oxygen delivery. The effect of propranolol on hemoglobin P50 was evaluated in 12 patients with angina pectoris and documented coronary artery disease. Determinations were made during oral propranolol therapy (mean daily dose 152 mg) of at least 3 months' duration and after administration of propranolol had been discontinued for at least 4 days. Hemoglobin P50 and erythrocyte 2,3-diphosphoglycerate (DPG) were measured. Data in 12 patients were: the mean P50 after discontinuation of propranolol was 28.2 mm Hg+/-0.9 (standard error of the mean) and during propranolol therapy 31.7+/-0.7; P less than 0.001; red blood cell 2,3-DPG did not change to explain the increase in P50. This demonstrated shift could increase systemic oxygen delivery and thus benefit marginally perfused myocardium while sparing coronary flow. Propranolol, in addition to its negative chronotropic and inotropic effects, may increase tissue oxygen delivery in patients with the anginal syndrome.
改变血红蛋白对氧亲和力的药物可能会影响全身或心肌的氧输送。在体外实验以及正常人体中，普萘洛尔可使氧合血红蛋白平衡曲线右移，从而增加血红蛋白饱和度为50%时的氧分压（P50），并增强氧输送。本研究评估了普萘洛尔对12例心绞痛且确诊为冠状动脉疾病患者血红蛋白P50的影响。在至少持续3个月的口服普萘洛尔治疗期间（平均每日剂量152mg）以及普萘洛尔停药至少4天后进行测定。测量了血红蛋白P50和红细胞2,3 - 二磷酸甘油酸（DPG）。12例患者的数据如下：普萘洛尔停药后的平均P50为28.2mmHg±0.9（均值标准误），普萘洛尔治疗期间为31.7±0.7；P<0.001；红细胞2,3 - DPG未发生变化以解释P50的升高。这种已证实的变化可增加全身氧输送，从而使灌注不足的心肌受益，同时不影响冠状动脉血流。普萘洛尔除了具有负性变时性和变力性作用外，还可能增加心绞痛综合征患者的组织氧输送。
