Williams R G, Kavanagh K M, Teo K K
Department of Medicine, University of Alberta, Edmonton.
Can J Cardiol. 1996 Dec;12(12):1295-301.
To review the data on pharmacology, pathophysiology and treatment of cocaine toxicity, with particular relevance to the heart and cardiovascular system.
Published epidemiology, laboratory and clinical studies on the pharmacology, electrophysiology and pathophysiology of cocaine toxicity and its treatment.
Cocaine toxicity-related morbidity and mortality are frequent due to the potent pharmacological effects of the drug as an indirect-acting sympathomimetic agent and its class I antiarrhythmic property paradoxically inducing pro-arrhythmia. The cardiac and cardiovascular toxic effects of cocaine include various degrees of myocardial ischemia, cardiac arrhythmias, cardiotoxicity, hypertensive effects, cerebrovascular effects and a hypercoagulable state. Treatment of cocaine toxicity must be based on the multiple factors leading to the toxicity. Sodium bicarbonate appears to have an important role in the acute setting with conduction abnormalities, seizures or acidosis. Unopposed alpha-stimulation provided by beta-blockade should be avoided. Central nervous system hyperexcitability should be treated with diazepam. The use of calcium antagonists appears logical.
Cocaine is an alkaloid with widespread illicit use. The rationale for treating acute cocaine intoxication has become clearer and more logical with increased knowledge of its mechanisms of action.
回顾可卡因毒性的药理学、病理生理学及治疗方面的数据，尤其关注心脏和心血管系统。
已发表的关于可卡因毒性的药理学、电生理学、病理生理学及其治疗的流行病学、实验室和临床研究。
由于可卡因作为间接作用拟交感神经药的强大药理作用及其I类抗心律失常特性反而诱发心律失常，与可卡因毒性相关的发病率和死亡率很常见。可卡因对心脏和心血管的毒性作用包括不同程度的心肌缺血、心律失常、心脏毒性、高血压效应、脑血管效应和高凝状态。可卡因毒性的治疗必须基于导致毒性的多种因素。碳酸氢钠在伴有传导异常、癫痫发作或酸中毒的急性情况下似乎具有重要作用。应避免使用β受体阻滞剂导致的无对抗α刺激。中枢神经系统过度兴奋应用地西泮治疗。使用钙拮抗剂似乎合理。
可卡因是一种广泛非法使用的生物碱。随着对其作用机制的了解增加，治疗急性可卡因中毒的基本原理变得更加清晰和合理。
