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            <h1 id="seo-header">【迁移】药理二：传出神经系统药物之肾上腺受体</h1>
            
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                    Last updated on March 19, 2024 pm
                  
                
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                <p><img src="https://img.limour.top/2023/09/01/64f1a6ae3086c.webp" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload alt=""></p>
<h2 id="激动药">激动药</h2>
<p>药物种类<br>
麻黄碱、多巴胺，α β 肾上腺<br>
去甲肾、间羟胺，β 只有异丙肾</p>
<p>肾上腺素<br>
α β 受体兴奋药，肾上腺素是代表<br>
血管收缩血压升，局麻用它延时间<br>
局部止血效明显，过敏休克当首选<br>
心脏兴奋气管扩，哮喘持续它能缓<br>
心跳骤停用三联，应用注意心血管<br>
α 受体被阻断，升压作用能翻转<br>
心衰高压脑硬化，甲亢糖尿都禁用</p>
<p>多巴胺<br>
α β 多巴胺，心脏兴奋血压升<br>
肾脏调节分两种，中低多巴血流增<br>
高浓α 致肾衰，联合利尿治肾衰</p>
<p>麻黄碱<br>
鼻塞麻黄碱，麻醉低血压<br>
缓解皮肤粘，防治轻哮喘<br>
兴奋中枢不良反，缓慢持久耐受性</p>
<p>去甲肾上腺素<br>
去甲强烈缩血管，升压作用不翻转，药物中毒低血压<br>
只能静滴要缓慢，上消化道出血时，引起肾衰很常见<br>
用药期间看尿量，休克常用间羟胺</p>
<p>异丙肾上腺素<br>
异丙扩张支气管，哮喘发病他能缓<br>
扩张血管治感染，血容补足效才显<br>
房室阻滞毒休克，甲亢心冠切莫选</p>
<p><img src="https://img.limour.top/2023/09/01/64f1a6bd34d40.webp" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload alt=""></p>
<p>肾上腺素对心肌β1受体激动作用最强大，正性三变，输出量增加，收缩压升高、耗氧量增加，用来抢救心跳骤停，但会导致心悸、心肌缺血，导致致死性心律失常。支气管、骨骼肌血管、冠脉平滑肌和睫状肌上长β2，能控制哮喘急性发作、治疗青光眼。皮肤、黏膜、内脏血管上长α1，收缩舒张压升高。β2扩血管和α1缩血管对舒张压的作用互相抵消，小剂量舒张压下降、大剂量舒张压升高。大剂量需小心脑出血。</p>
<p>皮肤、黏膜血管收缩，可以减缓局麻药扩散吸收，常用利多卡因配伍，同时也能用来局部止血。局部进针注射玻尿酸时，可以用来缩血管，降低玻尿酸注入血管中的概率。</p>
<p>α受体激动，可以加速糖原分解，使血糖升高。β3受体激动，可以促进脂肪分解，血中游离脂肪酸升高。所以运动可以减肥。</p>
<p>过敏性休克首选用肾上腺素，因为喉头α1缓解水肿，心肌β1强心，支气管β2解痉挛改善通气，同时还能抑制过敏介质释放。</p>
<p>多巴胺不易通过血脑屏障，外周给药无明显中枢作用（可以用左旋）。尿多小剂量激动D1，肾、肠系膜、冠脉血管扩张，直接排钠利尿，合用利尿剂治疗肾衰。中剂量激动β1，增加心输出量，常用于抗各种伴有肾衰、心衰的休克，但可能导致心动过速、心律失常。大剂量既直接激动α1受体，也能通过促进NA释放间接激动α受体，皮肤黏膜血管收缩，肾等内脏血管收缩，可能手足发冷、坏死，也会导致肾衰。</p>
<p>麻黄碱既能直接促进α1，也能通过促进NA释放间接激动α受体，使鼻等的黏膜皮肤血管收缩，广泛用于鼻塞，缓解荨麻疹和血管神经性水肿的皮肤黏膜症状。可以激动心肌β1，麻醉给药预防低血压。激动支气管黏膜β2，治疗轻度哮喘。中枢兴奋，可能产生焦虑、失眠。</p>
<p>去甲肾静滴，小动脉收缩外周阻力升高，收缩压升高，小静脉收缩，舒张压升高。可以用来治疗上消化道出血，改善造成神经源性休克、α受体阻断药中毒等低血压状态。注意密切关注尿量，可能发生急性肾衰。外漏容易发生组织血管怀死。有非常微弱的β1激动作用，进一步提高收缩压，心耗氧量增加，腺苷增多，可以扩冠脉，此激动作用刚好与降压反射时的迷走神经的抑制作用相抵消，甚至是下降。去甲肾外漏，需要停止注射、热敷，使用酚妥拉明阻断α受体、0.25%普鲁卡因局部封闭。</p>
<p>间羟胺（阿拉明），作用与去甲肾相似，但对肾脏血管收缩较弱，不易引起肾衰和心律失常，已经取代NA用于抗休克。</p>
<p>去氧肾上腺素（新福林），可以兴奋瞳孔扩大肌，作用弱、时间短，不易引起眼压升高，作为快速短效扩瞳药，用于眼底检查。</p>
<p>异丙肾对窦房结作用强，有起搏作用，能加速传导，常用于房室传导阻滞，少用于休克。对心室影响小，不易引起心律失常。激动β2，缓解哮喘急性发作。激动β3，促进脂肪分解。引起血管扩张，同时抑制过敏介质释放。</p>
<p>多巴酚丁胺，增加心输出量，但对心率影响小，可以治疗心肌梗塞并发心力衰竭，但只能短时间使用，长时间使用会增加心肌耗氧量，加重心肌梗塞。</p>
<p>沙丁胺醇吸入给药，速效短效的支气管舒张作用，而对心血管和中枢影响小，治疗支气管哮喘的一线药物。特罗长效、特步他林速效短效，奥西那林是新药。</p>
<h2 id="拮抗剂">拮抗剂</h2>
<p>β 洛尔<br>
β 受体阻断药，普萘洛尔是代表<br>
洛尔兄弟一大片，对抗交感降血压<br>
临床治疗高血压，心律失常心绞痛<br>
三条禁忌记心间，哮喘心衰心动缓<br>
β1 长心脏上，阻断效果是四降<br>
降率降传降耗氧，降低输出降血压<br>
β2 长在气管上，还有冠脉和腿上<br>
阻断无益反不良，哮喘急冠和肢凉</p>
<p><img src="https://img.limour.top/2023/09/01/64f1a6d2272fa.webp" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload alt=""></p>
<p>α1 唑嗪<br>
特拉唑嗪哌唑嗪，扩张血管降血压<br>
一般不做首选药，属于二线降压药<br>
引起体位低血压，起的太猛易摔倒<br>
最好使用控释剂，最好用在睡觉前<br>
同时扩张下尿道，老年男性较适用</p>
<p><img src="https://img.limour.top/2023/09/01/64f1a6e21e35f.webp" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload alt=""></p>
<p>普萘洛尔是非特异性β受体阻断剂，在阻断心脏β1受体缓解心动过速，降低心率、抑制球旁细胞β1受体减少肾素分泌等来控制高血压的同时，也会阻断冠脉平滑肌、支气管平滑肌、骨骼肌血管平滑肌上的β2受体，其中支气管平滑肌β2受体被阻断后，会发生支气管痉挛，呼气困难，机体缺氧，进而面色发绀。</p>
<p>除支气管平滑肌β2被阻断的不良反应外，还有：阻断心脏β1，心脏受抑制，如果过度，可能诱发急性左心衰、加重房室传导阻滞，血压下降幅度过大可能发生头昏、眩晕、神智模糊、精神抑郁、反应迟钝等中枢神经系统不良反应；阻断冠脉β2，冠脉收缩，可能诱发变异性心绞痛；阻断骨骼肌血管β2，血管收缩，外周血供不足，可能发生手脚冰凉等雷诺氏综合征样症状；阻断外周组织新陈代谢相关的β2受体亚型和抑制低活性T4变成高活性T3，会抑制糖异生和糖原分解，如果患者合用了胰岛素，会导致致死性低血糖；阻断脂肪细胞β3，抑制脂肪分解，长期用可能发胖；大剂量会抑制血小板聚集，可能导致出血倾向；大剂量会抑制粒细胞生成，可能发生咽痛和发热；如果发生过敏，则会出现皮疹。此外大剂量有膜稳定作用（奎尼丁样作用），抗心律失常。</p>
<p>酚妥拉明/妥拉唑啉最基本的作用是扩张血管，此外还有心脏兴奋引起心绞痛、心悸、心律失常等不良反应，这一不良反应既有阻断交感神经末梢突触前膜上的α2，促进NA释放，有微弱的β1激动效果，也能通过降压反射兴奋心脏。强大的扩血管作用，可以解除血管痉挛，主治动脉狭窄引起的雷诺综合征、闭塞性脉管炎、冻伤、NA外漏等。降血压很猛，治疗嗜铬细胞瘤引起的高血压、高血压危象。解除心衰时的小动脉小静脉反射性收缩，降低心脏负荷，治疗顽固性心衰和急性心肌梗死。改善微循环，补足血容时与NA合用抗休克。此外还有拟胆碱作用、组胺样作用和抗五羟色胺的作用，诱发消化道反应，诱发和加重溃疡。</p>

                
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