ÀÚÀ²½Å°æ: 6 catecholamine
ÀÛ¼ºÀÚ ´ÚÅÍÄÚ¸®¾Æ Á¶È¸¼ö 1905
catecholamine
direct-acting sympathomimetic amines·Î catechol¿¡ amine±â°¡ ºÙÀº ÈÇÕ¹°ÀÇ ÃÑĪÀÌ´Ù.
(1) epinephrine(adrenaline)
Ձ-¿Í,β-receptor¿¡ ¸ðµÎ ÀÛ¿ëÇϸç ü³»ÀÇ È¿°ú´Â ³óµµ¿Í receptorÀÇ ÇüÅ¿¡ µû¶ó ´Ù¸£´Ù.
Áï Àú³óµµ¿¡¼´Â β-receptorÀÇ È¿°ú°¡ ¿ì¼¼, °í³óµµ¿¡¼´Â Ձ-receptorÀÇ È¿°ú°¡ ¿ì¼¼ÇÏ´Ù.
a. blood pressure
* ´Ù·® I.V.½Ã Ç÷¾Ð »ó½Â *
Ձ-receptor¸¦ ÀÚ±Ø vasoconstriction
β-receptor¸¦ activationÇÏ¿© ventricular constriction
* Àú³óµµ¿¡¼´Â Ç÷¾Ð°ÇÏ *
À̶§´Â β2-receptor(vasodilation)°¡ Ձ-receptor(vasoconstriction) º¸´Ù ¹Î°¨ÇÏ°Ô ¹ÝÀÀÇÑ´Ù.
b. smooth muscle¿¡ÀÇ È¿°ú
epinephrineÀº gastrointestinal smooth muscle(Ձ2¿Í β-receptor stimulation)À» Áõ°¡½ÃŲ´Ù.
bronchiolar smooth muscle(β2)¸¦ ÀÌ¿Ï, Áï ±â°üÁöõ½Ä(bronchospasm)¿¡ ÁÁ´Ù.
c. heart¿¡ÀÇ È¿°ú
β1-receptorÀÇ Á÷Á¢È¿°ú·Î heart rate¸¦ Áõ°¡½ÃŲ´Ù.
cardiac output°¡ Áõ°¡
d. mydriasis : Ձ-receptorÀÇ ÈïºÐÀÛ¿ë¿¡ ÀÇÇÑ´Ù.
e. local vasoconstriction(hemostatic) :
1: 100,000 - 1: 200,000 in local anesthetic solution -> delays the absorption of infilterable
anesthetics
f. anaphylactic shock½Ã¿¡ ³ªÅ¸³ª´Â bronchiolar smooth muscleÀÇ histamine like constrictionÀÇ
antagonist·Î ÀÛ¿ëÇϸç smooth muscleÀÇ relaxationÀ¸·Î bronchiolar passage way°¡ È®ÀåµÈ´Ù.
(2) norepinephrine
epinephrine°ú À¯»çÇÑ ÀÛ¿ëÀ» ÇÑ´Ù.
a. I.V.½Ã Ձ-receptor¿¡ ÀÛ¿ëÇÏ¿© vascular smooth muscleÀÇ contriction¿¡ ÀÇÇÑ systolic ¹×
diastolic pressure¸¦ Áõ°¡½ÃŲ´Ù.
b. Ձ-receptor¿¡ °ÇÑ ÀÛ¿ëÀ» ³ªÅ¸³»¸ç Ղ-receptorÀÇ ÀÛ¿ëÀº ´Ù¼Ò ¾àÇÏ´Ù.
Áï norepinephrine > epinephrine > isoproterenol
c. À§Àå¿îµ¿Àº ¾ïÁ¦ÇÑ´Ù.
d. mydriasis
* epinephrine°ú norepinephrineÀÇ Ä¡·áÇÐÀû ÀÀ¿ë
a. epinephrine
bronchospasmÀÇ Ä¡·á¿¡ »ç¿ëÇÑ´Ù.
anaphylactic shockÀÇ primary treatment
to prolong the duration of infiltrative anesthesia
b. norepinephrine → ¸¶Ãë½Ã hypotensionÀÇ Ä¡·á
(3) isoproterenol - chemically synthesized
a. pharmacologic effect
¼±ÅÃÀûÀÎ β-agonist·Î¼ Ձ-receptorÀÇ È¿°ú´Â ÀÛ´Ù.
b. bronchial¹× gastrointestinal smooth muscleÀÇ relaxation.-- ±×·¡¼
bronchial asthma¿¡ bronchodilator·Î »ç¿ëÇÑ´Ù.
c. cardiac stimulant·Î¼ coronary artery¸¦ È®ÀåÇÑ´Ù.(Iso > Epi > Nor)
(4) dopamine
a. norepinephrineÀÇ ÇÕ¼ºÀ» À§ÇÑ Á÷Á¢ÀûÀÎ intermediator(Àü±¸¹°Áú)ÀÌ´Ù.
b. β-receptor¿¡ ´ëÇÑ Á÷Á¢ÀûÀÎ agonist·Î¼ ¼±ÅÃÀû cardiovascular agent·Î¼ myocardial
stimulationÀ» ÇÑ´Ù.
(5) dobutamine(synthetic catecholamine)
a. β1(cardiac)-receptorÀÇ È°¼ºÈ¸¦ ÅëÇÑ ½ÉÀåÀÇ (+)inotropic response(cardiac outputÀÇ Áõ°¡)°¡
ÀÖ´Ù. -- Dopa, Epi, NE, Isop.Àº tachyarrythmogenic potential µû¶ó¼ dobutamineÀº inotropicÀÇ
¼±ÅüºÀ» Áö´Ñ´Ù.
b. °³ÀÇ °æ¿ì pentobarbitalÀÇ ¸¶Ãë½Ã myocardial functionÀ» ÁÁ°Ô ÇϱâÀ§ÇØ »ç¿ëÇÑ´Ù.
c. Ÿ ¾à¹°Àº myocardial oxygen demand¸¦ Áõ°¡½ÃŰ³ª dobutamineÀº ÃÖ¼ÒÈÇϹǷΠÀåÁ¡ÀÌ
ÀÖ´Ù.--> ±×·¡¼ ¿ïÇ÷¼º ½ÉºÎÀüÁõ¿¡ »ç¿ëÇÑ´Ù.
"°á·ÐÀ¸·Î cardiac outputÀº Áõ°¡, total peripheral resistance´Â °¨¼ÒÇÑ´Ù"