Kaplan J A, Jones E L
J Thorac Cardiovasc Surg. 1979 Feb;77(2):301-9.
Intraoperative hypertension is a common problem in patients undergoing myocardial revascularization. Twenty patients who developed acute hypertension after sternotomy were studied. Ten patients received three doses of intravenous nitroglycerin (32, 64, and 96 mcg. per minute), and 10 patients received nitroprusside, (20, 40, and 60 mcg. per minute). All patients were anesthetized with morphine, diazepam, nitrous oxide, oxygen, and pancuronium bromide. Five patients in each group also received enflurane. The study compared the effects of nitroglycerin and nitroprusside on systemic hemodynamics, myocardial oxygen supply/demand relationships, and ischemic changes on the electrocardiogram. Both drugs decreased preload and afterload in a dose-related manner. Heart rate increased significantly only with the largest dose of each drug. Myocardial oxygen demand was decreased significantly by both drugs, while the coronary perfusion pressure was decreased more by nitroprusside. Both nitroglycerin and nitroprusside improved left ventricular performance. Nitroglycerin improved ST-segment depression in eight of 10 patients; while nitroprusside improved the ST segments in six patients, and worsened the ST segments in three patients. None of the nitroglycerin group had worsening of the electrocardiographic ST segments. These findings demonstrate that both drugs can control intraoperative hypertension and can decrease myocardial oxygen demand. Nitroglycerin was shown to improve ischemic changes on the electrocardiogram more often than nitroprusside.
术中高血压是接受心肌血运重建患者的常见问题。对20例胸骨切开术后出现急性高血压的患者进行了研究。10例患者接受了三剂静脉注射硝酸甘油（每分钟32、64和96微克），10例患者接受了硝普钠（每分钟20、40和60微克）。所有患者均用吗啡、地西泮、氧化亚氮、氧气和泮库溴铵麻醉。每组5例患者还接受了恩氟烷。该研究比较了硝酸甘油和硝普钠对全身血流动力学、心肌氧供需关系及心电图缺血性改变的影响。两种药物均以剂量相关方式降低前负荷和后负荷。仅在每种药物最大剂量时心率显著增加。两种药物均显著降低心肌氧需求，而硝普钠使冠状动脉灌注压降低更多。硝酸甘油和硝普钠均改善了左心室功能。硝酸甘油使10例患者中的8例ST段压低改善；而硝普钠使6例患者的ST段改善，3例患者的ST段恶化。硝酸甘油组无一例心电图ST段恶化。这些发现表明，两种药物均可控制术中高血压并可降低心肌氧需求。结果显示，硝酸甘油比硝普钠更常改善心电图缺血性改变。
