Bussmann W D, Berghof E, Wagner P, Klepzig H, Kaltenbach M
Klin Wochenschr. 1979 Apr 1;57(7):341-9. doi: 10.1007/BF01476564.
In 38 patients with acute myocardial infarction the effect of nitroglycerin on infarct size was studied. Patients were randomized into two groups. 16 patients received continuous nitroglycerin infusions of 0.6 to 6.0 mg/h (mean 2.3 mg/h) over a 48 h period, 22 patients received no specific therapy and served as control. Nitroglycerin was given in the mean 12 +/- 5 (+/- 1 SD) hours following onset of chest pain and 8 +/- 5 after the increase of CK values. Infarct size was determined according to the time activity curve of creatine kinase (CK) and of its myocardial isoenzyme (CK-MB). In all but one patient hemodynamic parameters (left ventricular filling pressure, blood pressure, cardiac index) were measured. The mean infarct size was 51 +/- 30 CK-g-equiv. in control patients, and 48 +/- 33 g in nitroglycerin treated patients. Infarct size as calculated from CK-MB values was 60 +/- 36 g (n=16) in control, and 52 +/- 41 g (n=11) in treated patients. At left ventricular filling pressure values (LVFP) below 20mm Hg infarct size amounted to 43 +/- 30 g (n=12) in control, and to 41 +/- 32 g (n=11) in the nitroglycerin group. At LVFP values above 20 mmHg infarct size was 61 +/- 29 g (n=10) in control as opposed to 64 +/- 32 g (n=5) in treated patients. There was no difference between infarct size as predicted during the first 7 h and the observed infarct size. - Despite the known beneficial effect of nitroglycerin on hemodynamics and on myocardial ischemia, infarct size seems not to be greatly reduced, however, intervention occurred fairly late (12 h). In early intervention beneficfial effects seem likely.
对38例急性心肌梗死患者研究了硝酸甘油对梗死面积的影响。患者被随机分为两组。16例患者在48小时内接受0.6至6.0毫克/小时（平均2.3毫克/小时）的硝酸甘油持续输注，22例患者未接受特殊治疗作为对照。硝酸甘油在胸痛发作后平均12±5（±1标准差）小时给予，在肌酸激酶（CK）值升高后8±5小时给予。根据肌酸激酶（CK）及其心肌同工酶（CK-MB）的时间活性曲线确定梗死面积。除1例患者外，均测量了血流动力学参数（左心室充盈压、血压、心脏指数）。对照组患者的平均梗死面积为51±30 CK-克当量，硝酸甘油治疗组患者为48±33克。根据CK-MB值计算，对照组梗死面积为60±36克（n = 16），治疗组为52±41克（n = 11）。左心室充盈压（LVFP）低于20mmHg时，对照组梗死面积为43±30克（n = 12），硝酸甘油组为41±32克（n = 11）。LVFP值高于20mmHg时，对照组梗死面积为61±29克（n = 10），治疗组为64±32克（n = 5）。最初7小时预测的梗死面积与观察到的梗死面积之间无差异。 - 尽管硝酸甘油对血流动力学和心肌缺血有已知益处，但梗死面积似乎并未大幅减小，然而，干预发生得相当晚（12小时）。早期干预似乎可能有益。
