Engelberg S, Singer A J, Moldashel J, Sciammarella J, Thode H C, Henry M
Department of Emergency Medicine, State University of New York at Stony Brook, USA.
Prehosp Emerg Care. 2000 Oct-Dec;4(4):290-3. doi: 10.1080/10903120090940967.
To assess the effects of prehospital nitroglycerin (NTG) on vital signs and chest pain intensity.
A retrospective review of advanced life support (ALS) run sheets was performed in a suburban volunteer emergency medical services (EMS) system receiving 8,000 annual ALS calls. All consecutive patients who were administered NTG by EMS were included. Standardized forms were used to collect data on patient demographics, history, and physical exam. Patients assessed their chest pain (CP) before and after NTG on a verbal numeric scale of 0-10 from least to most severe. The presence of syncope, dysrhythmias, or profound hypotension [loss of peripheral pulses, a systolic blood pressure (SBP) of <90 mm Hg after NTG, or a drop of >100 mm Hg in BP] was noted. Results. One thousand six hundred sixty-two patients received NTG over 18 months, their mean age was 66 years, and 48% were female. Indications for NTG included CP (83%), dyspnea (45%), and congestive heart failure (20%). After NTG administration, the CP score decreased from 6.9 to 4.4 (mean difference = 2.6; 95% CI = 2.4 to 2.8). The CP completely resolved in 10% of the patients. Mean decreases in SBPs and diastolic BPs were 11.8 mm Hg (95% CI = 10.7 to 13.0) and 4.0 mm Hg (95% CI = 2.9 to 5.1). The mean pulse rate increased by 2.7 beats/min (95% CI = 0.6 to 4.9). There were 12 patients with adverse events [0.7% (95% CI = 0.4% to 1.3%)], including profound bradycardia and hypotension (1), transient drop in SBP of 100 mm Hg responding to fluids (6), post-NTG SBP <90 mm Hg (4), and syncope (1). There were no deaths in the prehospital setting.
Use of prehospital NTG appears safe. While NTG reduces CP, most patients have residual pain.
评估院前使用硝酸甘油（NTG）对生命体征和胸痛强度的影响。
对一个每年接到8000次高级生命支持（ALS）呼叫的郊区志愿紧急医疗服务（EMS）系统中的ALS运行记录进行回顾性研究。纳入所有由EMS给予NTG的连续患者。使用标准化表格收集患者人口统计学、病史和体格检查数据。患者在使用NTG前后用0至10的言语数字量表评估胸痛（CP），从最轻到最严重。记录是否存在晕厥、心律失常或严重低血压[外周脉搏消失、使用NTG后收缩压（SBP）<90 mmHg或血压下降>100 mmHg]。结果。1662例患者在18个月内接受了NTG治疗，他们的平均年龄为66岁，48%为女性。NTG的适应证包括胸痛（83%）、呼吸困难（45%）和充血性心力衰竭（20%）。使用NTG后，CP评分从6.9降至4.4（平均差值=2.6；95%CI=2.4至2.8）。10%的患者胸痛完全缓解。SBP和舒张压的平均下降分别为11.8 mmHg（95%CI=10.7至13.0）和4.0 mmHg（95%CI=2.9至5.1）。平均脉搏率增加2.7次/分钟（95%CI=0.6至4.9）。有12例患者发生不良事件[0.7%（95%CI=0.4%至1.3%）]，包括严重心动过缓和低血压（1例）、对液体治疗有反应的SBP短暂下降100 mmHg（6例）、使用NTG后SBP<90 mmHg（4例）和晕厥（1例）。院前环境中无死亡病例。
院前使用NTG似乎是安全的。虽然NTG可减轻胸痛，但大多数患者仍有残余疼痛。
