Baligadoo S, Ingrand J C, Maïti D, Derrida J P, Savier C H, Chiche P
Nouv Presse Med. 1979 Jan 23;8(4):283-92.
The effects of nitroglycerin on systemic vascular resistance and cardiac output are highly debated. This study demonstrates that these effects depend on the initial haemodynamic condition, and explains the conflicting results previously reported. 31 patients presenting initially with a fairly wide spectrum of various haemodynamic parameters underwent cardiac catheterisation with measures of parameters before and after nitroglycerin infusion. Multifactorial statistical analysis by correspondence analysis identifies 3 types of haemodynamic responses and demonstrates the association of each response with a particular haemodynamic profile. It is demonstrated that systemic vascular resistance is decreased only when it is initially elevated and cardiac output is increased only when initial pulmonary wedge pressure and systemic vascular resistance are elevated and cardiac output is low. The effects of nitroglycerin on cardiac output, systemic vascular resistance, heart rate and arterial pressure differ significantly according to the presence or not of cardiac insufficiency and depend mainly on the initial value of three parameters: systemic vascular resistance, pulmonary wedge pressure and cardiac output.
硝酸甘油对体循环血管阻力和心输出量的影响极具争议。本研究表明,这些影响取决于初始血流动力学状态,并解释了先前报道的相互矛盾的结果。31例最初呈现出相当广泛的各种血流动力学参数的患者接受了心导管检查,测量了硝酸甘油输注前后的参数。通过对应分析进行的多因素统计分析确定了3种血流动力学反应类型,并证明了每种反应与特定血流动力学特征的关联。结果表明,仅当初始体循环血管阻力升高时,体循环血管阻力才会降低;仅当初始肺楔压和体循环血管阻力升高且心输出量较低时,心输出量才会增加。根据是否存在心功能不全,硝酸甘油对心输出量、体循环血管阻力、心率和动脉压的影响差异显著,且主要取决于三个参数的初始值:体循环血管阻力、肺楔压和心输出量。