Wilson J, Commerford P J, Millar R S, Opie L H
Department of Medicine, University of Cape Town, South Africa.
Cardiovasc Drugs Ther. 1992 Feb;6(1):41-6. doi: 10.1007/BF00050916.
The aim of the study was to investigate the hemodynamic effects of a short-acting, potent, highly specific calcium antagonist, nisoldipine, in patients with acute myocardial infarction. Twenty-four patients were selected on the basis of an elevated wedge pressure and/or elevated blood pressure, less than 12 hours after the onset of symptoms. Patients were randomized to receive either placebo or low-dose nisoldipine (2 micrograms/kg) as a single intravenous injection over a 3-minute period. hemodynamic effects were monitored for 20 minutes, and thereafter patients were crossed over to the other agent after the preserved parameters had returned to baseline. An open-label study using double the dose of nisoldipine in 20 patients who had not reacted adversely to low-dose nisoldipine followed. Standard hemodynamic monitoring showed that peak effects of nisoldipine were reached at 5 minutes, with some residual effect at 20 minutes, and it took up to 60 minutes to return to baseline. Both doses of nisoldipine had similar effects: a fall in the systemic vascular resistance by about 600 units, variable tachycardia, little or no change in the wedge pressure, a decrease in the arterial pressure, an unchanged rate-pressure product, and an increase in ejection fraction. Tachycardia of more than 15 beats/min resulted in 5 of 24 patients with low-dose nisoldipine and 6 of 20 patients with high-dose nisoldipine. In view of the risk of tachycardia, nisoldipine seems unsuitable for use in the acute phase of myocardial infarction.
本研究的目的是调查一种短效、强效、高特异性钙拮抗剂尼索地平对急性心肌梗死患者的血流动力学影响。根据症状发作后不到12小时时的楔压升高和/或血压升高，选择了24例患者。患者被随机分为两组，一组接受安慰剂，另一组在3分钟内静脉注射低剂量尼索地平（2微克/千克）。监测血流动力学效应20分钟，此后，在各项参数恢复到基线水平后，患者交叉接受另一种药物治疗。接下来对20例对低剂量尼索地平无不良反应的患者进行了开放标签研究，使用双倍剂量的尼索地平。标准血流动力学监测显示，尼索地平在5分钟时达到峰值效应，20分钟时仍有一些残余效应，恢复到基线水平需要长达60分钟。两种剂量的尼索地平效果相似：全身血管阻力下降约600单位，心率呈不同程度加快，楔压变化很小或无变化，动脉压降低，心率与血压乘积不变，射血分数增加。低剂量尼索地平组的24例患者中有5例、高剂量尼索地平组的20例患者中有6例出现心率加快超过15次/分钟。鉴于存在心率加快的风险，尼索地平似乎不适合用于心肌梗死急性期。
