Makhoul N, Dakak N, Flugelman M Y, Merdler A, Shefer A, Schneeweiss A, Halon D A, Lewis B S
Department of Cardiology, Lady Davis Carmel Hospital, Haifa, Israel.
Am J Cardiol. 1990 Jun 4;65(21):28J-31J. doi: 10.1016/0002-9149(90)91307-r.
The hemodynamic profile of tolerance to intravenous nitroglycerin was studied in 9 patients with New York Heart Association Class III to IV congestive heart failure. After rapid dosage build-up to the maximal tolerated dose (decrease in pulmonary wedge pressure to 10 mm Hg or systolic blood pressure to 90 mm Hg), nitroglycerin (525 +/- 548 micrograms/min) was administered at a constant continuous intravenous infusion for a total of 24 hours. The extent of nitrate tolerance at 24 hours was calculated as the percentage loss of the benefit achieved at time of peak effect of nitroglycerin. Tolerance had a different time course and magnitude in the venous, arterial and pulmonary circulations. At 24 hours, right atrial pressure and pulmonary vascular resistance returned to control values in most patients, while 40 to 50% of the effect on systemic vascular resistance, cardiac index and pulmonary wedge pressure was maintained. These findings emphasize the importance of precise definitions in studies relating to nitrate tolerance.
对9例纽约心脏协会III至IV级充血性心力衰竭患者静脉输注硝酸甘油耐受性的血流动力学情况进行了研究。在迅速增加剂量至最大耐受剂量（肺楔压降至10 mmHg或收缩压降至90 mmHg）后，以525±548微克/分钟的剂量持续静脉输注硝酸甘油，共24小时。24小时时的硝酸盐耐受性程度以硝酸甘油达到峰值效应时所获益处的丧失百分比来计算。耐受性在静脉、动脉和肺循环中的时间进程和程度有所不同。24小时时，大多数患者的右心房压力和肺血管阻力恢复至对照值，而对体循环血管阻力、心脏指数和肺楔压的效应仍维持40%至50%。这些发现强调了在与硝酸盐耐受性相关的研究中精确定义的重要性。
