Melandri G, Semprini F, Branzi A, Magnani B
Institute of Cardiology, University of Bologna, Italy.
Eur Heart J. 1990 Jul;11(7):649-55. doi: 10.1093/oxfordjournals.eurheartj.a059771.
The comparative haemodynamic effects of transdermal and intravenous nitroglycerin were evaluated in 16 patients with haemodynamic and radiographic left heart failure following a recent myocardial infarction. After the control period patients were randomized to transdermal (10 mg(24 h)-1) or intravenous (mean dose: 40 +/- 9 micrograms min-1) nitroglycerin. Haemodynamic parameters were recorded after 0.5,1,2,6,12,18 and 24 h during administration of the drug and 2 h after drug discontinuation. After the washout period the alternate system of nitroglycerin administration was adopted, according to a cross-over design. No differences were found in baseline measurements. Transdermal nitroglycerin reduced the pulmonary artery wedge pressure after 0.5 h (from 21 +/- 5 to 16 +/- 5 mmHg; P less than 0.05). The peak effect occurred at 2 h (12 +/- 5 mmHg). The improvement was sustained over 24 h. Transdermal nitroglycerin also significantly reduced mean pulmonary arterial and right atrial pressures (from 28 +/- 3 to 20 +/- 5 mmHg and from 6 +/- 3 to 2 +/- 2 mmHg at peak effect, respectively). Cardiac index increased from 2.5 +/- 0.6 to 2.8 +/- 0.8 l min-1 m-2 (P less than 0.05). There was no change in heart rate. Similar haemodynamic changes were observed after the intravenous infusion of nitroglycerin. Thus transdermal nitroglycerin is a safe and effective treatment of acute myocardial infarction with signs of left ventricular failure when an intravenous nitroglycerin infusion cannot be properly implemented.
对16例近期发生心肌梗死后出现血流动力学和影像学左心衰竭的患者，评估了经皮和静脉应用硝酸甘油的血流动力学效应比较。在对照期后，患者被随机分为经皮（10mg(24h)-1）或静脉（平均剂量：40±9μg min-1）硝酸甘油组。在给药后0.5、1、2、6、12、18和24小时以及停药后2小时记录血流动力学参数。在洗脱期后，根据交叉设计采用交替的硝酸甘油给药系统。基线测量未发现差异。经皮硝酸甘油在0.5小时后降低了肺动脉楔压（从21±5降至16±5mmHg；P<0.05）。峰值效应出现在2小时（12±5mmHg）。改善持续24小时。经皮硝酸甘油还显著降低了平均肺动脉压和右心房压（峰值效应时分别从28±3降至20±5mmHg和从6±3降至2±2mmHg）。心脏指数从2.5±0.6升至2.8±0.8l min-1 m-2（P<0.05）。心率无变化。静脉输注硝酸甘油后观察到类似的血流动力学变化。因此，当不能正确实施静脉输注硝酸甘油时，经皮硝酸甘油是治疗有左心室衰竭体征的急性心肌梗死的一种安全有效的方法。
