Dupuis J, Lalonde G, Lebeau R, Bichet D, Rouleau J L
Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.
Am Heart J. 1990 Sep;120(3):625-37. doi: 10.1016/0002-8703(90)90021-o.
To determine whether a 72-hour infusion of nitroglycerin produces hemodynamic improvement in patients with severe congestive heart failure and to assess the contributing role of various possible causes of hemodynamic tolerance to nitroglycerin, 19 patients received an infusion of nitroglycerin 1.5 micrograms/kg/min for 72 hours. In a subgroup of patients (n = 10), there was an increase in stroke work index and a decrease in ventricular filling pressures throughout the infusion and even after it was discontinued. Tolerance to the hemodynamic effects of nitroglycerin was partially reversed 8 hours after the infusion was stopped. Neurohumoral changes occurred but appeared to play only a minor role in the development of nitroglycerin tolerance. However, hematocrit fell 9 +/- 5%, which suggests that an increased intravascular volume contributed to tolerance. In summary: (1) a 72-hour infusion of nitroglycerin improves ventricular function in some patients with severe heart failure; (2) volume shifts from the extravascular to the intravascular compartments may, at least in part, be responsible for nitroglycerin tolerance; and (3) reflex neurohumoral activation may also play a small role in nitrate tolerance.
为了确定72小时静脉输注硝酸甘油是否能改善重度充血性心力衰竭患者的血流动力学，并评估导致对硝酸甘油产生血流动力学耐受性的各种可能原因的作用，19例患者接受了1.5微克/千克/分钟的硝酸甘油输注，持续72小时。在一组患者（n = 10）中，整个输注过程中以及输注停止后，每搏功指数增加，心室充盈压降低。输注停止8小时后，对硝酸甘油血流动力学效应的耐受性部分逆转。发生了神经体液变化，但在硝酸甘油耐受性的发展中似乎仅起次要作用。然而，血细胞比容下降了9±5%，这表明血管内容量增加促成了耐受性。总之：（1）72小时静脉输注硝酸甘油可改善一些重度心力衰竭患者的心室功能；（2）从血管外间隙向血管内间隙的容量转移可能至少部分地导致了硝酸甘油耐受性；（3）反射性神经体液激活在硝酸盐耐受性中也可能起较小作用。
