Laslett L J, Baker L
Division of Cardiovascular Medicine, University of California, Davis Medical Center.
Cardiology. 1990;77(4):303-10. doi: 10.1159/000174612.
The comparative timing of hemodynamic alterations by sublingual nitroglycerin administered by spray vs. tablet has not been studied. Similarly, the directly measured comparative effects on left ventricular pressures have not been reported. To investigate these issues, we analyzed 49 patients undergoing elective diagnostic cardiac catheterization who were randomized to receive 0.4 mg sublingual nitroglycerin by either spray or tablet. Before administration of contrast medium, control determinations of left ventricular end-diastolic and systolic pressures and heart rate were done. These parameters were then evaluated at half-minute intervals for 5 min. Left ventricular end-diastolic pressure was reduced similarly in both groups, with the reduction achieving significance at 1.5 min in the spray and 2.0 min in the tablet group. Lowering of the left ventricular systolic pressure was also similar in the two groups, reaching significance at 2.5 min with spray and 2.0 min with tablet. Heart rate increased significantly by 2.0 min in the tablet group but did not change in the spray group. These findings were not altered by the level of resting left ventricular end-diastolic pressure or use of chronic nitrates. Thus, we found nitroglycerin to be similarly effective in timing and extent of response whether administered by spray or tablet, though the difference in heart rate responses remains unexplained.
舌下喷雾与舌下含服硝酸甘油引起血流动力学改变的比较时机尚未得到研究。同样，关于两者对左心室压力的直接测量比较结果也未见报道。为研究这些问题，我们分析了49例接受择期诊断性心导管检查的患者，他们被随机分为两组，分别通过喷雾或含服方式接受0.4mg舌下硝酸甘油。在注射造影剂之前，测定左心室舒张末期和收缩期压力以及心率作为对照。然后每隔半分钟评估一次这些参数，共持续5分钟。两组患者的左心室舒张末期压力均有相似程度的降低，喷雾组在1.5分钟时降低达到显著水平，含服组在2.0分钟时达到显著水平。两组患者左心室收缩压的降低情况也相似，喷雾组在2.5分钟时达到显著水平，含服组在2.0分钟时达到显著水平。含服组心率在2.0分钟时显著增加，而喷雾组心率无变化。这些结果不受静息左心室舒张末期压力水平或长期使用硝酸盐类药物的影响。因此，我们发现无论通过喷雾还是含服方式给药，硝酸甘油在反应时机和程度上同样有效，尽管心率反应的差异仍无法解释。
