Class J J, Bareiss P, Pasquali J L, Meyer R, Weryha A, Storck D, Warter J
Sem Hop. 1978;54(29-32):919-24.
Thirteen patients with left ventricular failure complicating acute myocardial infarction were treated with intravenous nitroglycerin. The hemodynamic criterium for admission to this study was a pulmonary capillary wedge pressure greater than 15 mm Hg. All patients received intravenous nitroglycerin at infusion rates sufficient to lower pulmonary capillary wedge pressure by an average of 15 mm Hg, corresponding to the optimal left ventricular filling pressure in acute myocardial infarction. During this study, heart rate did not vary significantly; pulmonary capillary wedge pressure decreased from 24 +/- 0,7 to 15 +/- 0,8 mm Hg (p less than 0,001), mean arterial pressure from 95 +/- 5 to 80 +/- 4 mm Hg (p less than 0,005), mean right atrium pressure from 8,7 +/- 1 to 4,6 +/- 0,8 mm Hg (p less than 0,001), systemic vascular resistance index from 36,4 +/- 2 to 29,6 +/- 2 mm Hg/mm-1/l/m2 (p less than 0,005). Cardiac index increased from 2,5 +/- 0,2 to 2,7 +/- 0,1 l/mn/m2 (p less than 0,025) and stroke work index did not vary significantly. These data indicate that nitroglycerin provides a significant improvement of cardiac performance, more through reduction of preload than through reduction of afterload, the later being however significant. This study points out that intravenous nitroglycerin is a most efficient drug in patients with left ventricular failure complicating acute myocardial infarction.
13例急性心肌梗死合并左心室衰竭的患者接受了静脉硝酸甘油治疗。本研究的入组血流动力学标准为肺毛细血管楔压大于15 mmHg。所有患者均接受静脉硝酸甘油治疗，输注速率足以使肺毛细血管楔压平均降低15 mmHg，这与急性心肌梗死时的最佳左心室充盈压相对应。在本研究期间，心率无显著变化；肺毛细血管楔压从24±0.7降至15±0.8 mmHg（p<0.001），平均动脉压从95±5降至80±4 mmHg（p<0.005），平均右心房压从8.7±1降至4.6±0.8 mmHg（p<0.001），全身血管阻力指数从36.4±2降至29.6±2 mmHg/mm-1/l/m2（p<0.005）。心脏指数从2.5±0.2升至2.7±0.1 l/min/m2（p<0.025），每搏功指数无显著变化。这些数据表明，硝酸甘油可显著改善心脏功能，更多是通过降低前负荷而非后负荷实现的，不过后负荷的降低也很显著。本研究指出，静脉硝酸甘油对急性心肌梗死合并左心室衰竭的患者是一种非常有效的药物。
