硝酸甘油软膏对急诊科患者的血流动力学影响。

Hemodynamic effects of nitroglycerin ointment in emergency department patients.

作者信息

Mumma Bryn E, Dhingra Kapil R, Kurlinkus Charley, Diercks Deborah B

机构信息

Department of Emergency Medicine, University of California Davis, Sacramento, California.

Department of Emergency Medicine, University of California Davis, Sacramento, California; Department of Emergency Medicine, Kaiser Permanente South Sacramento, Sacramento, California.

出版信息

J Emerg Med. 2014 Aug;47(2):192-7. doi: 10.1016/j.jemermed.2014.01.026. Epub 2014 Mar 31.

DOI:10.1016/j.jemermed.2014.01.026

PMID:24698507

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4112004/

Abstract

BACKGROUND

Nitroglycerin ointment is commonly used in the treatment of emergency department (ED) patients with suspected acute heart failure (AHF) or suspected acute coronary syndrome (ACS), but its hemodynamic effects in this population are not well described.

OBJECTIVE

Our objective was to assess the effect of nitroglycerin ointment on mean arterial pressure (MAP) and systemic vascular resistance (SVR) in ED patients receiving nitroglycerin. We hypothesized that nitroglycerin ointment would result in a reduction of MAP and SVR in the acute treatment of patients.

METHODS

We conducted a prospective, observational pilot study in a convenience sample of adult patients from a single ED who were treated with nitroglycerin ointment. Impedance cardiography was used to measure MAP, SVR, cardiac output (CO), stroke volume (SV), and thoracic fluid content (TFC) at baseline and at 30, 60, and 120 min after application of nitroglycerin ointment. Mixed effects regression models with random slope and random intercept were used to analyze changes in hemodynamic parameters from baseline to 30, 60, and 120 min after adjusting for age, sex, and final ED diagnosis of AHF.

RESULTS

Sixty-four subjects with mean age of 55 years (interquartile range, 48-67 years) were enrolled; 59% were male. In the adjusted analysis, MAP and TFC decreased after application of nitroglycerin ointment (p=0.001 and p=0.043, respectively). Cardiac index, CO, SVR, and SV showed no change (p=0.113, p=0.085, p=0.570, and p=0.076, respectively) over time.

CONCLUSIONS

Among ED patients who are treated with nitroglycerin ointment, MAP and TFC decrease over time. However, other hemodynamic parameters do not change after application of nitroglycerin ointment in these patients.

摘要

背景

硝酸甘油软膏常用于急诊科（ED）疑似急性心力衰竭（AHF）或疑似急性冠状动脉综合征（ACS）患者的治疗，但其在该人群中的血流动力学效应尚未得到充分描述。

目的

我们的目的是评估硝酸甘油软膏对接受硝酸甘油治疗的急诊科患者平均动脉压（MAP）和全身血管阻力（SVR）的影响。我们假设硝酸甘油软膏在急性治疗患者时会导致MAP和SVR降低。

方法

我们在来自单一急诊科的成年患者便利样本中进行了一项前瞻性观察性试点研究，这些患者接受了硝酸甘油软膏治疗。使用阻抗心动图在基线以及应用硝酸甘油软膏后30、60和120分钟测量MAP、SVR、心输出量（CO）、每搏输出量（SV）和胸腔液体含量（TFC）。在调整年龄、性别和AHF的最终急诊科诊断后，使用具有随机斜率和随机截距的混合效应回归模型分析从基线到应用硝酸甘油软膏后30、60和120分钟血流动力学参数的变化。

结果

纳入了64名平均年龄为55岁（四分位间距，48 - 67岁）的受试者；59%为男性。在调整分析中，应用硝酸甘油软膏后MAP和TFC降低（分别为p = 0.001和p = 0.043）。随着时间推移，心脏指数、CO、SVR和SV无变化（分别为p = 0.113、p = 0.085、p = 0.570和p = 0.076）。