Prehosp Emerg Care. 2019 Sep-Oct;23(5):603-611. doi: 10.1080/10903127.2018.1558318. Epub 2019 Jan 28.
: While widely used in the treatment of cardiac conditions, only limited data characterize out-of-hospital nitroglycerin (NTG) use. We sought to determine the safety of out-of-hospital sublingual NTG administered for suspected ST-segment elevation myocardial infarction (STEMI) and its effect on the patient's pain score. : We prospectively identified adult patients with suspected STEMI transported by paramedics to three percutaneous Coronary Intervention PCI-capable hospitals in a large urban-suburban emergency medical services (EMS) system. We compared patients who received field NTG to those who did not. The primary outcome was the change in systolic blood pressure (SBP) between initial EMS measurement and emergency department (ED) triage vital signs. Secondary outcomes included the frequency of hypotension (SBP < 100 mmHg) and bradycardia (HR < 60) on ED arrival, drop in SBP ≥ 30 mmHg, out-of-hospital cardiac arrest (OHCA), and the change in pain score compared to an a priori threshold of -1.39. : Among 940 EMS transports for suspected STEMI, we excluded 160 for initial SBP < 100 mmHg, leaving 780 subjects for the analysis. Median age was 67 with 61% male. NTG was administered to 340 (44%) patients. The median change in SBP was -10 mmHg (IQR -27, 2) and -3 mmHg (IQR -20, 9) in patients treated with and without NTG, respectively. The median difference in the decrease in SBP was 6 mmHg (95% CI 3, 9 mmHg). The frequencies of ED hypotension and bradycardia, the drop in SBP ≥ 30 mmHg, and the OHCA did not differ between groups. For patients with an initial pain score > 0, the average change in pain score for patients treated with NTG was -2.6 (95% CI -3.0, -2.2), while patients who did not receive NTG had a change in pain score of -1.4 (95% CI -1.8, -1.0). : In this cohort, field NTG did not result in a clinically significant decrease in blood pressure when compared with patients who did not receive NTG. However, NTG did cause a clinically significant reduction in pain.
虽然在治疗心脏疾病方面广泛应用，但只有有限的数据描述了院外使用硝化甘油（NTG）的情况。我们旨在确定院外舌下含服 NTG 用于疑似 ST 段抬高型心肌梗死（STEMI）的安全性及其对患者疼痛评分的影响。
我们前瞻性地确定了由护理人员送往三个位于大城市-郊区急诊医疗服务（EMS）系统中可进行经皮冠状动脉介入治疗（PCI）的医院的疑似 STEMI 成年患者。我们比较了接受现场 NTG 治疗的患者和未接受治疗的患者。主要结局是初始 EMS 测量与急诊科（ED）分诊生命体征之间的收缩压（SBP）变化。次要结局包括 ED 到达时低血压（SBP < 100mmHg）和心动过缓（HR < 60）的频率、SBP 下降≥30mmHg、院外心脏骤停（OHCA）以及与预先设定的 -1.39 疼痛评分相比的变化。
在疑似 STEMI 的 940 次 EMS 转运中，我们排除了 160 次初始 SBP < 100mmHg 的患者，留下 780 例进行分析。中位年龄为 67 岁，61%为男性。NTG 给予 340 例（44%）患者。接受和未接受 NTG 治疗的患者的 SBP 中位数分别为 -10mmHg（IQR -27，2）和 -3mmHg（IQR -20，9）。SBP 下降中位数差异为 6mmHg（95%CI 3，9mmHg）。ED 低血压和心动过缓的频率、SBP 下降≥30mmHg 和 OHCA 在两组之间无差异。对于初始疼痛评分>0 的患者，接受 NTG 治疗的患者的平均疼痛评分变化为 -2.6（95%CI -3.0，-2.2），而未接受 NTG 治疗的患者的疼痛评分变化为 -1.4（95%CI -1.8，-1.0）。
在本队列中，与未接受 NTG 治疗的患者相比，场下 NTG 并未导致血压显著下降。然而，NTG 确实导致疼痛显著减轻。
