Cotton D B, Longmire S, Jones M M, Dorman K F, Tessem J, Joyce T H
Am J Obstet Gynecol. 1986 May;154(5):1053-9. doi: 10.1016/0002-9378(86)90749-0.
Control of blood pressure in severe pregnancy-induced hypertension has often relied on agents with an unpredictable onset and duration of action. Because intravenous nitroglycerin is a potent, rapidly acting agent with a hemodynamic half-life measured in minutes, we evaluated its cardiovascular effects with and without volume expansion in six patients with severe pregnancy-induced hypertension. Nitroglycerin alone reduced mean arterial pressure by 27.5% without any significant changes in heart rate, central venous pressure, or stroke volume. The pulmonary capillary wedge pressure fell from 9 +/- 3 to 4 +/- 2 mm Hg (p less than 0.05) while the cardiac index decreased from 3.51 +/- 0.67 to 2.87 +/- 0.76 L/min X m2. Oxygen delivery fell significantly (p less than 0.05), from 617 +/- 78 to 491 +/- 106 ml/min X m2. While volume expansion alone had no effect on mean arterial pressure, the combination of blood volume expansion and nitroglycerin resulted in a marked resistance to the hypotensive effect of nitroglycerin. Cardiac index, pulmonary capillary wedge pressure, and oxygen utilization were not significantly different from baseline values when volume expansion preceded nitroglycerin. We conclude that the ease with which nitroglycerin reduces blood pressure is dependent on the individual patient's volume status. Although volume expansion allows one to maintain cardiac index, pulmonary capillary wedge pressure, and oxygen utilization when used in combination with nitroglycerin, this benefit may be offset by a concomitant reduction in hypotensive capability.
重度妊娠高血压综合征的血压控制通常依赖于作用起效和持续时间不可预测的药物。由于静脉注射硝酸甘油是一种强效、起效迅速的药物，其血流动力学半衰期以分钟计，我们评估了6例重度妊娠高血压综合征患者在扩容和未扩容情况下硝酸甘油的心血管效应。单独使用硝酸甘油可使平均动脉压降低27.5%，而心率、中心静脉压或每搏量均无显著变化。肺毛细血管楔压从9±3降至4±2 mmHg（p<0.05），而心脏指数从3.51±0.67降至2.87±0.76 L/min·m²。氧输送显著下降（p<0.05），从617±78降至491±106 ml/min·m²。单独扩容对平均动脉压无影响，但血容量扩充与硝酸甘油联合使用会导致对硝酸甘油降压作用的明显抵抗。在扩容后使用硝酸甘油时，心脏指数、肺毛细血管楔压和氧利用率与基线值无显著差异。我们得出结论，硝酸甘油降低血压的难易程度取决于个体患者的血容量状态。虽然扩容与硝酸甘油联合使用时可维持心脏指数、肺毛细血管楔压和氧利用率，但这种益处可能会因降压能力的相应降低而被抵消。
