Roth A, Kulick D, Freidenberger L, Hong R, Rahimtoola S H, Elkayam U
J Am Coll Cardiol. 1987 Apr;9(4):858-64. doi: 10.1016/s0735-1097(87)80242-5.
Transdermal systems for delivery of nitroglycerin have been shown to provide sustained blood levels of the drug for at least 24 hours. Investigations of hemodynamic effects of transdermal nitroglycerin in patients with heart failure have demonstrated a transient reduction in pressure lasting less than the expected 24 hours. These findings could be due to the development of circulatory tolerance to the vasodilatory effects of nitroglycerin or to insufficient drug dosing. In the present study, we compared the hemodynamic effects of the first and the second doses of high dose (120 mg) transdermal nitroglycerin given 24 hours apart in 11 responders (greater than or equal to 20% reduction in mean pulmonary artery wedge pressure lasting greater than or equal to 2 hours). Initiation of nitroglycerin therapy resulted in a significant reduction in mean right atrial pressure lasting for 14 hours and in a reduction in mean pulmonary artery and mean pulmonary artery wedge pressures lasting 24 hours. After administration of the second dose, mean right atrial pressure at 2 hours (9 +/- 5 versus 7 +/- 4 mm Hg), 4 hours (8 +/- 5 versus 6 +/- 4 mm Hg) and 8 hours (8 +/- 5 versus 6 +/- 3 mm Hg) was higher than after the first dose (p less than 0.05). Both mean pulmonary artery and mean pulmonary artery wedge pressures were significantly higher after the second nitroglycerin dose.(ABSTRACT TRUNCATED AT 250 WORDS)
经皮给药的硝酸甘油系统已被证明可使药物血药浓度持续至少24小时。对心力衰竭患者经皮应用硝酸甘油的血流动力学效应研究表明，压力短暂降低，持续时间短于预期的24小时。这些结果可能是由于对硝酸甘油血管舒张作用产生了循环耐受性，或者是药物剂量不足。在本研究中，我们比较了11例有反应者（平均肺动脉楔压降低大于或等于20%，持续大于或等于2小时）在间隔24小时给予两剂高剂量（120 mg）经皮硝酸甘油后的血流动力学效应。开始硝酸甘油治疗后，平均右心房压力显著降低，持续14小时，平均肺动脉压和平均肺动脉楔压降低，持续24小时。给予第二剂后，2小时（9±5对7±4 mmHg）、4小时（8±5对6±4 mmHg）和8小时（8±5对6±3 mmHg）的平均右心房压力高于第一剂后（p<0.05）。第二次给予硝酸甘油后，平均肺动脉压和平均肺动脉楔压均显著升高。（摘要截短于250字）
