Frishman W H
Am J Cardiol. 1985 Dec 27;56(17):8I-13I. doi: 10.1016/0002-9149(85)90701-5.
Nitrate therapy is the oldest treatment modality for angina pectoris. In addition to sublingual nitroglycerin, longer-acting preparations are available to provide angina prophylaxis. Nitrates work as venodilators and arterial dilators, and by these actions in patients with angina pectoris can reduce myocardial oxygen demands while maintaining or increasing coronary artery flow. On the cellular level, they may increase endothelial prostacyclin release to cause their vasodilating effects. Long-acting nitrates are available in sublingual, chewable, oral, buccal and topical forms. The topical forms include nitroglycerin paste and transcutaneous patches. Long-acting nitrates have a duration of action of 2 to 24 hours, depending on the preparation used. The transcutaneous patches, which provide the longest duration of activity, are being reexamined regarding long-term efficacy and drug tolerance. Nitrates are also available in an intravenous form and in a short-acting sublingual spray soon to be released. The safety of nitrates has been confirmed. Their hemodynamic and safety profiles allow them to be combined with calcium-channel blockers, beta-adrenergic blockers or both when trying to improve on the antianginal efficacy of single-drug therapy.
硝酸酯类药物治疗是心绞痛最古老的治疗方式。除了舌下含服硝酸甘油外，还有长效制剂可用于心绞痛的预防。硝酸酯类药物作为静脉扩张剂和动脉扩张剂，通过这些作用可在维持或增加冠状动脉血流的同时降低心绞痛患者的心肌需氧量。在细胞水平上，它们可能会增加内皮前列环素的释放以产生血管舒张作用。长效硝酸酯类药物有舌下含服、咀嚼、口服、颊部给药和局部给药等剂型。局部给药剂型包括硝酸甘油软膏和经皮贴片。长效硝酸酯类药物的作用持续时间为2至24小时，具体取决于所使用的制剂。作用持续时间最长的经皮贴片，其长期疗效和药物耐受性正在重新评估。硝酸酯类药物也有静脉注射剂型和即将推出的短效舌下喷雾剂。硝酸酯类药物的安全性已得到证实。它们的血流动力学和安全性特征使其在试图提高单药治疗抗心绞痛疗效时可与钙通道阻滞剂、β肾上腺素能阻滞剂或两者联合使用。
