Capurro N L, Kent K M, Epstein S E
J Clin Invest. 1977 Aug;60(2):295-301. doi: 10.1172/JCI108777.
The recent use of vasodilators to improve ventricular function in acute myocardial infarction led us to investigate the effects of nitroglycerin, nitroprusside, and phentolamine on coronary collateral flow. Dogs were studied 2-4 wk after an ameroid constrictor was placed around the left anterior descending (LAD) coronary artery. Retrograde flow and peripheral coronary pressure were measured from a cannula inserted in the LAD distal to the ameroid. Systemic arterial pressure was held constant by an aortic cuff. When administered intracoronary (i.c.), nitroglycerin, 0.3-100 mug/min, or nitroprusside, 3-100 mug/min, produced quantitatively similar, dose-dependent increases in retrograde flow. Neither drug, i.c., changed peripheral coronary pressure. Nitroglycerin, 3-300 mug/min, intravenous (i.v.), produced dose-dependent increases in retrograde flow; nitroprusside, i.v., increased retrograde flow only in high doses (100-300 mug/min). Nitroglycerin and nitroprusside, i.v., produced similar increases in peripheral coronary pressure. Phentolamine, 1-300 mug/min, i.v., decreased retrograde flow, and did not change peripheral coronary pressure. Nitroprusside was considerably more potent than nitroglycerin in decreasing systemic arterial pressure and in reducing total coronary resistance. Thus, (a) although i.c. nitroglycerin and nitroprusside produce similar effects on collateral function, i.v. nitroglycerin is more effective than i.v. nitroprusside in augmenting collateral flow; (b) phentolamine has deleterious effects on collateral function; and (c) the relative vasodilator potencies of nitroglycerin and nitroprusside vary in different vascular beds; thus, for a given reduction in systemic arterial pressure, nitroprusside is less effective in increasing retrograde flow.
近期使用血管扩张剂改善急性心肌梗死患者心室功能，促使我们研究硝酸甘油、硝普钠和酚妥拉明对冠状动脉侧支血流的影响。在左冠状动脉前降支（LAD）周围放置阿梅氏环缩窄器2 - 4周后对犬进行研究。通过插入阿梅氏环远端LAD的套管测量逆向血流和外周冠状动脉压力。通过主动脉袖带维持体动脉血压恒定。冠状动脉内给药（i.c.）时，硝酸甘油0.3 - 100μg/min或硝普钠3 - 100μg/min可使逆向血流产生定量相似的剂量依赖性增加。两种药物冠状动脉内给药均未改变外周冠状动脉压力。静脉内给药（i.v.）时，硝酸甘油3 - 300μg/min可使逆向血流产生剂量依赖性增加；硝普钠静脉内给药仅在高剂量（100 - 300μg/min）时增加逆向血流。硝酸甘油和硝普钠静脉内给药对外周冠状动脉压力产生相似的增加。静脉内给药时，酚妥拉明1 - 300μg/min可减少逆向血流，且不改变外周冠状动脉压力。硝普钠在降低体动脉血压和降低总冠状动脉阻力方面比硝酸甘油有效得多。因此，（a）尽管冠状动脉内给药时硝酸甘油和硝普钠对侧支功能产生相似影响，但静脉内给药时硝酸甘油在增加侧支血流方面比硝普钠更有效；（b）酚妥拉明对侧支功能有有害影响；（c）硝酸甘油和硝普钠在不同血管床中的相对血管扩张效力不同；因此，对于给定的体动脉血压降低，硝普钠在增加逆向血流方面效果较差。
