Moffitt E A, Sethna D H, Gray R J, Raymond M J, Bussell J A, Matloff J M
Can Anaesth Soc J. 1983 Jul;30(4):352-9. doi: 10.1007/BF03007857.
The haemodynamic and myocardial energy-metabolic effects of intravenous nitroglycerin (NTG) were investigated in seven male patients about to undergo coronary artery bypass grafting. Effects of one mg of NTG given at a rate of 100 micrograms . min-1 to sedated, awake hypertensive patients, were compared to effects of the same dose of NTG in the same patients, after sternotomy. Coronary sinus flow was measured by a thermodilution catheter and myocardial oxygen consumption (MVO2) was calculated using the arterio-coronary sinus difference of oxygen content. With the patients awake, cardiac index and stroke volume and work indices fell during NTG administration. There was only a small fall in arterial pressure as heart rate and systemic resistance increased. Pulmonary capillary wedge pressure decreased but not MVO2. With NTG administration during anaesthesia, arterial pressure fell significantly to normal, as systemic resistance decreased, without a change in heart rate or cardiac index. Calculated MVO2 decreased as the arterial-coronary venous difference of oxygen content increased. Both oxygen and lactate balance of the myocardium were maintained. NTG given during anaesthesia was more effective in reducing blood pressure and MVO2 than when given to awake patients.
在七名即将接受冠状动脉搭桥手术的男性患者中，研究了静脉注射硝酸甘油（NTG）的血流动力学和心肌能量代谢效应。将以100微克·分钟-1的速率给予镇静、清醒的高血压患者1毫克NTG的效应，与胸骨切开术后相同患者给予相同剂量NTG的效应进行比较。通过热稀释导管测量冠状窦血流量，并使用动脉-冠状窦氧含量差计算心肌耗氧量（MVO2）。患者清醒时，给予NTG期间心脏指数、每搏量和做功指数下降。随着心率和全身阻力增加，动脉压仅略有下降。肺毛细血管楔压降低，但MVO2未降低。麻醉期间给予NTG时，随着全身阻力降低，动脉压显著降至正常，心率和心脏指数无变化。随着动脉-冠状静脉氧含量差增加，计算出的MVO2降低。心肌的氧和乳酸平衡均得以维持。麻醉期间给予NTG在降低血压和MVO2方面比给予清醒患者时更有效。
