Pugliese P, Ellie J, Castro Cells A, Chauve A, Fontan F
G Ital Cardiol. 1980;10(8):1016-23.
The present study was performed to compare hemodynamic effect of intravenous Nitroglycerin (TNT i.v.) in 14 patients developing acute hypertension (Group I) and in 7 non hypertensives after open heart surgery (Group II). In all patients, m.a. 56.6 yrs, (10 mitral and/or aortic prosthetic valve replacements, 9 aorto-coronary bypass, 1 open mitral commissurotomy, 1 closure of atrial septal defect) TNT was infused at doses of 0.5, 1, 2 microgram X kg X min. and subsequently at 2 microgram X kg X min. after volume administration (2 + V.A.) to maintain right and left atrial pressure the same as control (P = N.S.). Mean arterial, right and left atrial pressures (MAP, RAP, LAP), cardiac frequency and index (CF, CI and systemic vascular resistance index (SVRI) were monitorized. TNT i.v. resulted in hypertensive patients (Group I) in reduction vs. control of: a) RAP (--20.17%) and LAP (--20.58%) at 0.5 microgram X kg X min. b) RAP (--26.13%), LAP (--27.50%), MAP (--19.94%) and CI (--12.98%) at 1 microgram X kg X X min. c) RAP (--22.47%), LAP (--26.89%), MAP (--24.68%), CI (--12.6%) and SVRI (--17.34%) at 2 microgram X kg X min. When RAP and LAP was maintained by volume administration TNT i.v. (2 microgram X kg X min.) resulted in an even greater increase in CI and a greater decrease in MAP and SVRI ((--22.04% and --24.88% respectively). No significant hemodynamic modification (P less than or equal to 0.05) were observed in non hypertensive patients (Group II) at all doses of TNT i.v. The results confirm a predominant venodilator effect of TNT at low doses and a good effect on arterial resistances at high doses in hypertensive patients. In view of previous reports of differing effects on ischemia TNT i.v. may be preferable to other vasodilator drugs for control of acute post-ECG hypertension, only on condition to maintain an adequate left ventricular filling pressure to prevent a fall of cardiac index. Moreover the absence of significant (P less than or equal to 0.05) hemodynamic modifications in non hypertensive patients may be a further advantage in the treatment of myocardial ischemia with i.v. TNT.
本研究旨在比较静脉注射硝酸甘油（TNT i.v.）对14例急性高血压患者（I组）和7例心脏直视手术后非高血压患者（II组）的血流动力学影响。所有患者平均年龄56.6岁（10例行二尖瓣和/或主动脉人工瓣膜置换术，9例行主动脉冠状动脉搭桥术，1例行二尖瓣直视交界切开术，1例行房间隔缺损修补术），以0.5、1、2微克/千克/分钟的剂量输注TNT，随后在容量给药（2 + V.A.）后以2微克/千克/分钟的剂量输注，以维持右心房和左心房压力与对照组相同（P =无显著性差异）。监测平均动脉压、右心房和左心房压力（MAP、RAP、LAP）、心率和心指数（CF、CI）以及全身血管阻力指数（SVRI）。静脉注射TNT使高血压患者（I组）与对照组相比，在以下方面降低：a）在0.5微克/千克/分钟时，RAP（-20.17%）和LAP（-20.58%）；b）在1微克/千克/分钟时，RAP（-26.13%）、LAP（-27.50%）、MAP（-19.94%）和CI（-12.98%）；c）在2微克/千克/分钟时，RAP（-22.47%）、LAP（-26.89%）、MAP（-24.68%）、CI（-12.6%）和SVRI（-17.34%）。当通过容量给药维持RAP和LAP时，静脉注射TNT（2微克/千克/分钟）导致CI进一步增加，MAP和SVRI进一步降低（分别为-22.04%和-24.88%）。在所有静脉注射TNT剂量下，非高血压患者（II组）均未观察到显著的血流动力学改变（P≤0.05）。结果证实，低剂量时TNT主要具有静脉扩张作用，高剂量时对高血压患者的动脉阻力有良好作用。鉴于先前关于对缺血影响不同的报道，静脉注射TNT在控制急性心电图后高血压方面可能比其他血管扩张药物更可取，但前提是要维持足够的左心室充盈压以防止心指数下降。此外，非高血压患者无显著（P≤0.05）血流动力学改变可能是静脉注射TNT治疗心肌缺血的另一个优势。
