Moody J M, Bailey S R, Rubal B J
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200.
Clin Cardiol. 1993 Apr;16(4):331-8. doi: 10.1002/clc.4960160408.
Although amyl nitrite inhalation (ANI) antedates all current short acting vasodilators as a clinically useful pharmacologic stressor, few clinicians are aware of the subtle hemodynamic actions of this agent. This study examined transients in left and right heart hemodynamics after ANI in seven men (ages 44 +/- 7 years) undergoing elective cardiac catheterization. High-fidelity central aortic (AoP), left ventricular (LVP), pulmonary artery (PAP), right ventricular (RVP), and right atrial (RAP) pressures were simultaneously recorded from left and right heart multisensor catheters. As expected, ANI caused an acute fall in Ao pressure (27%; p < 0.01) and reflex tachycardia (p < 0.001). Little change was noted in PAP, RVP, RAP, or LV end-diastolic pressures or the time constant of LV isovolumetric relaxation (tau). LV ejection time decreased 23 +/- 10 ms (p < 0.05) and RV ejection time did not change. Baroreflex sensitivity was similar during pressure fall and recovery (6.4 +/- 4.5 vs. 6.1 +/- 3.6 ms/mmHg), however hysteresis (p < 0.05) was noted. Aortic pressure waveforms also changed following ANI. Changes were determined to be in part a consequence of the attenuation and delay in arterial wave reflections. This study extends the understanding of the complex nature of the hemodynamic response associated with ANI.
尽管亚硝酸异戊酯吸入（ANI）作为一种临床上有用的药理应激源比所有当前的短效血管扩张剂出现得更早，但很少有临床医生了解该药物的细微血流动力学作用。本研究检测了7名（年龄44±7岁）接受择期心导管插入术的男性在吸入ANI后左右心血流动力学的瞬态变化。通过左右心多传感器导管同时记录高保真中心主动脉压（AoP）、左心室压（LVP）、肺动脉压（PAP）、右心室压（RVP）和右心房压（RAP）。正如预期的那样，ANI导致主动脉压急性下降（27%；p<0.01）和反射性心动过速（p<0.001）。PAP、RVP、RAP或左心室舒张末期压力以及左心室等容舒张时间常数（tau）几乎没有变化。左心室射血时间减少23±10毫秒（p<0.05），右心室射血时间没有变化。压力下降和恢复期间的压力反射敏感性相似（6.4±4.5对6.1±3.6毫秒/毫米汞柱），但存在滞后现象（p<0.05）。ANI后主动脉压力波形也发生了变化。确定这些变化部分是动脉波反射衰减和延迟的结果。本研究扩展了对与ANI相关的血流动力学反应复杂性质的理解。
