Come P C, Flaherty J T, Baird M G, Rouleau J R, Weisfeldt M L, Greene H L, Becker L, Pitt B
N Engl J Med. 1975 Nov 13;293(20):1003-7. doi: 10.1056/NEJM197511132932001.
Nitroglycerin has been shown to reduce ST-segment elevation during acute myocardial infarction, an effect potentiated in the dog by agents that reverse nitroglycerin-induced hypotension. Our study was designed to determine the effects of combined nitroglycerin and phenylephrine therapy. Ten patients with acute transmural myocardial infarctions received intravenous nitroglycerin, sufficient to reduce mean arterial pressure from 107 +/- 6 to 85 +/- 6 mm Hg (P less than 0.001), for 60 minutes. Left ventricular filling pressure decreased from 19 +/- 2 to 11 +/- 2 mm Hg (P less than 0.001). SigmaST, the sum of ST-segment elevations in 16 precordial leads, decreased (P less than 0.02) with intravenous nitroglycerin. Subsequent addition of phenylephrine infusion, sufficient to re-elevate mean arterial pressure to 106 +/- 4 mm Hg (P less than 0.001) for 30 minutes, increased left ventricular filling pressure to 17 +/- 2 mm Hg (P less than 0.05) and also significantly increased sigmaST (P less than 0.05). Our results suggest that addition of phenylephrine to nitroglycerin is not beneficial in the treatment of patients with acute myocardial infarction.
硝酸甘油已被证明可降低急性心肌梗死期间的ST段抬高，在犬类中，可逆转硝酸甘油所致低血压的药物可增强这一效应。我们的研究旨在确定硝酸甘油与去氧肾上腺素联合治疗的效果。10例急性透壁性心肌梗死患者接受静脉注射硝酸甘油60分钟，剂量足以使平均动脉压从107±6降至85±6 mmHg（P<0.001）。左心室充盈压从19±2降至11±2 mmHg（P<0.001）。16个胸前导联ST段抬高总和SigmaST在静脉注射硝酸甘油后降低（P<0.02）。随后加用去氧肾上腺素输注，剂量足以使平均动脉压在30分钟内重新升至106±4 mmHg（P<0.001），这使左心室充盈压升至17±2 mmHg（P<0.05），且SigmaST也显著升高（P<0.05）。我们的结果表明，在硝酸甘油治疗基础上加用去氧肾上腺素对急性心肌梗死患者的治疗并无益处。
