Jugdutt B I
Walter Mackenzie Health Sciences Centre, Division of Cardiology, University of Alberta, Edmonton, Canada.
Heart Vessels. 1994;9(1):3-13. doi: 10.1007/BF01744490.
After a decade of warnings against the use of nitrates in acute myocardial infarction (MI), they are becoming recognized for their potential to salvage left ventricular (LV) myocardium, geometry and function. Low-dose intravenous (IV) nitroglycerin (NTG) infusion for the first 48 h after acute MI, titrated to lower mean blood pressure by 10% to 30%, but not below 80 mmHg, has been shown to be safe, to improve hemodynamics, and to decrease infarct size, infarct expansion, complications, and deaths in a prospective, randomized, single-blind study of 310 patients. In addition, low-dose NTG infusion for the first 48 h, followed by prolonged buccal NTG given during healing after acute MI in an eccentric dose schedule to minimize tolerance, was found to limit further progressive remodeling and preserve LV function. Meta-analysis of nitrate studies in acute MI indicate that they improve survival. Preliminary and ongoing studies suggest that prolonged NTG therapy post MI can produce further benefit.
在经历了十年对急性心肌梗死（MI）患者使用硝酸盐的警告之后，它们挽救左心室（LV）心肌、几何形状和功能的潜力正逐渐得到认可。在一项针对310名患者的前瞻性、随机、单盲研究中，急性心肌梗死后最初48小时内静脉输注低剂量硝酸甘油（NTG），将平均血压降低10%至30%，但不低于80 mmHg，已被证明是安全的，可改善血流动力学，并减少梗死面积、梗死扩展、并发症和死亡。此外，在急性心肌梗死后最初48小时内输注低剂量NTG，随后在愈合期间以偏心剂量方案给予延长的颊下NTG以尽量减少耐受性，发现可限制进一步的进行性重塑并保留左心室功能。急性心肌梗死硝酸盐研究的荟萃分析表明它们可提高生存率。初步和正在进行的研究表明，心肌梗死后延长NTG治疗可产生进一步益处。
