Kaplan J A, Dunbar R W, Jones E L
Anesthesiology. 1976 Jul;45(1):14-21. doi: 10.1097/00000542-197607000-00004.
The effects of an intravenous infusion of nitroglycerin were studied in 20 acutely hypertensive patients during coronary-artery surgery. Eight patients had histories of essential hypertension and six had been treated for it. They were anesthetized with morphine, diazepam, N2O, O2, pancuronium, and enflurane. Control measurements were obtained after sternotomy. Nitroglycerin was then administered until the blood pressure returned to normal, and the measurements then repeated. The mean dose of nitroglycerin was 80.0 +/- 4.7 mug/min, or 0.96 mug/kg/min. This produced significant decreases (P less than .05) in systolic, diastolic, and mean arterial blood pressures, central venous pressure, pulmonary capillary wedge pressure, systemic vascular resistance, and left ventricular stroke work index. Cardiac index, stroke index, and heart rate were unchanged. Two indices of myocardial oxygen demand (rate-pressure product and tension-time index) were significantly decreased by nitroglycerin (P less than .005). Fifty per cent of the patients had improvement in ST-segment depression on the electrocardiogram. These findings demonstrate that nitroglycerin can be safely administered intravenously during operation, and suggest that nitroglycerin decreases myocardial oxygen demand and relieves myocardial ischemia.
在20例冠状动脉手术期间的急性高血压患者中研究了静脉输注硝酸甘油的效果。8例患者有原发性高血压病史，6例曾接受过治疗。他们用吗啡、地西泮、N2O、O2、泮库溴铵和恩氟烷麻醉。胸骨切开术后进行对照测量。然后给予硝酸甘油直至血压恢复正常，然后重复测量。硝酸甘油的平均剂量为80.0±4.7μg/min，或0.96μg/kg/min。这使收缩压、舒张压和平均动脉压、中心静脉压、肺毛细血管楔压、全身血管阻力和左心室每搏功指数显著降低（P<0.05）。心脏指数、每搏指数和心率未改变。硝酸甘油使两项心肌需氧量指标（心率-血压乘积和张力-时间指数）显著降低（P<0.005）。50%的患者心电图ST段压低有所改善。这些发现表明硝酸甘油在手术期间可安全地静脉给药，并提示硝酸甘油可降低心肌需氧量并缓解心肌缺血。
