Lambert C R, Grady T, Hashimi W, Blakely M, Panayioutou H
Division of Cardiology, University of South Alabama College of Medicine, Mobile 36617.
Am J Cardiol. 1993 Feb 15;71(5):420-3. doi: 10.1016/0002-9149(93)90443-g.
Twenty patients were studied during cardiac catheterization to compare hemodynamic and quantitative angiographic effects of intravenous nicardipine and nitroglycerin. After baseline measurements, nicardipine or nitroglycerin was administered by randomized continuous infusion beginning at 10 micrograms/min titrated to achieve a 10 to 12% reduction in systemic arterial pressure. Hemodynamic measurements and angiography were then repeated. Nicardipine did not change heart rate, and a small decrease (82 +/- 4 vs 75 +/- 4 beats/min) was observed with nitroglycerin, whereas mean arterial pressure decreased similarly (-11%) in both groups. Nicardipine increased (+13%) and nitroglycerin decreased (-21%) cardiac output. Although both drugs were associated with significant reductions in pulmonary artery wedge and pulmonary artery pressures, changes were greater with nitroglycerin for pulmonary artery wedge (-49% vs -26%) and pulmonary artery (-39% vs -13%) pressures, whereas only nitroglycerin reduced right atrial pressure significantly. Neither drug altered left ventricular ejection fraction or pulmonary vascular resistance, and only nicardipine decreased systemic vascular resistance significantly. Quantitative coronary angiography (videodensitometry) showed dilation of the left main, proximal, mid and distal anterior descending and circumflex segments by both nitroglycerin and nicardipine. Nicardipine dilated small (< 2 mm2) and large (> 2) arterial segments equally, whereas nitroglycerin showed a proportionately greater effect on small vessels.
对20例患者在心脏导管插入术期间进行了研究，以比较静脉注射尼卡地平和硝酸甘油的血流动力学及定量血管造影效果。在进行基线测量后，随机开始以10微克/分钟的速度持续输注尼卡地平或硝酸甘油，并进行滴定以实现体动脉压降低10%至12%。然后重复进行血流动力学测量和血管造影。尼卡地平未改变心率，而硝酸甘油使心率有小幅下降（82±4次/分钟对75±4次/分钟），两组的平均动脉压下降幅度相似（-11%）。尼卡地平使心输出量增加（+13%），而硝酸甘油使其降低（-21%）。虽然两种药物都与肺动脉楔压和肺动脉压显著降低有关，但硝酸甘油对肺动脉楔压（-49%对-26%）和肺动脉压（-39%对-13%）的降低幅度更大，而只有硝酸甘油能显著降低右心房压。两种药物均未改变左心室射血分数或肺血管阻力，只有尼卡地平能显著降低体循环血管阻力。定量冠状动脉造影（视频密度测定法）显示，硝酸甘油和尼卡地平均可使左主干、前降支近端、中段和远端以及回旋支节段扩张。尼卡地平对小动脉段（<2平方毫米）和大动脉段（>2平方毫米）的扩张程度相同，而硝酸甘油对小血管的作用相对更大。
