Muikku O, Hynynen M, Salmenperä M, Nieminen M S
Department of Cardiothoracic Anaesthesia, Helsinki University Central Hospital, Finland.
Acta Anaesthesiol Scand. 1996 Sep;40(8 Pt 1):909-12. doi: 10.1111/j.1399-6576.1996.tb04559.x.
Severe preoperative pulmonary hypertension predicts a poor outcome after heart transplantation and therefore pulmonary vasoreactivity is frequently evaluated in the pretransplantation screening. Among the i.v. organic nitrates used in this evaluation, isosorbide dinitrate and nitroglycerin differ in their pharmacokinetics, and isosorbide dinitrate has been suggested to be more selective in its effects on pulmonary vasculature than nitroglycerin.
Haemodynamic effects of nitroglycerin and isosorbide dinitrate were compared in 8 patients with end-stage cardiomyopathy. Each patient was given increasing i.v. infusion-doses of the two nitrates in a random order and double-blind and cross-over fashion until the target of at least 25% decrease in mean pulmonary artery pressure was achieved.
A total dose of 11 (3-20) (mean, 95% confidence interval) microgram kg-1 of nitroglycerin and that of 87 (12-161) micrograms kg-1 of isosorbide dinitrate were given during the infusions of 20 (14-27) and 28 (18-37) min duration, respectively. With these doses producing similar acute decreases in mean pulmonary artery pressure, both nitroglycerin and isosorbide dinitrate also showed equal effects on pulmonary and systemic vascular resistances as well as on other systemic and right ventricular haemodynamic parameters.
We conclude that there is no difference between i.v. nitroglycerin and isosorbide dinitrate in their selectivity on the pulmonary vasculature in patients with end-stage cardiomyopathy.
术前严重肺动脉高压预示心脏移植术后预后不良，因此在移植前筛查中常评估肺血管反应性。在用于该评估的静脉注射有机硝酸盐中，二硝酸异山梨酯和硝酸甘油的药代动力学不同，有人认为二硝酸异山梨酯对肺血管系统的作用比硝酸甘油更具选择性。
比较了8例终末期心肌病患者使用硝酸甘油和二硝酸异山梨酯的血流动力学效应。每位患者以随机、双盲和交叉方式接受两种硝酸盐递增的静脉输注剂量，直至平均肺动脉压至少降低25%的目标达成。
输注期间，硝酸甘油的总剂量为11（3 - 20）（均值，95%置信区间）微克/千克，持续时间为20（14 - 27）分钟；二硝酸异山梨酯的总剂量为87（12 - 161）微克/千克，持续时间为28（18 - 37）分钟。这些剂量使平均肺动脉压产生相似的急性下降，硝酸甘油和二硝酸异山梨酯对肺血管阻力和全身血管阻力以及其他全身和右心室血流动力学参数的影响也相同。
我们得出结论，对于终末期心肌病患者，静脉注射硝酸甘油和二硝酸异山梨酯对肺血管系统的选择性没有差异。
