Bussmann W D, Schöfer H, Kaltenbach M
Eur J Cardiol. 1978 Aug;8(1):61-74.
In 24 patients with acute myocardial infarction intravenous nitroglycerin in 2 different dosages was administered and the effect on hemodynamics and extent of myocardial ischemia was investigated. According to the initial left ventricular filling pressure (LVFP) the patients were divided in Group I: LVFP below 20 mm Hg (13 patients) and in Group II: LVFP above 20 mm Hg (11 patients). Following an infusion of 3 mg of nitroglycerin in the first and 6 mg in the second hour, a significant decrease (P less than 0.0001) in the filling pressure (in Group I from 15 +/- 4 to 9 +/- 3 (+/-1 SD) and in Group II from 28 +/- 11 to 16 +/- 7 mm Hg) was observed. The mean arterial pressure decreased in both groups by an average of 9 mm Hg. The changes in the heart rate were minimal. The cardiac output decreased in Group I from 4.4 +/- 1.0 to 3.9 +/- 0.8 1/min (P less than 0.005) whereas in the group with left ventricular failure it increased significantly from a lowered initial value (3.4 +/- 1.0 to 4.0 +/- 1.1 1/min) (P less than 0.001). By using precordial mapping for estimation of ischemic injury in 12 patient sigma ST elevation decreased from 14.6 +/- 11.9 to 12.2 +/- 9.8 mV at a dose of 3 mg/h (P less than 0.03). The dose of 6 mg/h, however, was less effective on the extent of myocardial ischemia than 3 mg/h. Thus, the dosage of nitroglycerin may be critical in respect to infarct size, despite the beneficial hemodynamic effects of the drug.
对24例急性心肌梗死患者静脉输注两种不同剂量的硝酸甘油，研究其对血流动力学及心肌缺血范围的影响。根据初始左心室充盈压（LVFP），将患者分为两组：I组，LVFP低于20 mmHg（13例）；II组，LVFP高于20 mmHg（11例）。在第1小时输注3 mg硝酸甘油，第2小时输注6 mg硝酸甘油后，观察到充盈压显著降低（P<0.0001）（I组从15±4降至9±3（±1标准差），II组从28±11降至16±7 mmHg）。两组平均动脉压平均下降9 mmHg。心率变化极小。I组心输出量从4.4±1.0降至3.9±0.8 l/min（P<0.005），而左心室衰竭组心输出量从较低的初始值显著增加（3.4±1.0至4.0±1.1 l/min）（P<0.001）。通过胸前区心电图描记法评估12例患者的缺血损伤，在3 mg/h剂量时，ST段抬高从14.6±11.9降至12.2±9.8 mV（P<0.03）。然而，6 mg/h剂量对心肌缺血范围的效果不如3 mg/h剂量。因此，尽管硝酸甘油具有有益的血流动力学效应，但其剂量对于梗死面积可能至关重要。
