硝酸甘油在肺栓塞中的作用

Role of nitroglycerin in pulmonary embolism

内皮素具有强而持久的血管收缩功能，在肺栓塞急性期含量升高，引起右心房张力增加、肺血管阻力增加和肺动脉血氧饱和度的下降。降钙素基因相关肽是强的血管扩张因子，与内皮素作用相反，两者的平衡失调在急性肺栓塞的血流动力学变化中起着重要作用。脑钠肽反映心室张力，可以预测急性肺栓塞的预后。从目前研究中推论，硝酸甘油可以分别作用于三者，使各血流动力学指标趋于稳定。同时，硝酸甘油对降低肺动脉高压有肯定的作用，还可减少急性肺栓塞溶栓后的缺血再灌注损伤，在急性肺栓塞与急性心肌梗塞不能鉴别时硝酸甘油可用于早期治疗，因此硝酸甘油在肺栓塞中具有重要作用。

Endothelin has a powerful and lasting function of vasoconstriction. The plasma endothelin level is elevated in the patients with acute pulmonary embolism, which causes the increase of the tension of right atrium and pulmonary vascular resistance, but the decrease of arterial oxygen saturation. Calcitonin gene-related peptide is a strong vessel dilator, which is opposite to endothelin. Disequilibrium of the two factors play important role in haemodynamics change of acute pulmonary embolism. Brain natriuretic peptide can reflect the tension of ventricle, which can anticipate the prognosis of acute pulmonary embolism. From the recent research, it can be deduced that nitroglycerin can affect the three factors respectively, thus, stabilize the hemodynamical indexes. Meanwhile nitroglycerin has affirmative effect in lowering the pulmonary hypertension. It can also reduce the ischemical reperfusion injury, when acute pulmonary embolism can not be distinguished form acute myocardial infarction, nitroglycerin can be chosen to use for early treatment,thus nitroglycorin plays an important role in pulmonary embolism.