单硝酸异山梨酯与硝酸甘油治疗充血性心力衰竭时的血流动力学比较

Isosorbide mononitrate vs nitroglycerin on hemodynamics during congestive heart failure

目的：比较单硝酸异山梨酯与硝酸甘油治疗充血性心力衰竭（ＣＨＦ）时的血流动力学。方法：３１例ＣＨＦ病人分为治疗组２１例，给单硝酸异山梨酯２０ｍｇ，舌下含服，ｂｉｄ×１ｄ；对照组１０例，给硝酸甘油１０～２５μｇ／ｍｉｎ，每隔５～１０ｍｉｎ叠加１０～２５μｇ／ｍｉｎ，当剂量达到最佳血流动力学效应时，该剂量持续静脉滴注共２４ｈ。结果：治疗组用药３０ｍｉｎ起效，平均右房压显著下降，心脏指数显著升高（Ｐ＜０．０１），且维持疗效１０ｈ。对照组在用药３０ｍｉｎ血流动力学５项指标均显著改善（Ｐ＜０．０１），而体循环阻力于用药６０ｍｉｎ才显著改善（Ｐ＜０．０５）。结论：持续滴注硝酸甘油疗效优于舌下含服单硝酸异山梨酯。

AIM: To compare the isosobide mononitrate (Iso) and nitroglycerin (NG) on hemodynamics during congestive heart failure (CHF). METHODS: Thirty-one patients with CHF were divided into 2 groups, Iso group (M 14, F 7; age 58±s 6 a) was given sublingual Iso 20 mg, bid; NG group (M 7, F 3; 59±8 a) was given NG 10-25 μg/min, iv, drip, increased repeatedly 10-15 μg/min, q 5-10 min, and maintained at the dose yielding the best effect on hemodynamics, Hemodynamics was measured with Swan-ganz balloon floating catheter, before medication, immediately and within 24 h after medication. RESULTS: In Iso group 30 min after medication, MRAP (mean right atrial pressure) descended (P<0.05) and the CI (cardiac index) ascended after 1 h (P<0.05). In NG group 30 min after iv drip, MRAP, MPCWP (mean pulmonary capillary wedge pressure), and MPAP (mean pulmonary arterial pressure) all descended (P<0.01). CI and LVSWI(left ventricular stroke work in index) ascended (P<0.01), after iv drip 60 min, SVR(systemic vascular resistance) descended (P<0.05). CONCLUSION: Continuous iv drip NG is better than sublingual Iso on improving in the hemodynamics.