硝酸甘油致心肌缺血效应的心电图评估

Evaluation of electrocardiogram for myocardial ischemia induced by sublingual administration of nitroglycerine

目的用心电图评估舌下含化硝酸甘油致心肌缺血效应。方法采用前瞻、随机、对照设计，将入选的292例门诊患者进行两次分组分析。首先按诊断分为缺血性心脏病组、非缺血性心脏病组和非心脏病组。然后三组患者分别进行硝酸甘油试验，按硝酸甘油试验后血压、心率变化，将所有患者又划分为血压未降低、心跳未加快组和血压降低、心跳加快组。对以上分组后硝酸甘油的心肌效应进行Ridit分析。结果在缺血性心脏病、非缺血性心脏病和非心脏病三组患者中，硝酸甘油均有致心肌缺血效应，且均超过抗心肌缺血效应，有显著性统计学差异（X^2=7．824、P〈0．05）。硝酸甘油试验后，血压、心率变化分组结果显示，两组致心肌缺血效应无明显差异（X^2=0．002，P〉0．05）。结论硝酸甘油对缺血性心脏病、非缺血性心脏病和非心脏病均有致心肌缺血效应，以后者在缺血性心脏病中较甚，这种效应是可逆的。血压下降、心率加快不是硝酸甘油致心肌缺血效应产生的原因。

Objective To evaluate the effect of myocardial ischemia induced by sublingual nitroglycerine with elec-trocardiogram. Methods All selected patients were analyzed twice, according to the prospective, random and contrastive design. Firstly, 292 cases were divided into ischemic heart disease group, non - ischemic heart disease group and non - heart disease group on the basis of clinical diagnosis. All the patients in three groups were divided into decreased blood pressure/accelerated heart rate group and non - decreased blood pressure/non - accelerated heart rate group again, according to the variation of blood pressure and heart rate to the nitroglycerine test performed on them. Ridit analysis was made with the effect of ni- troglycerine on myocardium. Results Myocardial isehemia appeared in all the three groups and showed exceeded the effect of anti - myocardial ischemia（X^2 = 7. 824, P 〈 0. 05 ）. However, the effects of myocardial isehemia were not different between the decreased blood pressure/accelerated heart rate group and the non - decreased blood pressure/non - accelerated heart rate group （X^2 = 0. 002,P 〉 0. 05 ）. Conclusion Nitroglycerine induces myocardial isehemia in selected patients and the effect is reversible. Moreover, myocardial isehemia is the most evident in the patients with ischemic heart disease. Decreased blood pressure and accelerated heart rate are not the cause of myocardial isehemia induced by nitroglycerine.