硝酸异山梨酯静脉滴注对冠心病血液动力学效应的观察

HEMODYNAMIC ASSESSMENT OF INTRAVENOUS ISOSORBIDE DINITRATE ADMINISTRATION IN CORONARY HEART DISEASE

本文在冠心病、心肌梗塞后患者中用硝酸异山梨酯(ISDN,Isoket)中等剂量静脉滴注,发现用药前后心率、主动脉舒张压、左室收缩压力最大上升速率、心率血压乘积均无显著变化,而左室舒张末期压力(LVEDP)显著下降,左室心肌灌注压力显著升高,提示对心肌缺血的改善有利。用药后LVEDP显著降低而左室收缩压力最大上升速率保持不变,提示用药后左心室能在较低负荷状态下完成同样的收缩作功。

The present study investigated the systemic hemodynamic effects of intravenous isosorbide dinitrats (ISDN, Isoket) on 20 angina patients with angiographically documented coronary lesions or myocardial infarction. Before end after ISDN infusion the following items were recorded or calculated: heart rate (HR): systolic, diastolic and mean pressure in aorta (ASP, ADP, A_P); systolic and mean pressure in left ventricule (LVSP, LV_P);End-diastolic pressure in LV (LVEDP); left ventricular contractility (dp/dt max); the product of HR and LVSP; myocardial perfusion pressure of LV (LVPP). After ISDN, ASP, Ap, LVEDP were decreased while HR, ADP, dp/dt and DP showed no significant change. However, LVEDP was significantly decreased from 2.6±0.9 to 1.6±0.6 kPa (p<0.01) with an increased LVPP from 6.54±1.6 to 7.4±1.7kPa (p<0.01), which may be favourable for the relief of myocardial ischemia. There was no significant change of dp/dt max in the presence of decreased LVEDP after ISDN. It suggests that the left ventricle could maintain normal performance at lower intracardiac volume (preload) in such patients.