Effectiveness and safety of rocuronium or nitroglycerin plus ropivacaine on pain during intravenous regional anesthesia:A double-blind randomized controlled trial

Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 2023.Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital,Arak,Iran.They were allocated by block randomization to three different groups,namely nitroglycerin group,rocuronium group and control group.Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time.Sensory block and motor block onset and duration and pain were also evaluated.The data analysis was carried out by IMB SPSS software 20.0.Results:177 Eligible patients were included in study,with 59 in each group.Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups(P<0.001).Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness.The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups(P=0.009).Conclusions:Nitroglycerin significantly reduces the time to sensory and motor block onset,while rocuronium is more effective in prolonging the time of motor block.Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration,nitroglycerin is associated with a higher prevalence of medication side effects.Therefore,both nitroglycerin and rocuronium can be used as adjuvant for IVRA.The final choice relies on patients’conditions and anesthesiologists’judgment.

Nitroglycerine effects on portal vein mechanics and oxidative stress in portal hypertension

AIM:Тo examine the effects of nitroglycerine on portal vein haemodynamics and oxidative stress in patients with portal hypertension.METHODS:Thirty healthy controls and 39 patients with clinically verified portal hypertension and increasedvascular resistance participated in the study.Liver di-ameters,portal diameters and portal flow velocities were recorded using color flow imaging/pulsed Doppler detection.Cross-section area,portal flow and index of vascular resistance were calculated.In collected blood samples,superoxide anion radical (O 2-),hydrogen per-oxide (H 2 O 2),index of lipid peroxidation (measured as TBARS) and nitric oxide (NO) as a marker of endothelial response (measured as nitrite-NO 2-) were determined.Time-dependent analysis was performed at basal state and in 10th and 15th min after nitroglycerine (sublingual 0.5 mg) administration.RESULTS:Oxidative stress parameters changed sig-nificantly during the study.H 2 O 2 decreased at the end of study,probably via O 2-mediated disassembling in Haber Weiss and Fenton reaction;O 2-increased signifi-cantly probably due to increased diameter and tension and decreased shear rate level.Consequently O 2-and H 2 O 2 degradation products,like hydroxyl radical,initi-ated lipid peroxidation.Increased blood flow was to some extent lower in patients than in controls due to double paradoxes,flow velocity decreased,shear rate decreased significantly indicating non Newtonian char-acteristics of portal blood flow.CONCLUSION:This pilot study could be a starting point for further investigation and possible implemen-tation of some antioxidants in the treatment of portal hypertension.

Preventive Effects of Nitroglycerine on Glucocorticoid-induced Osteoporosis in Growing Rats

The preventive effects of nitroglycerine （NG） on glucocorticoid-induced osteoporosis in growing rats were studied. Three-month-old female Wistar rats were randomly divided into control group （CON）, dexamethasone group （DXM）, DXM plus a low dose NG group （NG-L）, DXM plus a middle dose NG group （NG-M） and DXM plus a high dose NG group （NG-H）, 8 rats in each group. The rat model of osteoporosis was developed by intramuscular injection of dexamethasone twice a week. NG 0.2, 0.4 and 1.0 mg/kg was administered by oral gavages to the treatment groups every day for 12 weeks. Rats in CON group and DXM group were treated with normal saline of the same amount. After the treatment, the bone mineral density （BMD） and bone metabolism-associated biochemical markers were determined. Compared with CON group, BMD of lumbar spine and femur in DXM group was decreased significantly （P〈0.05 and P〈0.01 respectively）, blood BGP levels and NO levels reduced （both P〈0.01）, and TRAP level increased （P〈0.05）. As compared with DXM group, BMD, serum BGP and NO were increased, and TRAP decreased in NG-L group and NG-M group, but had no significant difference in comparison to CON group. All the markers other than serum NO and TRAP levels had no significant difference between NG-H group and DXM group. It was concluded that low or middle doses of NG could prevent glucocorticoid-induced bone loss in growing rats, but high dose of NG could not. Supplement with NO donor could be considered as a preventive treatment for glucocorticoid-induced osteoporosis in a developing skeleton.

Fullerene bisadduct stabilizers:The effect of different addition positions on inhibiting the autocatalytic decomposition of nitrocellulose absorbed nitroglycerin

To explore the effect of different positions and number of pyrrolidine bound to the carbon cage on the stabilization effect of fulleropyrrolidine derivatives to nitrocellulose(NC)/nitroglycerine(NG),we synthesized N-(4-methoxy)phenylpyrrolidine-C_(60) and four different of bis(N-(4-methoxy)phenylpyrrolidine)-C_(60) compounds through Prato reaction.Their structures were characterized by UVevis,^(1)H NMR,^(13)C NMR,high-resolution mass spectroscopy,and single-crystal X-ray diffraction.Their stabilization effect to NC/NG were investigated using differential scanning calorimetry,methyl violet,vacuum stabilization effect,weight loss,and accelerating rate calorimeter tests.The results indicated these compounds had excellent stabilization effect to NC/NG.The stabilization effect of the fulleropyrrolidine bisadducts to NC/NG is significantly better than that of fulleropyrrolidine monoadduct and C_(60).Moreover,the position where pyrrolidine binds to fullerene in fulleropyrrolidine bisadducts is different,and its stabilization effect to NC is also different.The stabilization effect order of different bisadduct isomers to nitrocellulose is as follows:e-edge>trans-2>cis-2>trans-3.Electron paramagnetic resonance(EPR)and FT-IR were used to study the stabilization mechanism of fulleropyrrolidine derivatives to NC/NG.The EPR results also show that fulleropyrrolidine bisadducts with different addition sites have different abilities to absorb nitroxide,and their ability is better than that of the monoadduct and C_(60),which is consistent with the results of stabilization effect performance test.

Nitroglycerin reduces augmentation index and central blood pressure independent of effects on cardiac preload

Objective To determine whether reduction in central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-load or is due to arterial dilation. Methods We compared effects of NTG with those of lower body negative pressure (LBNP). Hemodynamic measurements were made at rest,during LBNP (10,20 and 30 mmHg,each for 15 min) and after NTG (10,30 and 100 μg/min,each dose for 15 min) in ten healthy volunteers. Cardiac pre-load,stroke volume and cardiac output were assessed by echocardiography. Central pressure augmentation and central systolic pressure were obtained by radial tonometry using a transfer function. Results LBNP (20 mmHg) and NTG (30 μg/min) reduced pre-load (as measured by the peak velocity of the S wave in the superior vena cava) to a similar degree [by (26.8±3.8)% and (23.9±3.4)%,respectively]. Compared to LBNP,NTG reduced systemic vascular resistance [by (32.9±7.5)%,P<0.01],decreased peripheral and central pressure augmentation [by (20.8±3.4)% units and (12.9±2.9)% units,respectively,each P<0.01]. Conclusion These results suggest that a reduction in pre-load does not explain reduction in pressure augmentation and central systolic blood pressure by NTG and that these effects are mediated through arterial dilation.

“Dermal Nitroglycerin Patch” in Treatment of Preterm Labour

Although preterm birth is the delivery before 37 + 0 weeks of gestation, the majority of prema-turity-related complications occur before 33 + 0 weeks of gestation. The need of today is to select the best agent out of the broad spectrum of available tocolytic agents, for providing maximum benefit to unfortunate sufferers of prematurity. The study aims to assess the role of “Dermal Nitroglycerin Patch” in treatment of preterm labour. Method: Study conducted in Department of Obstetrics & Gynecology, NIMS Medical College & Hospital, Jaipur from July 2014-December 2014. A prospective randomized study of 50 women of preterm labor was enrolled after informed consent. Patients were given dermal nitroglycerin patch as tocolytic agent according to study protocol. Result: 1) Results of NTG PATCH are comparable with other tocolytic drugs in terms of successful tocolysis;2) Maternal and fetal outcome is favourable in cases of NTG PATCH USE in preterm labour;3) Side effect profile was also better with NTG Patch. Conclusion: This randomized prospective study lends support to the proportion that Transdermal Nitroglycerine (NTG Patch) may be promising safe, effective, well tolerated, cost effective and non invasive method of tocolysis.

EFFECT OF ANGIOTENSIN II RECEPTOR ANTAGONIST AND ENDOTHELIN RECEPTOR ANTAGONIST ON NITROGLYCERIN TOLERANCE IN RATS

Objective. To investigate whether angiotensin II receptor antagonist and endothelin receptor antagonist can improve the nitroglycerin (Nit) tolerance in vivo. Methods. Twenty- four rats were divided into 4 groups (n=6,each): Control group, Nitroglycerin (Nit) group, Nit＋ bosentan group and Nit＋ losartan group. Nitroglycerin tolerance was induced by 2- day treatment of nitroglycerin patch (0.05 mg/h). AngiotensinⅡ receptor antagonist losartan ( 10 mg· kg－ 1· d－ 1 ) and endothelin receptor antagonist bosentan ( 100 mg· kg－ 1· d－ 1 ) were given by gavage for 2 days respectively. Results. The least hypotensive response to sodium nitroprusside (SNP) was observed in Nit group . The effective percentages of hypotensive response to SNP were increased in both Nit＋ losartan group and Nit＋ bosentan group compared with Nit group [(31.95± 4.45 )％ vs (21.00± 3.69 )％ , P< 0.01 and (33.18± 6.16 )％ vs (21.00± 3.69 )％ , P< 0.01 ,respectively]. The maximal vessel relaxation induced by SNP was the same in 4 different groups but the highest EC50 (concentration which produces 50％ of the maximal response to SNP) was found in tolerant group[(34± 10) nmol/ L,P < 0.01 .The ET- 1 amounts in plasma and vascular tissue were markedly increased by 54％ and 60％ in Nit group compared with those in control group(P< 0.01).The ET- 1 amounts in plasma and vascular tissue were decreased by 30％ and 37％ in Nit＋ losartan group compared with those in Nit group (P< 0.01). Conclusion. Endothelin receptor antagonist and angiotensinⅡ receptor antagonist could prevent against the Nit tolerance .

Perioperative Changes of Plasma Endothelin-1 in Patients Undergoing Coronary Artery bypass Grafting and the Effect of Nitroglycerin

Objective To observe the dynamic changes of the plasma ET 1 and the effect of low dose nitroglycerin in patients with coronary artery bypass surgery. Methods\ Forty patients with coronary artery bypass surgery were divided into two group: A and B. Group B received intravenous nitroglycerin 1 μg·kg\+\{ 1\}·min\+\{ 1\} perioperatively. RIA was used to assay the plasma ET 1 level. All the hemodynamic parameters were recorded by the Swan Ganze catheter. Results\ The preoperative plasma ET 1 level in patients with coronary artery disease was significantly higher than the normal level. Five minutes after cardiopulmonary bypass in these patients the plasma ET 1 level was increased significantly until 6 to 8 h after operation. The increasing plasma ET 1 level in group B was less intense than that in group A. There was a positive correlation between the plasma ET 1 level and the mean pulmonary artery pressure in group A 2 and 8 h after operation. Conclusion\ In patients undergoing coronary artery bypass surgery, the increased plasma ET 1 level may be due to the influence of cardiopulmonary bypass partly. Low dose nitroglycerin is beneficial to these patients.

Joint Effects of Mexidol and Nitroglycerine on Nitric Oxide Formation in Animal Liver Tissues

This work is investigating Mexidol (2-ethyl-6-methyl-3-hydroxy pyridine succinate) effect on the formation of nitric oxide (NO) in animal liver tissues, which is a regulator of many physiological processes and plays an important role in the vascular relaxation, neurotransmission and immune system functioning. Analyses performed by EPR spectroscopy revealed Hem-NO complex signals from paramagnetic centers in arbitrary units;produced nitrogen oxide amount in liver tissues was determined by method of double integration signals from nitrosyl complexes.

Effects of Nitroglycerine on Erythrocyte Rheology:A Novel Mechanism to Explain the Enhancement of Nutrient Blood Flow to Ischemic Zones

Objectives Nitroglycerine (NTG) enhances coronary blood flow to compromised myocardium is important in relieving ischemia. However, the mechanism for this increase in myocardial blood flow (MBF) is not well defined. In small vessels and capillaries, relative blood viscosity plays a very important role in determining myocardial vascular resistance (MVR). MVR reduce is due partly to the increase in negative charge of erythrocyte surface. We therefore hypothesized that the enhancement of nutrient blood flow to zones of myocardial ischemia during NTG is partly secondary to reduced MVR and blood flow viscosity. The latter is affected by the negative charge of erythrocyte surface. Methods 6 dogs with LAD flow-limiting stenosis (group 1) and 6 dogs with LAD flow-limiting stenosis and LCx occmusion (group 2) were studied. At baseline and during intracoronary infusions of NTG (0.3-0.6 μg·kg-1·min-1), hemodynamics, MBF (mL·min-1·g-1), whole blood viscosity (WBη, mPa. S), elongation index (EI), eletrophoretic mobility of erythocytes (EME, [μ.s-1)/(V.cm-1)]) and percent wall thickening (%WT) were determined. MVR was calculated using driving pressure/MBF. Results As compared to baseline, no changes in hemodynamics were seen during NTG. MBF increased and MVR decreased significantly in normal bed, the central 25% and the entire of stenosed bed (P<0.05), with a decrease in WBη in both group 1 and group 2 dogs (18.6±9.7 % and 19.2±14.5 %, respectively). However, the % decrease in WBη was proportioned to the % increase in MBF or the % decrease in MVR only in the central 25% of stenosed bed (r=0.87, P<0.001), but not in the entire stenosed bed and normal bed. EI did not show statistically significant differences between during NTG and at baseline, but EME did increase. And the % decrease in WBη during NTG was related to the % increase in EME (r=0.83, P=0.01). Conclusions NTG reduced myocardial vascular resistance and blood viscosity due to the change of negative charge of erythrocyte surface may, in part, be the mechanism of the enhancement of nutrient blood flow to zones of myocardial ischemia. These results provide additional insights into the complex anti-ischemic effects of NTG.

电针对硝酸甘油致偏头痛小鼠疼痛行为及三叉神经血管系统的影响

目的观察电针对硝酸甘油致偏头痛小鼠疼痛行为及三叉神经血管功能的影响,探讨其可能作用机制。方法将20只C57BL/6雄性小鼠随机分为对照组、模型组、假针组、电针组,每组5只。除对照组外,其余组小鼠于实验第1,3,5,7,9,11,13天给予10 mg/kg硝酸甘油腹腔注射建立慢性偏头痛模型。在每次注射后30 min,电针组和假针组进行电针干预。实验当天(第0天)注射前及实验第2,4,6,8,10,12,14天分别检测小鼠眶周机械痛阈及后足机械痛阈、热痛痛阈;实验第14天,采用ELISA法检测血清一氧化氮(NO)和降钙素基因相关肽(CGRP)水平,采用免疫荧光和Western blot法检测三叉神经节中c-Fos蛋白表达情况。结果实验第6,8,10,12,14天,模型组小鼠的眶周机械刺激反应评分均明显高于同期对照组(P均<0.05);实验第10,12,14天,电针组小鼠的眶周机械刺激反应评分均明显低于同期模型组(P均<0.05),且电针组小鼠实验第12,14天的眶周机械刺激反应评分均明显低于同期假针组(P均<0.05)。实验第8,10,12,14天,模型组小鼠的后足50%撤退阈值均明显低于同期对照组(P均<0.05),后足热痛撤退潜伏期均明显短于同期对照组(P均<0.05);实验第10,12,14天,电针组小鼠的后足50%撤退阈值均明显高于同期模型组(P均<0.05),后足热痛撤退潜伏期均明显长于同期模型组(P均<0.05),且电针组小鼠实验第12,14天的后足50%撤退阈值明显高于同期假针组(P均<0.05),后足热痛撤退潜伏期均明显长于同期假针组(P均<0.05)。模型组小鼠血清NO、CGRP水平和三叉神经节中c-Fos阳性表达平均光密度、c-Fos蛋白相对表达量均明显高于对照组(P均<0.05),而电针组各指标均明显低于模型组(P均<0.05)。结论电针能明显改善硝酸甘油致慢性偏头痛小鼠的疼痛行为,其可能是通过降低血清NO、CGRP水平及三叉神经敏化蛋白c-Fos的表达,从而改善三叉神经血管功能障碍实现的。

高效液相色谱法测定室温下硝酸甘油注射液的存贮期限

目的高效液相色谱法测定硝酸甘油注射液在室温下的含量变化,预测硝酸甘油注射液在室温下的存贮期限。方法(1)HPLC法测定硝酸甘油注射液的含量。采用色谱柱(Kromasil C18),以甲醇:水(59:41)为流动相,流速1.0 ml·min^(-1),检测波长215 nm,柱温30℃;(2)采用加速试验和长期留样试验对硝酸甘油注射液的稳定性进行研究,经典恒温试验预测其在室温下的有效期。结果硝酸甘油注射液检测浓度在10μg·ml^(-1)-600μg·ml^(-1)范围内与峰面积呈良好的线性关系(R=0.9999),日内精密度、日间精密度、稳定性试验、重复性实验RSD均小于2%,含量测定平均值在99.99μg·ml^(-1)(标准值100μg·ml^(-1)),加样回收率RSD为1.67%。经典恒温试验测得硝酸甘油的含量变化符合一级反应规律,在25℃,硝酸甘油注射液的速率变化常数K_(25)=7.1395×10^(-4),有效贮存期限为147 d;在30℃时,K_(30)=9.4175×10^(-4),有效贮存期限为111 d。长期留样观察实验可以验证该实验的可靠性。结论高效液相色谱法检测方法简单、快速、精密度高,重复性好。硝酸甘油注射液在室温(25℃)下的存储期限约5个月,可以为临床管理抢救车药品提供参考依据。

硝酸甘油溶液及其制剂有关物质测定方法优化

目的 优化硝酸甘油溶液及其制剂有关物质的测定方法。方法 更换现行标准2020年版《中国药典(二部)》高效液相色谱(HPLC)法中的流动相,采用梯度洗脱,并优化系统适用性溶液的制备方法。色谱柱为Ecosil 120-5-C18AQ柱(250 mm×4.6 mm,5μm),流动相为水-甲醇(梯度洗脱),流速为1.0 mL/min,检测波长为215 nm,柱温为30℃,进样量为20μL。结果 硝酸甘油的定量限和检测限分别为0.21μg/mL和0.07μg/mL。精密度、稳定性试验结果的RSD均小于2.0%。优化HPLC条件后成功分离了硝酸甘油与已知杂质2-硝酸甘油、1-硝酸甘油、1,3-二硝酸甘油、1,2-二硝酸甘油;明确了游离硝酸根扣除问题;参考British Pharmacopoeia2023并结合样品测定情况,拟订除硝酸根外,4个已知杂质均不得过0.5%,其余单个最大杂质溶液不得过0.1%、注射液和片剂不得过0.5%,杂质总量溶液和注射液不得过1.5%,、片剂不得过2.0%。结论 建立的方法准确、快速、专属性强,适用于硝酸甘油溶液及其制剂的有关物质检查,为加强本品的质量控制和进一步的质量标准修订提供参考。

中国急性ST段抬高型心肌梗死患者院前应用硝酸甘油或中成药对症状改善及梗死相关动脉血流影响的比较研究

目的:比较中国急性ST段抬高型心肌梗死(STEMI)患者院前应用硝酸甘油或中成药对症状改善及对梗死相关动脉(IRA)血流的影响。方法:依托中国急性心肌梗死注册研究于2013年1月1日至2014年3月31日期间,纳入全国108家医院7 d内发病且明确报告院前使用或不使用硝酸甘油或中成药的13064例STEMI患者(已排除共用两类药物患者),其中5280例患者接受了急诊冠状动脉造影。对比使用两类药物对患者症状缓解及IRA的TIMI血流分级水平的影响,其中症状缓解包括完全缓解(症状消失)和部分缓解(不同程度缓解)。结果:13064例患者中,2892例(22.1%)院前应用了硝酸甘油或中成药,其中1149例(8.8%)使用了硝酸甘油,1743例(13.3%)使用了中成药,10172例院前未用药。应用硝酸甘油或中成药的患者,6 h内到达医院的比例(57.4%vs.60.8%vs.50.3%,P<0.0010),与使用院前急救系统的比例(11.8%vs.12.2%vs.9.5%,P=0.0004)均高于未用药的患者。使用硝酸甘油的患者部分缓解比例高于使用中成药的患者(33.8%vs.25.1%,P<0.0010)。多因素Logistic分析显示,使用硝酸甘油较使用中成药完全和部分缓解的可能性较高(OR=1.331,95%CI:1.129~1.569,P=0.0007)。使用硝酸甘油或中成药的患者与未用药患者的院内死亡率相似。在接受急诊冠状动脉造影的患者中,使用中成药或硝酸甘油及未用药患者IRA的TIMI血流达到2~3级的比例分别为21.6%、15.8%和19.3%(P=0.0405)。多因素Logistic回归分析显示,与未用药患者相比,使用中成药患者的TIMI血流达到2~3级水平无明显优势(OR=0.856,95%CI:0.705~1.040,P=0.1171),使用硝酸甘油的患者TIMI血流达到2~3级水平可能性降低(OR=0.666,95%CI:0.495~0.895,P=0.0071)。结论:中国约有22.1%的STEMI患者院前单用硝酸甘油或中成药,含服硝酸甘油对症状改善作用优于中成药,与未用药患者相比,应用这两类药物的患者的TIMI血流未见明显改善。

硝酸甘油软膏联合九华痔疮栓治疗混合痔患者术后疼痛的疗效观察

目的:探究硝酸甘油软膏联合九华痔疮栓对混合痔患者术后疼痛的疗效观察。方法:选取2022年5月—2022年11月入住安徽中医药大学第一附属医院肛肠二科并行混合痔外剥内扎术治疗的混合痔患者,共70例。随机分成对照组和观察组,每组35例。其中对照组患者术后予肛泰软膏换药,九华痔疮栓1粒纳肛,1次/d;观察组患者术后予硝酸甘油软膏换药,其余同对照组。比较2组患者术后疼痛程度、追加止痛药的使用率、创缘水肿以及不良反应。结果:治疗期间,观察组术后第4天和首次排便的疼痛视觉模拟评分法评分均低于对照组;观察组术后第4天追加止痛药的使用率为11.43%,显著优于对照组(37.14%);术后第4天、第7天创缘水肿评分,观察组的视觉模拟评分法评分低于对照组,差异均有统计学意义。结论:硝酸甘油软膏联合九华痔疮栓可减轻混合痔患者术后的肛门疼痛,减少创缘水肿的发生率,有利于促进创面的修复。

硝酸甘油在早产儿外周组织缺血应用1例并文献复习

目的:总结硝酸甘油在新生儿外周组织缺血中的应用。方法:回顾性分析2022年3月我院1例硝酸甘油治疗早产儿外周组织缺血的临床资料,检索中国知网、万方和PubMed数据库筛选使用硝酸甘油治疗新生儿外周组织缺血患儿的临床资料,采用描述性统计分析方法。结果:本研究1例早产儿经外周置入中心静脉导管(PICC)置管1 h后,穿刺肢体发生外周组织缺血,常规处理8 h无改善后使用硝酸甘油成功治愈。本研究(1例)及文献报道(47例)共48例新生儿发生外周组织缺血首次使用硝酸甘油的中位时间为外周组织缺血发生后3(0,192)h,中位治疗时间2(0.02,32)d。79.2%(38/48)患儿完全康复,20.8%(10/48)发生组织坏死;95.8%(46/48)顺利出院,4.2%(2/48)在后续治疗中死亡。结论:硝酸甘油在新生儿外周组织缺血治疗中有良好的疗效和安全性,早期应用效果显著。

《中国药典》2020年版硝酸甘油片质量标准增修订建议

目的:针对《中国药典》2020年版二部硝酸甘油片质量标准中色谱条件不能有效分离4个已知杂质及游离硝酸根与辅料未能分离的问题,对该质量标准提出增修订建议。方法:采用高效液相色谱法,通过梯度洗脱的方法检查有关物质,同时通过另一色谱系统检查游离硝酸根的量。结果:按改进方法进行有关物质及游离硝酸根检查,11批硝酸甘油片的1-硝酸甘油及2-硝酸甘油均小于0.1%,1,2-二硝酸甘油及1,3-二硝酸甘油均小于0.5%,杂质总量均不过2.4%,游离硝酸根均不过6.3%。结论:本改进方法操作简单,实验结果准确可靠,为《中国药典》2020年版二部中硝酸甘油片质量标准增修订提供了参考。

Effect of Aldehyde Dehydrogenase 2 Gene Polymorphism on Hemodynamics After Nitroglycerin Intervention in Northern Chinese Han Population

Background：Nitroglycerin （NTG） is one of the few immediate treatments for acute angina.Aldehyde dehydrogenase 2 （ALDH2） is a key enzyme in the human body that facilitates the biological metabolism of NTG.The biological mechanism of NTG serves an important function in NTG efficacy.Some reports still contradict the results that the correlation between ALDH2 gene polymorphisms and NTG and its clinical efficacy is different.However,data on NTG measurement by pain relief are subjective.This study aimed to investigate the influence ofALDH2 gene polymorphism on intervention with sublingual NTG using noninvasive hemodynamic parameters of cardiac output （CO） and systemic vascular resistance （SVR） in Northern Chinese Han population.Methods：This study selected 559 patients from the Affiliated Hospital of Qingdao University.A total of 203 patients presented with coronary heart disease （CHD） and 356 had non-CHD （NCHD） cases.All patient ALDH2 genotypes （G504A） were detected and divided into two types：Wild （GG） and mutant （GA/AA）.Among the CHD group,103 were wild-type cases,and 100 were mutant-type cases.Moreover,196 cases were wild-type,and 160 cases were mutant type among the NCHD volunteers.A noninvasive hemodynamic detector was used to monitor the CO and the SVR at the 0,5,and 15 minute time points after medication with 0.5 mg sublingual NTG.Two CO and SVR indicators were used for a comparative analysis of all case genotypes.Results：Both CO and SVR indicators significantly differed between the wild and mutant genotypes at various time points after intervention with sublingual NTG at 5 and 15 minutes in the NCHD （F =16.460,15.003,P =0.000,0.000） and CHD groups （F =194.482,60.582,P =0.000,0.000）.All CO values in the wild-type case of both NCHD and CHD groups increased,whereas those in the mutant type decreased.The CO and △CO differences were statistically significant （P 〈 0.05; P 〈 0.05）.The SVR and △SVR changed between the wild-and mutant-type cases at all-time points in both NCHD and CHD groups had statistically significant differences （P 〈 0.05; P 〈 0.05）.Conclusion：ALDH2 （G504A） gene polymorphism is associated with changes in noninvasive hemodynamic parameters （i.e.CO and SVR） after intervention with sublingual NTG.This gene polymorphism may influence the effect of NTG intervention on Northern Chinese Han population.

银杏酮酯滴丸对稳定型心绞痛患者心绞痛发作及外周血miR-29a、ICAM-1水平的影响

目的观察银杏酮酯滴丸对稳定型心绞痛患者心绞痛发作及外周血microRNA-29a(miR-29a)、细胞间黏附分子-1(ICAM-1)水平的影响。方法研究选取2022年1月至2023年12月,就诊于长沙市第四医院心内科的78例稳定型心绞痛患者,将患者采用随机数字表法随机分为常规组和中成药组各39例。常规组给予常规西药治疗,中成药组在常规组基础上联合银杏酮酯滴丸治疗。观察两组心绞痛发作情况、心电图平板运动试验指标、血液流变学、6 min步行试验距离、中医症状评分及外周血miR-29a、ICAM-1变化,统计两组硝酸甘油停减率和不良反应发生率。结果两组治疗前心绞痛发作情况比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后每周发作次数、每周硝酸甘油用量、单次持续时间降低,中成药组较常规组更低(P<0.05)。两组治疗前心电图平板运动试验指标比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后诱发阳性时间、运动终止时间、最大ST下降时间增加,中成药组诱发阳性时间、最大ST下降时间较常规组更高,运动终止时间与治疗前比较,差异无统计学意义(P>0.05);两组治疗后最大ST下降幅度、ST恢复时间降低,中成药组较常规组更低(P<0.05)。两组治疗前miR-29a、ICAM-1、血液流变学比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后ICAM-1及全血高/低切黏度、FIB、血小板凝聚率、血浆黏度降低,中成药组较常规组更低(P<0.05);两组治疗后miR-29a与治疗前比较,差异无统计学意义(P>0.05)。两组治疗前6 min步行试验距离、中医症状评分比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后6min步行试验距离增加,中成药组较常规组更高(P<0.05);两组治疗后中医症状评分降低,中成药组较常规组更低(P<0.05)。中成药组硝酸甘油停减率(79.49%,31/39)高于常规组(56.41%,22/39),不良反应发生率(7.69%,3/39)与常规组(5.13%,2/39)比较,差异无统计学意义(P>0.05)。结论银杏酮酯滴丸治疗稳定型心绞痛患者可改善心肌缺血程度和血液流变学,减少心绞痛发作,降低ICAM-1水平,提高硝酸甘油停减率。

前壁STEMI直接PCI后伴心力衰竭的药物治疗疗效对比研究

目的探究前壁急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)后伴心力衰竭的药物治疗疗效对比。方法选取云浮市人民医院心血管内科2021年7月—2023年6月期间住院的90例前壁STEMI直接PCI后伴心力衰竭患者,按照随机数字表法将其分为A、B、C三组,各30例。A组采用呋塞米+硝酸甘油治疗,B组采用呋塞米+硝酸甘油+新活素治疗,C组采用呋塞米+硝酸甘油+多巴胺治疗。对比三组治疗后的临床疗效、心功能[左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、氨基末端B型利钠肽前体(NT-ProBNP)]及临床指标。结果①三组治疗总有效率相比(P<0.05);其中B、C两组治疗总有效率均明显高于A组(P<0.05);②治疗3 d后,三组LVEF水平均升高(P>0.05),NT-ProBNP、LVESD、LVEDD水平均降低,且B、C两组较A组NT-ProBNP、LVESD、LVEDD水平较低(P<0.05);③三组患者住院时间、再次入院率比较,差异具有统计学意义(P<0.05);其中B、C两组住院时间、再次入院率低于A组(P<0.05)。结论呋塞米+硝酸甘油联合新活素或多巴胺治疗前壁STEMI直接PCI后伴心力衰竭患者疗效更加显著,能够改善患者心功能,缩短住院时间,降低再次入院率,值得临床推广。