【摘要】 目的：探讨静脉滴注硝酸甘油（ｎｉｔｒｏｇｌｙｃｅｒｉｎ， ＮＴＧ）对室间隔缺损合并充血性心力衰竭婴幼儿血流动力学影响。方法：１５ 例室间隔缺损合并充血性心力衰竭婴幼儿，在连续监测心率和血压的情况下，静脉滴注ＮＴＧ０ ．４～０ ．８ μｇ·ｋｇ－ １·ｍｉｎ －１ ，利用超声心动图在用药前、用药后１ ｈ、６ ｈ 分别测定左心室射血分数（ｅｊｅｃｔｉｏｎｆｒａｃｔｉｏｎ，ＥＦ） 、短轴缩短率（ｆｒａｃｔｉｏｎａｌｓｈｏｒｔｅｎｉｎｇ，ＦＳ）、肺动脉平均压（ｐｕｌｍｏｎａｒｙ ａｒｔｅｒｙ ｍｅａｎ ｐｒｅｓｓｕｒｅ，ＰＡＭＰ） 、肺毛细血管楔压（ｐｕｌｍｏｎａｒｙｃａｐｉｌｌａｒｙ ｗｅｄｇｅ ｐｒｅｓｓｕｒｅ，ＰＣＷＰ） 和左心室壁应力（ｌｅｆｔ ｖｅｎｔｒｉｃｕｌａｒ ｗａｌｌｓｔｒｅｓｓ，ＬＶＷＳ） 等。结果：ＰＣＷＰ用药前（２．８ ±０ ．４） ｋＰａ，用药后１ ｈ 降至（１．７ ±０ ．４） ｋＰａ，６ ｈ 降至（１．６±０．４） ｋＰａ（ Ｐ＜ ０ ．０５） ；ＬＶＷＳⅠ用药前（４－３２±０－５６） Ｎ／ｃｍ２ ，用药后１ ｈ 降至（３－６５ ±０－５９） Ｎ／ｃｍ２ ，６ ｈ 降至（３－８７ ±０－６０） Ｎ／ｃｍ２（ Ｐ＜ ０．０５） ；ＬＶＷ更多还原

【Abstract】 Objective:To investigate the hemodynamic effect of intravenous nitroglycerin in infants and small children with ventricular septal defect (VSD) and congestive heart failure. Methods: Nitroglycerin at doses ranging from 0.4 to 0.8 μg·kg -1 ·min -1 was administered intravenously to 15 infants and small children with VSD and congestive heart failure under continuously monitoring heart rate(HR) and blood pressure(BP), left ventricular ejection fraction(EF), fractional shortening(FS), pulmonary artery mean pressure(PAMP), pulmonary capillary wedge pressure(PCWP) and left ventricular wall stress(LVWS) were measured by echocardiography before and at 1 and 6 hours after administration of nitroglycerin. Results: PCWP was reduced from (2.8±0.4) kPa before administration of nitroglycerin to (1.7±0.4) kPa at 1 h and (1.6±0.4) kPa at 6 h after administration of nitroglycerin( P <0.05); LVWS Ⅰ from (4 32±0 56) N/cm 2 to (3 65±0 59) N/cm 2 at 1 h and (3 87±0 60) N/cm 2 at 6 h ( P <0.05);LVWS Ⅱ from (1 56±0 57) N/cm 2 to (1 33±0 55) N/cm 2 at 1 h and (1 30±0 57) N/cm 2 at 6 h ( P <0.05);LVWS Ⅲ from (2.64± 0.54 ) N/cm 2 to (2.26±0.57) N/cm 2 at 1 h and (2.19±0.63) N/cm 2 at 6 h ( P <0.05), mid systolic stress from (1.48±0.43) N·cm -2 to (1.33±0.28) N·cm -2 at 1 h and (1.37±0.38) N·cm -2 at 6 h ( P <0.01) respectively. There were no significant effects of intravenous nitroglycerin at above dosages on BP, EF, FS, PAMP and left to right shunt etc.. Conclusion: Small dosage of intravenous nitroglycerin to infants and small children with VSD and congestive heart failure could decrease PCWP and LVWS and had no effects on other hemodynamic indexes, which can improve hemodynamics in children with congestive heart failure.更多还原