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目的 用无创脉搏波分析方法揭示硝酸甘油 (GTN)对不同特性血管的剂量依赖效应。方法 46名志愿者随机给予安慰剂或不同剂量的缓释GTN贴剂 ( 0 1～ 0 6mg h) ,记录桡动脉脉搏波 ,并与传统的袖带血压计测量结果对照。中心动脉脉搏波通过已验证的转换函数从桡动脉脉搏波实时生成。结果 除了 2个最大剂量组的肱动脉收缩压下降外 ,心率及肱动脉血压没有明显变化。通过脉搏波分析获得的中心动脉收缩压、反射波增压、积分平均压和左室射血分数均有一致的剂量依赖的改变。结论 脉搏波分析比传统袖带血压计有优势 ,揭示了很低剂量的GTN影响血流动力学的证据 ,其机制是传输动脉扩张 ,波反射降低 ,更大剂量的GTN可进一步引起静脉及阻力小动脉扩张。
Objective To explore the dose-dependent effect of nitroglycerin (GTN) on blood vessels with different characteristics by noninvasive pulse wave analysis. Methods 46 volunteers were randomized to placebo or different doses of delayed release GTN patch (0 1 ~ 0 6mg h), radial artery pulse wave was recorded and compared with the traditional cuff sphygmomanometer results. The central artery pulse wave is generated in real time from the radial artery pulse wave by a validated transfer function. Results In addition to the brachial artery systolic pressure drop in the two largest dose groups, there was no significant change in heart rate and brachial artery blood pressure. The central artery systolic pressure, reflex pressure boost, integral mean pressure and left ventricular ejection fraction obtained by pulse wave analysis all had a consistent, dose-dependent change. Conclusion The pulse wave analysis has advantages over the traditional cuff sphygmomanometer and reveals evidence of hemodynamic effects of GTN at very low doses due to dilatation of the arterial arteries and reduced wave reflexes. Higher doses of GTN can further cause venous and resistance Arterioles dilate.