A dramatic drop in blood pressure following prehospital GTN administration
A dramatic drop in blood pressure following prehospital GTN administration
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DOI：
10.1136/emj.2006.042432
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发表时间：
2007-03-01
影响因子：
3.1
通讯作者：
Boyle, Malcolm J.
中科院分区：
文献类型：
--
作者：
Boyle, Malcolm J.
一名60多岁的男性，没有心源性胸痛病史，下午睡觉后醒来时胸痛。患者未自行恢复。患者的观察结果在正常范围内，通过面罩给予氧气和三硝酸甘油（GTN）。GTN后几分钟，患者出现血压和心率突然下降，通过硫酸阿托品和液体挑战纠正。在送往医院的途中，患者的病情没有进一步恶化。在院前科学文献中很少有这样的病例记录。原因似乎是Bezold-Jarish反射，刺激心室壁，这反过来又减少了交感神经从血管中心流出。院前护理提供者管理任何晕厥发作患者，未能在合理的时间范围内恢复，应考虑Bezold-Jorch反射作为原因，并相应地管理患者。
A male in his sixties with no history of cardiac chest pain awoke with chest pain following an afternoon sleep. The patient did not self medicate. The patient's observations were within normal limits, he was administered oxygen via a face mask and glyceryl trinitrate (GTN). Several minutes after the GTN the patient experienced a sudden drop in blood pressure and heart rate, this was rectified by atropine sulphate and a fluid challenge. There was no further deterioration in the patient's condition during transport to hospital. There are very few documented case like this in the prehospital scientific literature. The cause appears to be the Bezold-Jarish reflex, stimulation of the ventricular walls which in turn decreases sympathetic outflow from the vasomotor centre. Prehospital care providers who are managing any patient with a syncopal episode that fails to recover within a reasonable time frame should consider the Bezold-Jarisch reflex as the cause and manage the patient accordingly.