SAFETY OF PREHOSPITAL NITROGLYCERIN
SAFETY OF PREHOSPITAL NITROGLYCERIN
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DOI：
10.1016/s0196-0644(94)70004-4
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发表时间：
1994-01-01
影响因子：
6.2
通讯作者：
ROTH, GS
中科院分区：
文献类型：
--
作者：
WUERZ, R;SWOPE, G;ROTH, GS
研究目的：了解院前患者舌下硝酸甘油治疗后生命体征和心律的变化。设计：以硝酸甘油给药为自变量，为期5个月的前瞻性观察研究。设置：五个独立的高级生命支持服务。受试者类型：300例院前患者，假定为心肌缺血或充血性心力衰竭，由高级生命支持人员给予硝酸甘油；排除了没有重复生命体征或心电图监测的患者以及接受额外药物治疗的患者。干预措施：硝化甘油由区域紧急医疗服务协议或在线医疗指挥医生的命令管理。结果：4名患者（1.3%）出现不良反应：1名患者出现了2分钟的心脏骤停和呼吸暂停，2名患者出现了深度心动过缓伴低血压，1名患者出现了低血压伴心动过速。所有的恢复。不良反应的95%置信区间为0.5% ~ 3.4%。另外296名患者的收缩压平均下降为一次剂量14毫米汞柱（置信区间，11至16毫米汞柱），第二次剂量8毫米汞柱（置信区间，2至13毫米汞柱）。硝酸甘油给药后心率变化极小。血压下降与初始收缩压呈线性相关（r= - 0.44； P< .001），但与硝酸甘油先前剂量、初始心率、晚期生命支持时间间隔、年龄或性别无关。结论：硝酸甘油是一种相对安全的晚期生命维持药物；然而，少数患者会出现严重的不良反应。我们观察到的大多数不良反应是心动过缓的低血压反应，这似乎是预处理特性不可预测的。在考虑院前使用硝酸甘油时，急救人员应提高对这种危险的认识。
Study objective: To define changes in vital signs and cardiac rhythm in prehospital patients given sublingual nitroglycerin.Design: A five-month prospective observational study with nitroglycerin administration as the independent variable.Setting: Five independent advanced life support services.Type of participant: Three hundred prehospital patients who were given nitroglycerin by advanced life support personnel for presumed myocardial ischemia or congestive heart failure; excluded were those without repeat vital signs or ECG monitoring and those given additional medications.Intervention: Nitroglycerin was administered by regional emergency medical services protocols or by the order of an on-line medical command physician.Results: Four study patients (1.3%) had adverse effects: One became asystolic and apneic for two minutes, two experienced profound bradycardia with hypotension, and one became hypotensive while tachycardic. All recovered. The 95% confidence interval for adverse effects was 0.5% to 3.4%. Mean fall in systolic blood pressure for the other 296 patients was 14 mm Hg for one dose (confidence interval, 11 to 16 mm Hg) and 8 mm Hg (confidence interval, 2 to 13 mm Hg) for a second dose. Heart rate changed minimally with nitroglycerin administration. The blood pressure drop was linearly correlated with initial systolic pressure (r= -.44; P< .001) but not correlated with number of prior doses of nitroglycerin, initial heart rate, advanced life support time interval, age, or sex.Conclusion: Nitroglycerin seems to be a relatively safe advanced life support drug; however, a few patients experience serious adverse effects. Most of the adverse effects we observed were bradycardic-hypotensive reactions, which appeared to be unpredictable by pretreatment characteristics. Emergency personnel should have an increased awareness of this danger when considering the use of prehospital nitroglycerin.