SAFETY AND EFFECTIVENESS OF FIELD NITROGLYCERIN IN PATIENTS WITH SUSPECTED ST ELEVATION MYOCARDIAL INFARCTION
SAFETY AND EFFECTIVENESS OF FIELD NITROGLYCERIN IN PATIENTS WITH SUSPECTED ST ELEVATION MYOCARDIAL INFARCTION
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DOI：
10.1080/10903127.2018.1558318
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发表时间：
2019-01-01
影响因子：
2.4
通讯作者：
Niemann, James T.
中科院分区：
文献类型：
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作者：
Bosson, Nichole;Isakson, Benjamin;Niemann, James T.
目的：虽然广泛用于心脏疾病的治疗，但只有有限的数据表征了院外硝酸甘油（NTG）的使用。我们试图确定疑似ST段抬高型心肌梗死（STEMI）患者在院外舌下含服NTG的安全性及其对患者疼痛评分的影响。研究方法：我们前瞻性地确定了一个大型城市-郊区紧急医疗服务（EMS）系统中由护理人员运送到三家经皮冠状动脉介入PCI医院的疑似STEMI成人患者。我们比较了接受实地NTG的患者与未接受实地NTG的患者。主要结局是EMS初始测量值与急诊科（艾德）分诊生命体征之间的收缩压（SBP）变化。次要结局包括到达艾德时低血压（SBP < 100 mmHg）和心动过缓（HR < 60）的频率，SBP下降>= 30 mmHg，院外心脏骤停（OHCA），以及与先验阈值-1.39相比疼痛评分的变化。结果：在940例疑似STEMI的EMS转运中，我们排除了160例初始SBP < 100 mmHg的受试者，留下780例受试者进行分析。中位年龄为67岁，其中61%为男性。340例（44%）患者给予NTG。接受和未接受NTG治疗的患者SBP的中位变化分别为-10 mmHg（IQR-27，2）和-3 mmHg（IQR-20，9）。SBP降低的中位差异为6 mmHg（95% CI 3.9 mmHg）。两组间艾德低血压和心动过缓、SBP下降>= 30 mmHg和OHCA的频率无差异。对于初始疼痛评分> 0的患者，接受NTG治疗的患者疼痛评分的平均变化为-2.6（95%CI-3.0，-2.2），而未接受NTG治疗的患者疼痛评分的变化为-1.4（95%CI-1.8，-1.0）。结论：在该队列中，与未接受NTG的患者相比，现场NTG未导致具有临床意义的血压降低。然而，NTG确实引起了临床上显著的疼痛减轻。
Objective: While widely used in the treatment of cardiac conditions, only limited data characterize out-of-hospital nitroglycerin (NTG) use. We sought to determine the safety of out-of-hospital sublingual NTG administered for suspected ST-segment elevation myocardial infarction (STEMI) and its effect on the patient's pain score. Methods: We prospectively identified adult patients with suspected STEMI transported by paramedics to three percutaneous Coronary Intervention PCI-capable hospitals in a large urban-suburban emergency medical services (EMS) system. We compared patients who received field NTG to those who did not. The primary outcome was the change in systolic blood pressure (SBP) between initial EMS measurement and emergency department (ED) triage vital signs. Secondary outcomes included the frequency of hypotension (SBP < 100 mmHg) and bradycardia (HR < 60) on ED arrival, drop in SBP >= 30mmHg, out-of-hospital cardiac arrest (OHCA), and the change in pain score compared to an a priori threshold of -1.39. Results: Among 940 EMS transports for suspected STEMI, we excluded 160 for initial SBP < 100 mmHg, leaving 780 subjects for the analysis. Median age was 67 with 61% male. NTG was administered to 340 (44%) patients. The median change in SBP was -10 mmHg (IQR -27, 2) and -3 mmHg (IQR -20, 9) in patients treated with and without NTG, respectively. The median difference in the decrease in SBP was 6mmHg (95% CI 3, 9 mmHg). The frequencies of ED hypotension and bradycardia, the drop in SBP >= 30mmHg, and the OHCA did not differ between groups. For patients with an initial pain score > 0, the average change in pain score for patients treated with NTG was -2.6 (95% CI -3.0, -2.2), while patients who did not receive NTG had a change in pain score of -1.4 (95% CI -1.8, -1.0). Conclusion: In this cohort, field NTG did not result in a clinically significant decrease in blood pressure when compared with patients who did not receive NTG. However, NTG did cause a clinically significant reduction in pain.