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随着较新的血管扩张药的问世,人们曾经一度忽视硝酸酯治疗严重心衰的优越性,部分原因是认为理想的血管扩张剂应对动、静脉循环均发挥扩张作用,而硝酸酯主要是静脉扩张剂,不改善心输出量。因此,长期以来对硝酸酯的疗效指望不大。但是鉴于甲巯丙脯酸只轻微增加心输出量却显著改善心衰症状,近来对上述传统观点有异议,有理由重新评价硝酸酯对心衰病人的血液动力学作用及临床效应。硝酸酯对心室前、后负荷的影响心衰病人增加硝普盐(nitroprusside)剂量时发现,用低于1μg/kg/min的小剂量即可使心室充盈压出现接近最大的下降,而心输出量的
With the advent of newer vasodilators, the once overlooked superiority of nitrates in the treatment of severe heart failure is partly due to the belief that the ideal vasodilator acts to dilate the arterial and venous circulation, whereas the nitric acid esters are predominantly veins Expansion agent, does not improve cardiac output. Therefore, the long-term efficacy of nitrates little hope. However, in view of the fact that captopril only slightly increases cardiac output and significantly improves heart failure symptoms, there has been a recent objection to the above traditional viewpoints that it is reasonable to reevaluate the hemodynamic effects and clinical effects of nitrates on heart failure patients. Effects of nitrates on ventricular preload and postload When heart failure patients receive a nitroprusside dose, they find that near-maximum drop in ventricular filling pressure occurs at low doses of less than 1 μg / kg / min, whereas cardiac output Amount of