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Objective To compare the therapeutic impact of acute anterior wall ST-segment elevation myocardial infarc-tion(STEMI)and primary percutaneous coronary intervention(PCI)in patients with heart failure.Methods 90 patients with anterior wall STEMI with heart failure after primary PCI were selected from the cardiovascular Department of Yunfu People's Hos-pital from July 2021 to June 2023,and they were split into three groups using the random number expression approach,each group containing 30 examples.Group A was treated with furosemide+nitroglycerin,group B was treated with furosemide+nitro-glycerin+neoactin,and group C was treated with furosemide+nitroglycerin+dopamine.The clinical efficacy,cardiac function[left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection frac-tion(LVEF),amino terminal B-type natriuretic peptide precursor(NT-ProBNP)]and clinical indexes of the three groups after treatment were compared.Results ①There was significant difference in total treatment rate among the three groups(P<0.05).Group B and C had significantly greater total effective rates than group A.(P<0.05).②After 3 days of treatment,the levels of LVEF in the three groups were increased(P>0.05),while the levels of NT-ProBNP,LVESD and LVEDD were decreased,and the levels of NT-ProBNP,LVESD and LVEDD in group B and C were lower than those in group A(all P<0.05).③The length of hospital stay and readmission rate of the three groups were significantly different(P<0.05).The length of hospital staying and readmission rate of group B and C were lower than those of group A(P<0.05).Conclusion Furosemide+nitroglycerin combined with neoactin or dopamine in the treatment of anterior wall STEMI patients with heart failure after primary PCI is more effective,can enhance patients'heart health,shorten the length of hospital stay,reduce the readmission rate,worthy of clinical promotion.
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ABSTRACT Background: Newborn infants admitted to the neonatal intensive care unit require arterial cannulation for hemodynamic monitoring and blood sampling. Arterial access is achieved through catheterization of umbilical or peripheral arteries. Peripheral artery cannulation is performed in critically ill newborns, but artery localization and cannulation is often challenging and unsuccessful. Therefore, increasing the internal diameter and preventing vasospasm are important for successful peripheral artery cannulation in neonates. Topical glyceryl trinitrate has the potential to increase cannulation success by relaxing arterial smooth muscles and thus increasing the internal diameter. We aim to conduct a pilot randomized controlled trial to evaluate the efficacy and safety of topycal glyceryl trinitrate in increasing the diameter of the radial artery in neonates. Methods/Design: This study will be a single-center, observer-blind, randomized, placebo-controlled trial conducted in the neonatal intensive care unit of Perth Children's Hospital, Western Australia. A total of 60 infants born at >34 weeks of gestation who are admitted for elective surgery or medical reasons and for whom a peripheral arterial line is needed for sampling or blood pressure monitoring will be recruited after informed parental consent is obtained. The primary outcome will be the change in radial arterial diameter from baseline to postintervention. Secondary outcomes will be the absolute and percentage change from baseline in the radial arterial diameter in both limbs and safety (hypotension and methemoglobinemia). Discussion: This will be the first randomized controlled trial evaluating the use of topical glyceryl trinitrate to facilitate peripheral artery cannulation in neonates. If our pilot randomized controlled trial confirms the benefits of glyceryl trinitrate patches, it will pave the way for large multicenter randomized controlled trials in this field.
RESUMO Histórico: Os recém-nascidos internados na unidade de terapia intensiva neonatal necessitam de canulação arterial para monitoramento hemodinâmico e coleta de sangue. O acesso arterial é obtido por meio de cateterização das artérias umbilicais ou periféricas. A canulação da artéria periférica é realizada em recém-nascidos em estado grave, mas a localização e a canulação da artéria são, muitas vezes, desafiadoras e sem sucesso. Assim, o aumento do diâmetro interno e a prevenção do vasoespasmo são importantes para o sucesso da canulação da artéria periférica em recém-nascidos. O trinitrato de glicerilo tópico tem o potencial de aumentar o sucesso da canulação ao relaxar a musculatura lisa arterial e, dessa forma, aumentar o diâmetro interno. Nosso objetivo é realizar um ensaio piloto controlado e randomizado para avaliar a eficácia e segurança do trinitrato de glicerilo tópico no aumento do diâmetro da artéria radial em recém-nascidos. Métodos/Desenho: Este estudo será um estudo de centro único, cego para o observador, randomizado, controlado por placebo, conduzido na unidade de terapia intensiva neonatal do Perth Children's Hospital, Austrália Ocidental. Serão recrutados 60 bebês nascidos com mais de 34 semanas de gestação, internados para cirurgia eletiva ou por razões médicas e para os quais é necessária a colocação de um acesso arterial periférico para coleta de amostras ou monitoramento da pressão arterial, após a obtenção do consentimento informado dos pais. O desfecho primário será a mudança no diâmetro arterial radial basal e pós-intervenção. Os desfechos secundários serão a alteração absoluta e percentual basal no diâmetro arterial radial em ambos os membros e a segurança (hipotensão e metemoglobinemia). Discussão: Este será o primeiro estudo controlado e randomizado a avaliar o uso de trinitrato de glicerilo tópico para facilitar a canulação da artéria periférica em recém-nascidos. Se nosso estudo-piloto randomizado e controlado confirmar os benefícios dos adesivos de trinitrato de glicerilo, ele abrirá caminho para grandes estudos multicêntricos randomizados e controlados nesse campo.
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Introdução: O benefício do cateterismo transradial já foi confirmado em pacientes do sexo feminino. Mulheres submetidas a exames por cateterismo transradial apresentam desafios únicos. A ocorrência de espasmo e oclusão da artéria radial após o procedimento é maior em mulheres. Objetivamos avaliar o benefício da nitroglicerina na redução de espasmo e oclusão da artéria radial em mulheres submetidas a cateterismo transradial. Métodos: Estudo multicêntrico, prospectivo, randomizado 2x2 fatorial, duplo-cego. Participantes foram randomizados para nitroglicerina 500mcg ou placebo em dois momentos: após colocação do introdutor hemostático e antes da retirada. A avaliação de espasmo da artéria radial foi clínica, por meio de escala dor. A avaliação da oclusão da artéria radial foi realizada com Doppler, nas primeiras 12 horas. Resultados: Foram incluídos 2.040 pacientes, sendo 774 (37,5%) mulheres. A média de idade foi similar entre os sexos (62,2 anos versus 61,5 anos; p=0,27). A incidência de espasmo da artéria radial foi maior nas mulheres (21,2% versus 6,6%; p<0,01), bem como a incidência de oclusão da artéria radial (3,4% versus 1,8%; p=0,03). O uso da nitroglicerina no início do procedimento não reduziu a incidência de espasmo da artéria radial em mulheres quando comparado com o placebo (19,7% versus 22,6%; p=0,34), tampouco as taxas de oclusão da artéria radial (4,3% versus 2,5%; p=0,17). O uso da nitroglicerina ao fim do procedimento não reduziu a incidência de oclusão da artéria em mulheres (2,8% versus 3,9%; p=0,37). Conclusões: O espasmo e a oclusão da artéria radial são mais frequentes em mulheres submetidas a cateterismo transradial quando comparadas aos homens. O uso da nitroglicerina não apresenta efeito benéfico na redução dessas incidências.
Background: The benefit of transradial catheterization is well established in female patients. Women undergoing transradial catheterization exams present with unique challenges. The occurrence of radial artery spasm and occlusion after the procedure is higher in women. The objective of this study was to evaluate the benefit of nitroglycerin in reducing radial artery spasm and occlusion in women undergoing transradial catheterization. Methods: This was a 2x2 factorial randomized, multicenter, prospective, double-blinded study. Participants were randomized to nitroglycerin 500mcg or placebo at two time points: after placement of the hemostatic introducer and before its removal. The evaluation of the radial artery spasm was clinical, using a pain scale The evaluation of the radial artery occlusion was performed with Doppler, in the first 12 hours. Results: A total of 2,040 patients were included, of which 774 (37.5%) were female. Mean age was similar between sexes (62.2 years versus 61.5 years; p=0.27). The incidence of radial artery spasm was higher in women (21.2% versus 6.6%; p<0.01), as well as the incidence of radial artery occlusion (3.4% versus 1.8%; p=0.03). The use of nitroglycerin at the beginning of the procedure did not reduce the incidence of radial artery spasm in women when compared with placebo (19.7% versus 22.6%; p=0.34), nor did the rates of radial artery occlusion (4.3% versus 2.5%; p=0.17). The use of nitroglycerin at the end of the procedure did not reduce the incidence of artery occlusion in women (2.8% versus 3.9%; p=0.37). Conclusions: Radial artery spasm and occlusion are more frequent in women undergoing transradial catheterization when compared to men. The use of nitroglycerin does not have a beneficial effect in reducing these incidences.
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Introduction:Anal fissures or anal ulcers are considered one of the commonest causes of severe analpain. Surgical techniques like manual anal(lords) dilatation or lateral internalsphincterotomy, effectively heal most fissures within a few weeks, but mayresult in permanently impaired anal continence. This has led to the research foralternative non-surgical treatmentAIMS AND OBJECTIVES:The present study comprises the comparative study of 2% Diltiazem gel,0.2% Glyceryl Nitrate,2%lignocaine jelly application and need of surgical intervention in the treatment of chronic fissure inano.MATERIALS AND METHODS: This is a prospective study of fissure in ano during the period from September 2020 to September2021 in Sheth Lallubhai Gordhandas Municipal General Hospital, Ahmedabad. Clinical Data ofadmitted patient were collected by their detail history after stabilizing the patient, clinicalexamination with appropriate investigations.OBSERVATION AND DISCUSSION:Anal fissure is a very common problem across the world. It causes considerablemorbidity and adversely affects the quality of life. Therefore appropriate treatment ismandatory.In this study the commonest age group affected was 31-40 years agegroup (40%) and least affected were 51-60 years age groupThe incidence of fissure in males was slightly greater than females with MaleFemale ratio being 2.2: 1 in our study.CONCLUSION:Propper clinical examination and appropriate investigations helps in management of patient eitheroperative or non-operative which leads successful treatment in these patients.
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Objective: Nitroglycerin is a first-line treatment for hypertensive acute heart failure syndrome (AHFS). However, nicardipine is frequently used to treat hypertensive emergencies, including AHFS. In this study, we compared the effectiveness of nicardipine and nitroglycerin in patients with hypertensive AHFS.Patients and Methods: This single-center, retrospective, observational study was conducted at the intensive care unit of a Japanese hospital. Patients diagnosed with AHFS and systolic blood pressure 140 mmHg on arrival between April 2013 and March 2021 were included. The outcomes were the time to optimal blood pressure control, duration of continuous infusion of antihypertensive agents, duration of positive pressure ventilation, need for additional antihypertensive agents, length of hospital stay, and body weight changes. Outcomes were compared between the nicardipine and nitroglycerin groups. We also compared these outcomes between the groups after excluding patients who received renal replacement therapy.Results: Fifty-eight patients were enrolled (26 and 32 patients were treated with nitroglycerin and nicardipine, respectively). The nicardipine group had a shorter time to optimal blood pressure control (2.0 [interquartile range, 2.0–8.5] h vs. 1.0 [0.5–2.0] h), shorter duration of continuous anti-hypertensive agent infusion (3.0 [2.0–5.0] days vs. 2.0 [1.0–2.0] days), less frequent need for additional anti-hypertensive agents (1 patients [3.1%] vs. 11 patients [42.3%]), and shorter length of hospital stay (17.5 [10.0–33.0] days vs. 9.0 [5.0–15.0] days) than the nitroglycerin group. The duration of positive pressure ventilation and body weight changes were similar between the groups. The outcomes were similar after excluding patients who received renal replacement therapy.Conclusion: Nicardipine may be more effective than nitroglycerin for treating hypertensive AHFS.
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Abstract Introduction Controlled hypotension is a reversible procedure in which the patient's baseline mean arterial blood pressure is reduced by 30% and sustained at 60-70 mmHg during the procedure. It decreases blood loss and provides clear surgical field during the procedures. Objectives The purpose of this study was to compare the efficacy of controlled hypotension agents esmolol, remifentanil, and nitroglycerin in functional endoscopic sinus surgery, in terms of hemodynamic changes and impact on the surgical efficiency. Methods The research was carried out as a cohort study. Patients who underwent functional endoscopic sinus surgery were randomized into 3 groups. Controlled hypotension was achieved with remifentanil (Group R), esmolol (Group E) and nitroglycerin (Group N). The efficacy of the drugs was tested by comparing the length of time with the targeted mean arterial pressure, the amount of anesthetics used, surgical field bleeding score and surgeon's satisfaction. Results Between May to December 2015, 60 patients were included and randomized equally into 3 different study groups. The median of the length of time with the targeted mean arterial pressure was shorter in the Group R when compared with Group E (p = 0.01) and Group N (p = 0.14). The amount of volatile anesthetics used was 25.0 mL (15-51), 43.0 mL (21-105) and 40.0 mL (26-97) in Groups R, E and N, respectively (p < 0.001). While there was more bleeding with nitroglycerin, surgical field bleeding scores were lower in Group R when compared with esmolol (p = 0.001) and nitroglycerin (p < 0.001). The analysis of surgeon's satisfaction scores concluded that surgeons were more satisfied with the group R (100%), when compared with group E (60%) and group N (30%) (p < 0.001). Conclusion Less volatile agent, short time to achieve controlled hypotension, stable blood pressure, lower surgical field bleeding scores and larger length of time with the targeted mean arterial pressure were found as the advantages of Remifentanil. Less costly, efficiency of achieving the targeted median arterial pressure and less postoperative complications were the advantages of nitroglycerin. In functional endoscopic sinus surgery procedures, appropriate controlled hypotensive agents should be selected according to the patients' characteristics and advantages/disadvantages of the drugs.
Resumo Introdução Hipotensão controlada é um procedimento reversível no qual a pressão arterial média basal do paciente é reduzida em 30% e mantida em 60-70 mmHg durante o procedimento. Isso diminui a perda de sangue e propicia um campo cirúrgico limpo durante os procedimentos. Objetivo Comparar agentes usados para hipotensão controlada: esmolol, remifentanil e nitroglicerina em cirurgia sinusal endoscópica funcional, em termos de alterações hemodinâmicas e impactos na eficácia cirúrgica. Método O estudo foi feito como de coorte. Pacientes submetidos à cirurgia sinusal endoscópica funcional foram randomizados em 3 grupos. A hipotensão controlada foi feita com remifentanil (Grupo R), esmolol (Grupo E) e nitroglicerina (Grupo R). A eficácia dos medicamentos foi testada com a comparação do período de tempo com a pressão arterial média desejada, a quantidade de anestésicos usados, o escore de sangramento no campo cirúrgico e a satisfação do cirurgião. Resultados Entre maio e dezembro de 2015, 60 pacientes foram incluídos e randomizados igualmente nos três grupos de estudo. A mediana do período com a pressão arterial desejada foi menor no Grupo R quando comparado ao Grupo E (p = 0,01) e Grupo N (p = 0,14). A quantidade de anestésicos voláteis usados foi de 25,0 mL (15 ± 51), 43,0 mL (21 ± 105) e 40,0 mL (26 ± 97) nos Grupos R, E e N, respectivamente (p < 0,001). Houve mais sangramento com nitroglicerina e escores de sangramento no campo cirúrgico foram menores no Grupo R quando comparados com esmolol (p = 0,001) e nitroglicerina (p < 0,001). A análise dos escores da satisfação do cirurgião concluiu que os cirurgiões estavam mais satisfeitos com o grupo R (100%) quando comparados ao grupo E (60%) e o grupo N (30%) (p < 0,001). Conclusão Agente menos volátil, pouco tempo para obter a hipotensão controlada, pressão arterial estável, menor escore de sangramento no campo cirúrgico e período de pressão arterial desejada curto foram considerados como vantagens do remifentanil. Menor custo, eficácia de obtenção da pressão arterial média desejada e menos complicações pós-operatórias foram as vantagens da nitroglicerina. Nos procedimentos de cirurgia sinusal endoscópica funcional, os agentes apropriados para obtenção de hipotensão controlada devem ser selecionados de acordo com as características dos pacientes e as vantagens/desvantagens dos fármacos.
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Humanos , Nitroglicerina , Hipotensão Controlada , Propanolaminas , Estudos de Coortes , RemifentanilRESUMO
OBJECTIVE:To systematically evaluate the efficacy and safety of Kuanxiong aerosol in the treatment of coronary heart disease angina ,and to provide evidence-based reference for climical drug use . METHODS :Retrieved from Cochrane Library,PubMed,Embase,CKNI,Wanfang data ,VIP,and CBM ,randomized controlled trials (RCTs)about Kuanxiong aerosol (trial group )versus nitroglycerin (control group )in the treatment of coronary heart disease angina were collected during the inception to Mar. 20th,2020. After literature screening and data extraction ,quality assessment was performed using the bias risk assessment tool recommended by the Cochrane System Evaluator Manual 5.1.0. Meta-analysis was performed by using Rev Man 5.3 statistical software. Sensitivity analysis was conducted for the stability of the result ,and trial sequential analysis (TSA)was performed by using TSA 0.9 software. RESULTS :A total of 11 RCTs were included ,with a total of 1 847 cases. Meta-analysis showed that improvement rate of angina pectoris (within 3 min)[RR=1.11,95%CI(1.02,1.22),P=0.02] and total response rate of angina pectoris (within 5 min)[RR=1.04,95% CI(1.01,1.07),P=0.01] in trial group were significantly higher than control group;the incidence of ADR [RR=0.44,95%CI(0.35,0.57),P<0.000 01] in trial group was significantly lower than control group. There was no statistical significance in total response rate of ECG [RR=1.02,95%CI(0.97,1.09),P=0.42] or the level of NO after treatment [SMD =-0.08,95%CI(-0.61,0.45),P=0.76] between 2 groups. The results of sensitiv ity analysis and TSA showed that the efficacy evidence of Kuanxiong aerosol in the treatment of coronary heart disease pectoris was not accurate ,but the evidence of safety was accurate. CONCLUSIONS :Kuanxiong aerosol can improve the efficacy in patients with coronary heart disease angina ,and the safety is better ,but the conclusions of efficacy needs to be further confirmed by enlarging sample size.
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Objective: To evaluate the therapeutic effect of Toutongning Dropping Pills in the treatment of migraine in various experimental models. Methods: The experimental model of nitroglycerin-induced migraine in rats was used to observe the preventive effect of Toutongning Dropping Pills. The analgesic effect of Toutongning Dropping Pills was observed by chemical stimulation, thermal stimulation in mice, mechanical stimulation and formalin stimulation in rats. The sedative effect of Toutongning Dropping Pills was observed by using the mice convulsion model induced by strychnine nitrate and the model of spontaneous activity in normal mice. The blood-activating effects of Toutongning Dropping Pills were observed in rats with hyperviscosity and mice with microcirculation disorder. Results: Five days after Toutongning Dropping Pills were given, compared with the model group, 1 g/kg and 2 g/kg drug dose group significantly reduced the number of climbing cage and scratching head in migraine rats, and shortened the fading time of pink ears. Toutongning Dropping Pills 1.5 g/kg and 3 g/kg dose group significantly reduced the number of writhing induced by acetic acid in mice; While it had no obvious effect on the thermal stimulation model. Toutongning Dropping Pills 1 g/kg and 2 g/kg dose group could significantly improve pain threshold of the mechanical stimulation of rats, and shorten the phase II time of formalin pain in rats; 1.5 g/kg and 3 g/kg drug dose group could significantly prolong the incubation period of convulsion and reduce the number of spontaneous activities in mice; 0.5 g/kg and 1 g/kg and 2 g /kg drug dose group significantly inhibited the increase of whole blood viscosity in rats; 1.5 g/kg and 3 g/kg drug dose group significantly improved the blood flow pattern in mice, reduced erythrocyte aggregation, and increased the number of capillary intersection points. Conclusion: Toutongning Dropping Pills have obvious analgesic, sedative, blood-activating functions, and have therapeutic effects on experimental migraine.
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OBJECTIVE:To investigate the in vitro quality consistency of domestic Nitroglycerin table t imitative preparation and reference preparation (original drug ). METHODS :The contents of nitroglycerin and related substances in 1 batch of Nitroglycerin tablet reference preparation (manufacturer A )and 4 batches of imitative preparation (manufacturer B ,C,D,E) were determined according to Nitroglycerin Tablet Import Drugs Registration Standard JX 20010267. The paddle method of dissolution determination method was adopted ,with the rotating speed of 50 r/min. HPLC method was adopted to determine the dissolution amount of 5 batches of above preparations in 4 kinds of dissolution mediums (pH 1.2 hydrochloric acid solution ,pH 4.0 acetate buffer solution ,pH 6.8 phosphate buffer solution ,water) within 10 min.The accumulative dissolution rate was calculated,and dissolution curves of samples were drawn.The similarity of the dissolution curves was evaluated by calculating similarity factor (f2)of 2,5,8 min accumulative dissolution rate. RESULTS :The contents of nitroglycerin in the preparations from manufacturer A ,B,C,D,E were 99.8%,98.3%,94.0%,93.3%,96.7%,respectively(n=2);the contents of related substance were 0.46%,0.55%,0.63%,0.72%,0.49%,respectively(n=2). Using reference preparation of manufacturer A as control,f2 of imitative preparation from manufacturer B ,C,D,E were 74,28,25,67 in pH 1.2 hydrochloric acid solution ;76, 26,28,84 in pH 4.0 acetate buffer solution ;79,39,35,71 in pH 6.8 phosphate buffer solution ;69,32,37,62 in water , respectively. CONCLUSIONS :The method is suitable for in vitro quality consistency evaluation of Nitroglycerin table timitative preparation. Compared with reference preparation ,the contents of main components in the imitative preparations from manufacturer C,D are lower ;in vitro dissolution curves of those imitative preparation are not similar to reference preparation .
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Objective To observe the effect of Tongbi decoctionon for the changes of the endothelial function and hemorheology in patients with coronary heart disease. Methods A total of 90 patients with angina pectoris were divided into the observation group and the control group according to the random number table method, with 45 in each group. The control group was given routine clinical treatment, and the observation group was treated with Tongbi decoction on the basis of the control group. After treated for 4 weeks, the pain severity of angina pectoris was observed before and after treatment, and the frequency and duration of angina pectoris were recorded. The levels of serum vascular endothelin (ET) and endothelin (VEGF) were measured by ELISA. The serum NO was measured by nitrate reductase method, and whole blood viscosity and plasma viscosity were measured by blood viscometer. The hematocrit was measured by hematocrit analyzer and optical density method. The erythrocyte aggregation index was measured, and the fibrinogen level was measured by heating precipitation method. And the clinical efficacy was evaluated. Results After treatment, the total effective rate was 93.3% (42/45) in the observation group and 77.8% (35/45) in the control group, and there was significant difference between the two groups (Z=-3.164, P=0.002). After treatment, the score of angina pain (0.62 ± 0.05 vs. 1.17 ± 0.14, t=5.733) , the frequency of angina attack (3.62 ± 0.43 times/week vs. 5.02 ± 0.64 times/week, t=5.042), the duration of angina attack (3.17 ± 0.42 minutes/time vs. 4.06 ± 0.51 minutes/time, t=4.781) in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of VEGF and NO in the observation group were significantly higher than those in the control group (t value was 5.892, 5.347, all Ps<0.05), and ET was significantly lower than that in the control group (t=4.926, P=0.037). After treatment, the whole blood viscosity, plasma viscosity, hematocrit, aggregation index and fibrinogen levels in the observation group were significantly lower than those in the control group (t values were 4.832, 4.233, 5.031, 4.136, 4.531, all Ps<0.05). Conclusions The application of Tongbi decoction can improve the endothelial function of patients with angina pectoris, adjust the hemorheological indexes and relieve the symptoms related to angina pectoris.
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Objective@#To summarize and discuss the clinical effect of Shiquan Dabu Decoction combined with nitroglycerin in the treatment of heart failure after acute myocardial infarction.@*Methods@#From January 2016 to June 2017, 110 patients with heart failure after acute myocardial infarction admitted to the Department of Cardiology of Lishui Hospital of Traditional Chinese Medicine were selected as study objects.The patients were randomly divided into observation group and control group according to the digital table, with 55 cases in each group.The control group was treated with routine nitroglycerin therapy, while the observation group was treated with routine nitroglycerin therapy combined with Shiquan Dabu Decoction.The therapeutic effect of the two groups after one week of treatment was observed.@*Results@#The total effective rate in the observation group was 92.73%, which was significantly higher than that of the control group(78.18%), and the difference between the two groups was statistically significant(χ2=4.681, P<0.05). The HR level of the observation group[(82.5±6.5)times/min] was significantly lower than that of the control group[(102.6±3.9)times/min](t=19.655, P<0.01). The levels of SBP[(116.5±6.4)mmHg]and SpO2[(95.2±1.6)%] in the observation group were significantly higher than those in the control group[(108.8±5.2)mmHg, (92.5±1.2)%], there were statistically significant differences between the two groups(t=6.925, 10.012, all P<0.01). The incidence of adverse reaction in the observation group was 10.91%, which was higher than that in the control group(3.64%), but there was no statistically significant difference (χ2=2.157, P>0.05).@*Conclusion@#For patients with heart failure after acute myocardial infarction, the combination of traditional Chinese medicine Shiquan Dabu Decoction in clinical routine treatment has better effect and is worthy of popularizing.
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Objective To summarize and discuss the clinical effect of Shiquan Dabu Decoction combined with nitroglycerin in the treatment of heart failure after acute myocardial infarction .Methods From January 2016 to June 2017,110 patients with heart failure after acute myocardial infarction admitted to the Department of Cardiology of Lishui Hospital of Traditional Chinese Medicine were selected as study objects .The patients were randomly divided into observation group and control group according to the digital table ,with 55 cases in each group.The control group was treated with routine nitroglycerin therapy ,while the observation group was treated with routine nitroglycerin therapy combined with Shiquan Dabu Decoction.The therapeutic effect of the two groups after one week of treatment was observed.Results The total effective rate in the observation group was 92.73%,which was significantly higher than that of the control group (78.18%),and the difference between the two groups was statistically significant ( χ2 =4.681,P<0.05).The HR level of the observation group [(82.5 ±6.5)times/min] was significantly lower than that of the control group[(102.6 ±3.9)times/min](t=19.655,P<0.01).The levels of SBP[(116.5 ±6.4)mmHg] and SpO2[(95.2 ±1.6)%] in the observation group were significantly higher than those in the control group [(108.8 ± 5.2)mmHg,(92.5 ±1.2)%],there were statistically significant differences between the two groups ( t =6.925, 10.012,all P<0.01).The incidence of adverse reaction in the observation group was 10.91%,which was higher than that in the control group (3.64%),but there was no statistically significant difference (χ2 =2.157,P>0.05). Conclusion For patients with heart failure after acute myocardial infarction ,the combination of traditional Chinese medicine Shiquan Dabu Decoction in clinical routine treatment has better effect and is worthy of popularizing .
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OBJECTIVE: To study the mechanism of flunarizine in the nitroglycerin-induced migraine model rats by metabonomics. METHODS: The nitroglycerin-induced migraine rat model was used and the brain samples and serum samples were obtained at 30, 60, and 90 min after model establishment or drug administration. After the isolation of TCC sites was performed,GC-TOF-MS was used to analyze the metabolic status of rat serum and TCC sites in different groups. RESULTS: The metabolic status of the model group and the flunarizine group differed from that of the control group at the same time point.The metabolic state that compared with the model group or the flunarizine group at different time points changes continuously with time. Compared with those in the model group, L-asparagine, 5-methoxytryptamine, α-lactose, ribitol, arachidonic acid, and glycerol in the serum samples and the phosphoglycolic acid, erythrose, inosine, glyceric acid, and D-glucose in the TCC samples were changed in the flunarizine group, indicating that the energy metabolism pathways and amino acid metabolic pathways were involved in the mechanism of flunarizine intervening migraine. CONCLUSION: Flunarizine may improve metabolic disorders in nitroglycerin-induced migraine model rats by affecting energy metabolism and amino acid metabolism.
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OBJECTIVE: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. MATERIALS AND METHODS: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAG-EPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. RESULTS: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m2, and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. CONCLUSION: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.
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Humanos , Masculino , Angina Pectoris Variante , Angiografia , Índice de Massa Corporal , Constrição Patológica , Angiografia Coronária , Diagnóstico , Dislipidemias , Ergonovina , Hipertensão , Nitroglicerina , Estudos Prospectivos , Sensibilidade e Especificidade , EspasmoRESUMO
Objective: To observe the preventive effects of combined application of total coumarin and essential oil of Angelicae Dahuricae Radix on the migraine rats induced by nitroglycerin, and to explore their mechanisms. Methods: A total of 56 Wistar rats were randomly divided into normal control group (saline 0. 1 mL · 10 g 1), migraine model group (saline 0. 1 mL · 10 g 1), total coumarin of Angelicae Dahuricae Radix group (100 mg · kg-1), essential oil of Angelicae Dahuricae Radix group (100 mg · kg-1), and low dose (25 mg · kg-1), middle dose (50 mg · kg-1) and high dose (100 mg · kg-1) of total coumarin and essential oil composition of Angelicae Dahuricae Radix groups (composition groups) (n=8). After continuously intragastric adminstration for 7 d, the rats were injected subcutaneously with nitroglycerin (10 mg · kg-1) for establishing the migraine models. The behavior of the rats were observed, the levels of nitric oxide (NO) in serum and brain tissue of rats, the levels of calcitonin gene related peptide (CGRP) and endothelin (ET) in plasma of the rats in various groups were detected. Results: Compared with normal control group, the frequencies of head shaking, the face shoting times of posterior legs and the scratching times of anterior limbs of the rats in migraine model group were increased (P<0. 05 or P<0. 01), and the levels of NO in serum and brain tissue of the rats were increased (P< 0. 01). Compared with migraine model group, the frequencies of head shaking, the face shoting times of posterior legs and scratching times of anterior limbs of the rats in total coumarin group, essential oil group, and composition groups were decreased (P<0. 05 or P<0. 01), and the levels of NO in serum and brain tissue of the rats were decreased (P<0. 05 or P<0. 01). Compared with migraine model group, the levels of CGRP and ET in plasma of the rats in essential oil group, total coumarin group and middle and high doses of composition groups were decreased (P<0. 05). Conclusion: The composition of two active ingredients of Angelicae Dahuricae Radix, total coumarin and essential oil, has preventive effects in the migraine rats induced by nitroglycerin, and their mechanisms may be related to regulation of the levels and function of vasoactive substances.
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Objective To investigate effect and mechanisms of Liujing Toutong Tablets (LTT) on migraine model rats. Methods Rats were sc injected with nitroglycerin to establish migraine model, effect of LTT on scratching latency and frequency of migraine model rats was investigated; 5-hydroxytryptamine (5-HT), norepinephrine (NE), and dopamine (DA) in brain tissue were detected; And β-endorphin (β-EP), calcitonin gene related pepitde (CGRP), and endothelin (ET) in serum were examined by ELISA; The content of nitric oxide (NO) and activity of nitric oxide synthase (NOS) in serum were examined. Results After sc injected with nitroglycerin in 1 to 3 min, the rats in model group began to scratch its head frequently, scratching latency of rats in high- and low- dose (1.4 and 0.7 g/kg) of LTT group was extended (P < 0.01) and scratching frequency was decreased (P < 0.001); The content of β-EP and ET in serum and DA in brain tissue of rats in high- and low-dose (1.4 and 0.7 g/kg) of LTT group were increased (P < 0.05, 0.01, 0.001), and the content of CGRP and the activity of NOS in serum were decreased (P < 0.05). The content of 5-HT and NE in brain tissue of rats in high- and low- dose (1.4 and 0.7 g/kg) of LTT group had no significant change. Conclusion LTT has a significant therapeutic effect on migraine, and could inhibit contractile response of vascular. The mechanisms may be connected with increasing content of β-EP, ET, DA and decreasing content of CGRP and the activity of NOS.
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We report successful resuscitation of a patient after cardiac arrest on postoperative day 4 after coronary artery bypass grafting (CABG). The patient underwent proximal right coronary artery stent insertion 1 year preceding his CABG, and in-stent restenosis of the stent was found on coronary angiography (CAG). CABG was planned. The patient was treated with a nitroglycerin (NTG) for chest pain, and in the holding area of the operating theater, his chest pain resumed during brief cessation of the NTG while changing the syringe pump. Intraoperatively, normal flow was confirmed at the graft site with flowmetry, while the patient received a NTG infusion. On postoperative day 4, the patient developed chest pain and a subsequent cardiac arrest. He was resuscitated with chest compressions alone, and emergent CAG was performed. It showed coronary artery spasm of the left anterior descending coronary artery, confirmed by provocation testing. The patient was discharged with symptoms well controlled on oral medications.
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Humanos , Dor no Peito , Angiografia Coronária , Ponte de Artéria Coronária , Vasos Coronários , Parada Cardíaca , Nitroglicerina , Intervenção Coronária Percutânea , Ressuscitação , Reologia , Espasmo , Stents , Seringas , Tórax , TransplantesRESUMO
BACKGROUND: Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. METHODS: A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. RESULTS: Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). CONCLUSIONS: Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.
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Feminino , Humanos , Mama , Tontura , Ácido Fusídico , Cefaleia , Hipotensão , Incidência , Mamoplastia , Mastectomia , Necrose , Nitroglicerina , Pomadas , Estudos Retrospectivos , PeleRESUMO
Micro preemies usually undergo arterial catheterization for frequent blood pressure monitoring and blood sampling. Peripheral tissue injury associated arterial catheterization is a well-described morbidity observed in neonates. Despite the potential permanent disability associated with this complication, the currently available therapeutic options remain limited. We report a unique case of a preterm infant who developed severe tissue ischemia after arterial catheterization of the radial artery and was successfully treated using extensive humidification and topical nitroglycerin ointment application over an extended period (36 days) until complete clinical recovery.
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Humanos , Recém-Nascido , Monitores de Pressão Arterial , Cateterismo , Catéteres , Umidade , Recém-Nascido Prematuro , Isquemia , Nitroglicerina , Artéria RadialRESUMO
Calcitonin gene-related peptide (CGRP), a predominant neurotransmitter in sensory nerves, is widely distributed in central and peripheral tissues. In the cardiovascular system, besides relaxing vascular smooth muscle, CGRP protects against ischemic myocardium while inhibiting cardiac remodeling. The pharmacological effects of nitroglycerin and rutaecarpine have proved to be associated with the increase in the synthesis and release of CGRP. In gastrointestinal tissues, CGRP participates in the regulation of gastrointestinal function and has protective effects on the gastric mucosa. Rutaecar?pine, capsaicin and its derivatives can reduce gastric mucosa damage induced by a variety of factors by increasing synthesis and release of CGRP.