看过来！硝酸酯类药物的“八大应用”和“五项注意”
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">硝酸酯类<span style="color: black;">药品</span></span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">堪<span style="color: black;">叫作</span>心脏的“小助手”</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">它能有效地</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">扩张外周血管，降低前后负荷</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">扩张冠状动脉和侧支循环血管</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">降低心肌耗氧量，缓解心绞痛</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">抗血小板聚集、抗栓、降低主动脉收缩压等</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q4.itc.cn/q_70/images03/20240411/812c2f39d90140e8b28a0ecfc89984d9.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">《硝酸酯类在心血管<span style="color: black;">疾患</span>中规范化应用的专家共识》<span style="color: black;">举荐</span>，<strong style="color: blue;">只要存在<span style="color: black;">知道</span>的缺血客观依据，均应<span style="color: black;">运用</span>硝酸酯类<span style="color: black;">药品</span>等进行抗缺血治疗。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">常用硝酸酯类<span style="color: black;">药品</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">硝酸甘油：</strong></span><span style="color: black;">硝酸甘油有舌下含片、静脉、口腔喷剂和透皮贴片等多种剂型。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">硝酸异山梨酯：</strong></span><span style="color: black;">硝酸异出梨酯的常照栽型<span style="color: black;">包含</span>口服平片、缓释片、舌下含片以及静脉制剂等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">5-单硝酸异山梨酯：</strong></span><span style="color: black;">临床有口服平片和缓释剂型，<span style="color: black;">没</span>需经肝脏代谢而直接发挥药理学<span style="color: black;">功效</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">八大应用</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">硝酸酯类<span style="color: black;">药品</span>的临床应用</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q7.itc.cn/q_70/images03/20240411/b9daa2e8da2f4f05ad4fc3a774854b4e.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">慢性稳定型心绞痛</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">舌下含服或喷雾用硝酸甘油可<span style="color: black;">做为</span>慢性稳定性心绞痛<span style="color: black;">爆发</span>时缓解症状用药，<span style="color: black;">亦</span>可于运动前数分钟<span style="color: black;">运用</span>，以减少或避免心绞痛<span style="color: black;">爆发</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">急性冠脉<span style="color: black;">综合症</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>急性冠脉<span style="color: black;">综合症</span>，硝酸酯类<span style="color: black;">药品</span>为首选抗心肌缺血的血管扩张剂。<span style="color: black;">针对</span>急性心肌梗死<span style="color: black;">初期</span><span style="color: black;">一般</span>给予硝酸甘油静脉滴注。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">变异性心绞痛</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">硝酸酯可首<span style="color: black;">选择</span>于缓解冠状动脉痉挛<span style="color: black;">导致</span>的变异型心绞痛。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">微血管性心绞痛</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">科研</span><span style="color: black;">发掘</span>，约半数的<span style="color: black;">病人</span>口服硝酸酯类<span style="color: black;">药品</span>可在<span style="color: black;">必定</span>程度上缓解微血管性心绞痛。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">没</span>症状性心肌缺血</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">病人</span>虽<span style="color: black;">没</span>症状，但有心肌缺血存在，都<span style="color: black;">能够</span><span style="color: black;">运用</span>β受体阻滞剂、硝酸酯/钙通道阻滞剂等进行<span style="color: black;">长时间</span>的抗缺血治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">心力衰竭</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">慢性心力衰竭：在标准治疗的<span style="color: black;">基本</span>上，对仍有<span style="color: black;">显著</span>充血性症状的慢性收缩性心力衰竭<span style="color: black;">病人</span>可加用硝酸酯类<span style="color: black;">药品</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性心力衰竭：静脉滴注硝酸甘油是治疗急性心力衰竭广泛<span style="color: black;">运用</span>的血管扩张<span style="color: black;">药品</span>之一，尤其适宜于合并高血压、冠状动脉缺血者。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">7 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">高血压危象和围手术期高血压</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">静脉滴注硝酸甘油<span style="color: black;">指的是</span>南<span style="color: black;">举荐</span>的为数不多的治疗高血压危象的静脉制剂之一，宜从小剂量<span style="color: black;">初始</span>，用药过程中<span style="color: black;">连续</span>严密监测血压，尤其适用于冠状动脉缺血伴高血压危象者。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">8 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">经皮冠脉造影或介入术</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在经皮冠脉造影或介入术中，冠脉内注射硝酸甘油、硝酸异山梨酯可<span style="color: black;">快速</span>缓解手术中的冠脉痉挛；<span style="color: black;">也</span>可用于缓解心肌缺血及鉴别冠脉狭窄的性质。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">五项<span style="color: black;">重视</span></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">硝酸酯类<span style="color: black;">药品</span>的不良反应</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q0.itc.cn/q_70/images03/20240411/3379556cf1564546ad20f694d6db7791.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">头痛是硝酸酯类<span style="color: black;">药品</span>最<span style="color: black;">平常</span>的不良反应，呈剂量和时间依赖性。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q9.itc.cn/q_70/images03/20240411/c65f327b992b413c9cfb0b702f80cf66.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">图源网络</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其他<span style="color: black;">平常</span>的不良反应有面部潮红、心率加快、低血压、<span style="color: black;">头昏</span>等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">舌下含服硝酸甘油可<span style="color: black;">导致</span>口臭，少见皮疹。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">长时间</span>大剂量<span style="color: black;">运用</span>可<span style="color: black;">显现</span>罕见高铁血红蛋白血症。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">耐药性。</strong>硝酸酯类<span style="color: black;">药品</span>连续应用 24 小时后可<span style="color: black;">出现</span>耐药，一旦<span style="color: black;">出现</span>耐药，不仅疗效减弱或缺失，<span style="color: black;">况且</span>可能<span style="color: black;">导致</span>内皮功能损害，对预后产生不良影响，<span style="color: black;">长时间</span><span style="color: black;">运用</span>硝酸酯类<span style="color: black;">药品</span>应<span style="color: black;">重视</span>给予足够的<span style="color: black;">没</span>药间期，<span style="color: black;">保准</span><span style="color: black;">供给</span><span style="color: black;">每日</span>8-12小时的<span style="color: black;">没</span>硝酸酯或低硝酸酯浓度，以减少耐药性的<span style="color: black;">出现</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">点击<strong style="color: blue;"><span style="color: black;">“阅读原文”</span></strong>可<span style="color: black;">转</span>查看其他<span style="color: black;">媒介</span>账号<span style="color: black;">关联</span>内容</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">审核<span style="color: black;">颁布</span>：古小红</span></p>
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