うっ血性心不全に対するIsosorbide dinitrate tapeの臨床的，血行力学的検討—Nitroglycerin ointmentとの対比

Clinical and hemodynamic effects of isosorbide dinitrate tape in patients with congestive heart failure: a comparative study with nitroglycerin ointment

　心不全の治療には主として強心利尿剤が用いられてきたが，最近，血管拡張剤による心室負荷軽減療法が注目されている。

　血管拡張剤には主として末梢抵抗血管に作用するPhentolamine,Phenoxybenzamine,Hydralazine，容量血管を拡張させる亜硝酸製剤，その両作用を有するNitroprusside,Prazosin等があり，その有効性が報告されている^1〜10）。

The hemodynamic and clinical effects of Isosorbide dinitrate tape (ISDN tape) and Nitroglycerin ointment (NGO) were studied in 7 patients and 6 patients with congestive heart failure. Control measurements were obtained and observa-tions were made over the ensuing 24 hours. Effects occured within 2 hours after application of ISDN tape. Peak effect was observed at 24 hours after application of ISDN tape. At the peak effect, mean pulmonary capillary wedge pressure decreased from 28 mmHg to 12 mmHg (-61%, P<0.005), mean pulmonary arterial pressure 35 mmHg to 19 mmHg (-50%, P<0.005), mean right atrial pressure 10 mmHg to 3 mmHg (-66%, P<0.005), mean blood pressure 118 mmHg to 97 mmHg (-17.4%, P<0.01). On the other hand, effects occured within 30 min after application of NGO. Peak effect was observed at 1 or 3 hours after application of NGO. At the peak effect, mean pulmonary capillary wedge pressure decreased from 27 mmHg to 20 mmHg (-27%, P<0.05), mean pulmonary arterial pressure 39 mmHg to 32 mmHg (-20%, P<0.05), mean right atrial pressure 12 mmHg to 6 mmHg (-44%, P<0.05). There was no change in cardiac index, stroke volume index, stroke work index, double product, systemic vascular resistance or pulmonary vascular resistance after application of ISDN tape and NGO.

Hemodynamic effect time of ISDN tape continued longer than it of NGO.

These data indicate that ISDN tape and NGO are potent vasodilators with acting as preload reduction and useful for the treatment of congestive heart failure as deloading agents.