硝酸酯類藥物具有擴(kuò)張冠狀動(dòng)脈和外周動(dòng)靜脈的作用,能夠有效改善心肌缺血,緩解心絞痛癥狀,減輕心臟負(fù)荷,被廣泛應(yīng)用于心血管疾病的治療。但長(zhǎng)期使用硝酸酯類藥物可產(chǎn)生耐藥性,導(dǎo)致抗心絞痛等臨床療效減弱。目前,評(píng)價(jià)硝酸酯耐藥方法的研究很多,主要有觀察抗心絞痛作用、踏車運(yùn)動(dòng)試驗(yàn)、測(cè)量外周動(dòng)脈擴(kuò)張程度、前臂體積描記法、測(cè)量血漿中一些因子水平的變化、直接測(cè)量冠狀動(dòng)脈血管的擴(kuò)張程度等方法在臨床上得到應(yīng)用。各種方法均有其優(yōu)缺點(diǎn),在臨床工作中應(yīng)根據(jù)實(shí)際情況,多方面多手段個(gè)體化評(píng)估硝酸酯類耐藥性,從而得到最大臨床收益。

Nitrates have the effects of dilating coronary artery and peripheral and vein, and can effectively improve myocardial ischemia, relieve angina pectoris, and reduce cardiac load. Therefore, nitrates are widely used in treatment of cardiovascular diseases. But the long-term use of nitrates may cause resistance and weaken the effect of anti-angina pectoris. At present, there are many methods evaluating the nitrate tolerance, such as observing anti-anginal effects, bicycle ergometer test, measuring the dilation of peripheral artery, forearm plethysmography, measuring the changes of some factor levels in plasma, and directly measuring the dilation of coronary artery blood vessel used in clinic. These methods have their own advantages and disadvantages. More aspects and methods should be taken in evaluating the resistance of nitrates individually to make the maximal clinical benefit.