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Miếng dán GTN: một phương pháp đơn giản và hiệu quả mới trong bảo vệ tim mạch?
Tóm tắt
Còn tồn tại một nhu cầu lớn chưa được đáp ứng trong việc giảm thiểu sự tổn thương cơ tim do thiếu máu và tổn thương tái tưới máu ở những bệnh nhân trải qua cơn nhồi máu cơ tim ST-elevation. Mặc dù oxit nitric là trung tâm của nhiều chiến lược bảo vệ tim mạch đang được nghiên cứu, nhưng việc bảo vệ tim mạch từ việc cung cấp nitrates/nitrites vẫn chưa được quan sát một cách đồng nhất. Đường sử dụng có vẻ là một biến số quan trọng. Miếng dán glyceryl trinitrate (GTN) thường được sử dụng như một phương tiện đơn giản và thực tế để cung cấp oxit nitric cho bệnh nhân mắc bệnh tim thiếu máu cục bộ, nhưng việc liệu bảo vệ tim cấp tính có thể đạt được khi áp dụng miếng dán GTN chưa được nghiên cứu trước đây. Ở đây, chúng tôi sử dụng một mô hình chuột để chứng minh rằng miếng dán GTN có khả năng bảo vệ tim rất cao khi được áp dụng ngay trước khi thực hiện tắc động mạch vành trái trong 40 phút, tiếp theo là 2 giờ tái tưới máu, giúp giảm kích thước nhồi máu từ 54 ± 4% ở chuột kiểm soát, xuống còn 28 ± 4% (P < 0.001, N = 7). Mức độ bảo vệ đạt được tương tự như việc thực hiện một giao thức tiền điều kiện thiếu máu từ xa tiêu chuẩn. Hơn nữa, và có ý nghĩa lâm sàng lớn hơn, miếng dán GTN cũng có tác dụng bảo vệ khi được áp dụng lâu sau khi khởi phát thiếu máu và 15 phút trước khi tái tưới máu (28 ± 4 so với 59 ± 4%; P < 0.01, N = 5). Các thí nghiệm xác nhận đã chứng minh sự tăng cường dự kiến về mức nitrit huyết tương và sự giảm áp lực máu. Sự đơn giản và nhanh chóng trong việc áp dụng miếng dán GTN (dễ dàng áp dụng trong xe cứu thương hoặc phòng catheter tim) và chi phí thấp (có thể liên quan đến các nước có thu nhập thấp) khiến nó trở nên hấp dẫn cho những nghiên cứu tiếp theo.
Từ khóa
#miếng dán GTN #oxit nitric #bảo vệ tim #tổn thương cơ tim #thiếu máu cục bộTài liệu tham khảo
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