尼卡地平和硝普钠治疗高血压急症的价值比较

Comparison between intravenous nicardipine and sodium nitroprusside in hypertensive emergency

目的 :比较静滴尼卡地平和硝普钠治疗急症高血压的疗效和安全性。方法 :急症高血压 (非危急症高血压 )患者 92例随机分为 2组。尼卡地平组 (4 7例 )静滴尼卡地平 30 mg,以 0 .6 μg· kg- 1· m in- 1滴速开始 ,每隔 5 m in根据患者血压调节滴速 ,直至达到目标血压后维持该滴速 ,最大剂量不超过 6 μg· kg- 1· m in- 1 ;硝普钠组 4 5例静滴硝普钠 2 5 mg,以 0 .5 μg· kg- 1· m in- 1滴速开始 ,每隔 5 min以 0 .5～ 1.5 μg· kg- 1· min- 1滴速递增 ,直至达到目标血压后维持静滴 ,最大剂量不超过 10 μg· kg- 1· min- 1。结果 :尼卡地平组 SBP从治疗前的 184± 2 2 mm Hg降至用药结束时 12 5± 9mm Hg(P<0 .0 1) ,DBP则从 10 6± 18mm Hg降至 80± 6 mm Hg(P<0 .0 1)。而硝普钠组SBP从 183± 2 1mm Hg降至 12 9± 9m m Hg,DBP从 10 5± 17m m Hg降至 83± 4 mm Hg(P<0 .0 1)。两组的率压积均较治疗前明显降低 (P<0 .0 1)。尼卡地平组不良反应发生 4例 ,硝普钠组不良反应发生 8例 ,两组无显著差异(P>0 .0 5 )。结论 :静脉应用尼卡地平与硝普钠降压疗效相近 ,不良反应发生率低 ,可用于非危急症的重度高血压患者的治疗。

AIM: To compare the efficacy and safety of intravenous nicardipine with sodium in urgency of hypertension. METHODS: 92 patients with severe hypertension were randomized into two groups. Intravenous nicardipine was given at an initial rate of 0.6 μg·kg -1 ·min -1 , then the rate was adjusted every 5 minutes until the objective blood pressure was obtained in the group of nicardipine (n=47). The maximum dose was no more than 6 μg·kg -1 ·min -1 . Intravenous nitroprusside was give at increasing rates from 0.5 to 10 μg·kg -1 ·min -1 that was titrated on the basis of the objective blood pressure in the group of nitroprusside (n=45). RESULTS: After the therapy, SBP and DBP decreased obviously from 184±22 and 106±18 mm Hg to 125±9 and 80±6 mm Hg respectively in the group of nicardipine (P<0.01); SBP and DBP descended markedly from 183±21 and 105±17 mm Hg to 129±9 and 83±4 mm Hg in the group of nitroprusside (P<0.01). Compared with those of pretherapy, the rate-pressure products were regressed significantly in both groups (P<0.01). Adverse effects were observed in 4/47 (9%) and 8/45 (17%), respectively (NS). CONCLUSION : Intravenous nicardipine is not only as effective as nitroprusside, but also safe in the therapy of severe hypertensive emergency.