硝酸异山梨酯气雾剂治疗透析中高血压的临床研究

Ginical study of isosorbide dinitrate spray in the treatment of hypertension during hemodialysis

目的 观察硝酸异山梨酯气雾剂治疗透析中高血压的临床疗效。方法 30例维持性血透患者观察半年,透析中共发生高血压122人次,分层随机分成2组。A组每次予以硝酸异山梨酯2.5mg口腔喷雾,B组每次给予硝苯吡啶10mg舌下含服,连续监测血压、心率、心电图2小时。结果 A组给药30秒起效,5分钟显效并持续30分钟,有效率91.8％,心率下降12.5％,5人次无效,改B组治疗仍无效,无明显副作用;B组含服4分钟见效,10分钟显效并持续60分钟,有效率86.9％,心率增加4.4％,8人次无效,改A组治疗,5人次有效,部分人次出现头痛、面红、心慌等。10分钟时,A组血压从(189±31/122±13)mmHg下降至(152±34/102±9)mmHg,有显著差异(P<0.05);B组血压从(191±29/120±12)mmHg下降至(159±33/105±8)mmHg,有显著差异(P<0.05)。A组下降幅度大于B组,但差异没有显著性(P>0.05)。结论 硝酸异山梨酯气雾剂治疗透析中高血压迅速、可靠、安全、使用方便,值得临床推广和使用。

Objective To observe the effects of isosorbide dinitrate (ISDN) spray on intradialytic hypertension. Methods 30 patients with hypertensive emergencies during hemodialysis(HEH) were randomly divided into two groups of 15 patients each, respectively received 2. 5mg of ISA and 10mg of sublingual nifedipine. Blood pressure(BP),heart rate (HR) and ECG were monitored for 2 hours. Results In the ISDN group, the reduction of BP beginning 30 sec after drug administration, the significant effects occurred at 5 min and continued up to 30 min, the response rate was 91.8%, HR decreased by 12.5%, no adverse side effects were found. BP decreased in a period of 10 mins from (189±31/122±13) mmHg to (152±34/102±9)mmHg, (P < 0.05). In the nifedipine group, the reduction beginning 4 min after receiving the medication, a peak effect was produced between 10 and 60 mins, the response rate was 86.9%, HR increased 4. 4%, some patients suffered headache, flushing and tachycardia. BP declined from (189±31/122±13)mmHg to (152±34/102± 9)mmHg (P < 0.05) in a time of 10 mins. Conclusion ISDN spray is a safe, effective and practical agent and may be an excellent alternative to sublingual nifedipine in the urgent treatment of HEH .