硝普钠抢救88例老年心衰急性重症肺水肿的体会

Treatmeat of Acrte Pulmonary Edema in the elderly with Sodium Nitropruside Report of 88 cases

目的老年心衰急性重症肺水肿临床较常见，且病死率高。本文报告用硝普钠抢救８８例的临床体会。方法（１）选择６０～８１岁典型急性肺水肿者，常规抗心衰如用西地兰、速尿、吗啡等治疗。（２）病情危重者７２例立即用硝普钠静滴，另１６例经用硝酸甘油静滴疗效不佳而改用硝普钠。（３）用法和用量：硝普钠２５ｍｇ加入５％葡萄糖液２５０ｍｌ静滴，６～９滴／分（２０～３０μｇ／ｍｉｎ）。合并休克或用药后收缩压低于１２．６ｋＰａ（９５ｍｍＨｇ）者，加多巴胺或多巴酚酊胺２０～４０ｍｇ于２５０ｍｌ液体中静滴，使收缩压维持在１２．６～１３．３ｋＰａ（９５～１００ｍｍＨｇ）。硝普钠一般２５～５０ｍｇ／ｄ，２～３天后停用，改消心痛和巯甲丙脯酸口服。结果本组８６例（９７．７％）在用药后１０分钟至２小时临床症状迅速缓解，肺部罗音消失。结论小剂量硝普钠对老年心衰急性重症肺水肿疗效确切，未发生毒副作用。

Objective To observe the effect of small doses of sodium nitropruside in the treatment of 88 cases of typical acute pulmonary edema in the elderly,aged 60～81 years,with quite effective results Methods (1)All patients were regularly treated for heart failure by cedilanid D,furosemide,morphine,etc.(2)72 cases received IV dripping of sodium nitropruside immediately.Another 16 cases were first treated with nitroglycerine dripping without any improvement and were then switched to sodium nitropruside.(3)Dosage:Sodium nitropruside 25 mg,dissolved in 250 ml of 5% glucose,was given by iv drip at a rate of 6～9 gtt/min(20～30μg/min).If complicated with shock,or systolic Pressure<12 6kPa(95mmHg),dopamine 20～40 mg was added into the 250ml solution,until the pressure rose to 12 6～13 3kPa (95 100mmHg).In general 25～50 mg sodium nitropruside was used every day for 2～3 days,followed by isosorbide dinitrate and captopril orally.Results symptoms and signs(pulmonary rales)subsided rapidly within 10 min to 2 hrs in 86 cases(97%).Conclusions small doses of sodium nitropruside are beneficial to acute pulmonary edema in the elderly and are without any side effects.