氨氯地平与尼莫地平对高血压病脑血管痉挛的临床研究

Study of the Effects of Amlodipine and Nimodipine on the Basicranial Hemodynamics in Essential Hypertension Patients with Cerebrovascular Spasm

目的探讨氨氯地平与尼莫地平对高血压病I期脑血管痉挛颅底血流动力学的影响。方法对90例I期高血压病人行彩色三维经颅多普勒检测,确定有脑血管痉挛的病人,随机分为A、B、C三组,A组氨氯地平5mg;B组尼莫地平6mg+5%GNS或NS 250ml:C组氨氯地平+尼莫地平,用药剂量及给药方法同上,以上3组均联合应用氢氯噻嗪12.5mg,每周行TCD检测颅底血流动力学的变化,每日测血压及24h动态血压,评价血压变化及颅底血流动力学的变化。结果氨氯地平降压平稳,持续时间长,无反跳现象,和尼莫地平组比较,对24h平均收缩压、舒张压、舒张压负荷的降压值及降压谷峰比率均大于尼莫地平,扩张脑血管的作用持久但较尼莫地平弱,尼莫地平扩张脑血管迅速但作用时间比氨氯地平短,联合用药组对降压及改善脑血流量、缓解脑血管痉挛均优于单用组(P<0.01)。结论氨氯地平是一种平稳安全持久的降压药及稳定持久的扩张脑血管药,氨氯地平与尼莫地平联合应用,可达到互相弥补的治疗效果。

Objective To investigate the effect of amlodipine and nimodipine on the basieranial hemodynamies in hypertension pa- tients of first stage with cerebrovascular spasm. Methods The basieranial blood flow were measured by three-dimentional colorful transcranial doppler. In 90 essential hypertension patients of first stage, those with eerebrovaseular spasm were randomly divided into three groups （A,B and C）. Group A：amlodipine 5mg,group B：nimodipine 6mg solved in 5%GNS or NS 250ml,group C：amlodipine plus nimodipine,the doses and usage of each drug were the same as those of group A and group B. Hydrochlorolithene 12.5mg were combined in each group once day. The duration of treatment in the three groups was two weeks. The basicranial hemodynamies were detected by three-dimentional colorful transeranial doppler each week. Blood pressure and 24 hours blood pressure monitoring were performed every day to evaluate the changes of blood pressure and basiocranial hemodynamics. Results The anfihypertensive effect of amlodipine was stable and consistent and no rebound in compared with that of nimodipine. The 24 hours blood pressure lowing value and trough/peak ratio of mean systolic pressure, diastolic pressure and diastolic pressure load were superior to that of nimodipine, while the cerebrovascular dilating effect was constant but weaker than that of nimodipine. The eerebralvaseular dilating effect of nimodipine was faster and the effect was maintained shorter than that of amlodipine The effects of blood pressure lowing and cerebral blood flow improvment and cerebrovascular spasm relief in the group C were better than those of the group A and the group B （P〈 0.01 ）.Conclusion Arnlodipine is a kind of stable safe and permanent antihypertensive drug and a cerebrovaseular-dilating drug. The combination of amlodipine and nimodipine may enhance the treatment effects of each other.