硝普钠不良反应的临床分析及对策

Clinical analysis and countermeasures of Sodium Nitroprusside adverse reactions

目的分析静脉应用硝普钠（sNP）治疗心力衰竭发生的不良反应，探讨其处理对策。方法心功能Ⅲ～Ⅳ级（NYHA分级）住院患者138例，静脉滴注硝普钠25-50mg＋5％Glucose250-500ml，起始剂量为0．1μg·k^-1·min^-1，或以20-40μg／min静脉滴注，调整滴速，直至达到所需疗效。平均治疗剂量为0．5-8．0μg·kg^-1·min^-1，最大剂量〈10μg·kg^-1·min^-1。血压过低时加用多巴胺。结果应用硝普钠发生不良反应23例，发生率为16．67％，其中出现低血压6例，出汗、心悸3例，恶心、呕吐4例，腹部肌肉痉挛性疼痛5例，皮疹3例，恶心、呕吐伴腹部肌肉痉挛2例，伴有药物性静脉炎15例。结论静脉应用硝普钠过程中必须严密观察病情变化，一旦发生不良反应，立即停止静脉滴注并采取积极的对策，避免造成严重后果。

Objective To observe the adverse reactions of intravenous sodium nitroprusside in the treatment of heart failure, and to explore its countermeasures. Methods 138 cases of patients with cardiac function class Ⅲ-Ⅳ （NYHA classification）,were intravenous infused with sodium nitroprusside 25-50 mg 138 cases of patients with cardiac function class Ⅲ-Ⅳ （NYHA classification）,were intravenous infused with sodium nitroprusside 5% Glucose 250 or 500 ml, initial dose was 0.1μg·kg^-1·min^-1, or 20-40 μg/min, infusion speed was adjusted until the reasonable effect. Average treatment dose was 0.5-8.0 μg·kg^-1·min^-1, the maximum dose was 10 μg·kg^-1·min^-1. Dopamine was added if low blood pressure occurred. Results 23 cases （16.67%） of adverse reactions occurred. 6 patients were low blood pressure, three patients palpitated, four patients nausea and vomited, five patients abdominal muscle cramped pain, three cases with skin rash,nausea,vomiting,abdominal muscle spasm associated with two eases, accompanied by drug-induced phlebitis was 15 eases. Conclusion Intravenous application of sodium nitroprusside should be carefuly observed during the course of the disease, if adverse reactions occurred it should be an immediate termination and be taken rapid measures to avoid serious consequences.