地尔硫联合艾司洛尔对高血压急性主动脉夹层血压和心率的控制

Control of blood pressure and heart rate of hypertension with acute aortic dissection treated by diltiazem combined with esmolol

目的评价地尔硫联合艾司洛尔治疗合并高血压的急性主动脉夹层(AD)患者血压、心率控制疗效及不良反应。方法 72例合并高血压的AD患者按序贯试验研究方法分为对照组(n=36)和试验组(n=36),对照组予硝普钠1.5μg·kg-1·min-1开始持续泵入,根据血压水平缓慢增加剂量,并口服美托洛尔25 mg;试验组用地尔硫10 mg静脉注射(静注),随后5μg·kg-1·min-1持续静脉滴注(静滴),必要时地尔硫0.1 mg·kg-1重复静注,并用艾司洛尔200μg·kg-1·min-1静注,随后50μg.kg-1·min-1静滴维持。持续监测2组患者0.5、1、6 h时间点血压及心率。结果对照、试验2组血压、心率在0 h比较无显著差异(P>0.05),2组间治疗6 h后收缩压、心率、脉率乘积比较有显著差异(P<0.05);在治疗6 h后对照、试验2组血压控制达标率分别为67%、89%;心率达标率分别为36%、94%;2组血压和心率同达标率分别为31%、84%,呈非常显著差异(P<0.01);2组不良反应发生率分别为16%、11%,无显著差异(P>0.05)。结论静注地尔硫联合艾司洛尔治疗合并高血压的AD比常规硝普钠联合口服美托洛尔更有效,同时未增加不良反应。

AIM To evaluate the effects of diltiazem combined with esmolol on blood pressure（BP） and heart rate（HR） in patients with hypertension and acute aortic dissection（AD）.METHODS Seventy-two patients with hypertension and acute AD were divided into the control group（n = 36） and the experimental group（n = 36） according to sequential trial methodology.Patients in the control group were injected with sodium nitroprusside 1.5 μg·kg-1·min-1 to control BP,whose dosage was adjusted according to BP response,and administered orally with metoprolol 25 mg to control the HR.Patients in the experimental group were first injected with diltiazem 10 mg intravenously,and followed by the dose of 5 μg·kg-1·min-1 continuous intravenously.When necessary,BP was controlled by repeating intravenous injection of diltiazem 0.1 mg·kg-1.HR was controlled with the first dose of esmolol 200 μg·kg-1·min-1 intravenously,followed by the dose of 50 μg·kg-1.min-1 to maintain HR.The BP and HR of all patients were monitored at 0.5h,1h,and 6h.RESULTS There was no significant difference（P 0.05） in BP and HR at 0 h between two groups.There was a significant difference（P 0.05） in BP,HR and rate-pressure product（RPP） 6 h after the treatment.BP control rates in the control group and the experimental group were 67% and 89%,and the HR control rates were 36% and 94%,respectively.Control rate of both BP and HR were 31% in the control group and 84% in the experimental group,there was a significant difference（P 0.01）.There was no significant difference （P 0.05） in adverse reaction rates between two groups.CONCLUSION With no more adverse reactions,diltiazem combined with esmolol is more effective than conventional nitroprusside combined with metoprolol in patients with hypertension and AD.