静脉注射依那普利拉治疗重症高血压的疗效及安全性

Effect of intravenous enalaprilat on severe essential hypertension

目的验证国产依那普利拉（Ｅ）治疗重症高血压的降压疗效及安全性，以提供高血压急症的新药。方法对上海、镇江、扬州等４家医院收治的１７２例高血压病重症患者，男１１８例，女５４例，平均年龄（５３±９）岁，静脉注射Ｅ。分组：（１）对三组高血压病（各１０例）分别静脉注射Ｅ１．２５ｍｇ、２．５ｍｇ、５ｍｇ；（２）Ｅ与甲磺酸酚妥拉明（Ｐ）各５４例单次静脉注射开放平行比较试验；（３）３４例为２４小时内多次静脉注射Ｅ（ｑ６ｈ），观察２４小时内血压、心率及不良反应。结果结果显示：（１）不同剂量Ｅ静脉注射以２５ｍｇ降压效果最好；（２）两组比较：用药后２、４、６小时Ｅ组降压幅度优于Ｐ组（Ｐ＜０．０５），总有效率为９６．３％，Ｐ组总有效率９０７％；（３）２４小时多次给Ｅ，总有效率达１００％。Ｅ主要不良反应：轻度头昏（６／１１８）、头痛（２／１１８）、肢体麻木（４／１１８）及咳嗽（５／１１８）。结论国产Ｅ是一种安全有效的治疗高血压急症用药，我们推荐静脉首选剂量２．５ｍｇ为宜。

Objective To evaluate the acute antihypertensive effect and safety of intravenous administration of enalaprilat. Methods 172 patients with severe hypertension (DBP≥120 mm Hg, 118 male, 54 female, mean age 53±9 years old )were admitted to four hospitals which are in Shanghai, and Zhenjiang and Yangzhou in Jiangsu province. The study were divided into three groups: (1) Three different doses of enalaprilat (1.25mg, 2.5mg, 5mg)were injected by an intravenous bolus to 10 cases for each group to evaluate the appropriate dosage. (2) A comparison of enalaprilat (2.5mg iv )and phentolamin (5mg iv )in 54 for each group of severe hypertension. (3) The antihypertensive effect of continuous bolus injection of enalaprilat every 6 hours to 34 cases in 24 hours. Results (1) The bolus of 2.5 mg enalaprilat is the most appropriate dosage to decrease the severe hypertension. (2) After 1 24 hours,the blood pressure decreased significantly in both enalaprilat and phentolamin injection groups ( P <0.05), more reductions of systolic blood pressure and distolic blood pressure were seen in enalaprilat group than those in phentolamin group at 4, 6, 8 hours respectively ( P <0 05). (3) The antihypertensive effective rate was 96.3% in the group with bolus injection of 2.5mg enalaprilat, 100% in multitime (q6h) injection patients. (4)Slight adverse experiences of enalaprilat during the period of the study are dizziness(6/118), headache (2/118), numbness(4/118) and cough (5/118) included. Conclusion Intravenous enalaprilat(2.5 mg) can be used safely and effectively to control blood pressure in patients with severe hypertension.