氯丙嗪在主动脉夹层伴高血压患者治疗中的应用

The applications of chlorderazin in the treatment of patients with acute aortic dissection and hypertension

目的 探讨在硝普钠治疗主动脉夹层并高血压的基础上应用氯丙嗪的价值.方法 28例主动脉夹层伴高血压患者以随机数字法分为硝普钠组和氯丙嗪＋硝普钠组各14例.2组均用硝普钠,以20μg/min开始持续静脉泵入,每隔5 min将硝普钠的用量增加5 μg/min.氯丙嗪＋硝普钠组在此基础上加用氯丙嗪,始终以5μg/min静脉泵入.之后根据病情加用美托洛尔或其他降压药物口服,必要时再增加硝普钠用量,将血压维持在90～100/60～70 mm Hg（1 mm Hg=0.133 kPa）,心率控制在65次/min左右.观察30 min内血压控制情况、美托洛尔日用量及累计止痛、止吐药物应用次数.结果 随着治疗时间的延长,收缩压、舒张压及心率在2组均呈下降趋势,其中收缩压在氯丙嗪＋硝普钠组10 min及以后时间点,舒张压在15 min及以后时间点时下降幅度更大,组间比较,差异有统计学意义（P＜0.05）.心率在氯丙嗪＋硝普钠组15 min及以后时间点下降幅度更大,2组之间差异均有统计学意义（P＜0.05）.在血压和心率均控制理想时氯丙嗪＋硝普钠组的持续用药时间比硝普钠组明显缩短[分别为（74±10）、（56±12）h,P=0.030],此时硝普钠组美托洛尔日用量明显高于氯丙嗪＋硝普钠组[分别为（65±20）、（46±19）mg,P=0.043].另外,硝普钠组累计止痛药物及止吐药物应用次数多于氯丙嗪＋硝普钠组,差异有统计学意义[2组分别为（3.4±1.1）、（1.0±0.8）次,P=0.001;（1.4±0.8）、（0.4±0.3）次,P=0.005].结论 氯丙嗪是一种辅助硝普钠治疗主动脉夹层并高血压患者的理想药物.

Objective To explore the efficacy of intravenous chlorderazin for patients with acute aortic dissection and hypertension. Methods Twenty-eight patients with aortic dissection-related hypertension were randomly assigned in sodium nitroprusside group and chlorderazin and sodium nitroprusside group. Hypertension controll within 30 minutes, betaxolol daily dose, and application number of times of analgesic and antiemetic between two groups were observed. Results During 30 minutes treatment, the systolic blood pressure, diostolic blood pressure and heart rate both decreased in sodium nitroprusside group and chlorderazin and sodium nitroprusside group. The degree of decline was more distinct in chlorderazin and sodium nitroprusside group after 15 minutes than that in sodium nitroprusside group. When blood pressure and heart rate were both under control, the continued drug use times were longer in sodium nitroprusside group than that in chlorderazin and sodium nitroprusside group[（74 ± 10）h vs （56 ±12） h, P = 0.030]. Betaxolol daily dose [（65 ± 20）mg vs （46 ± 19） mg, P = 0. 043] and application number of times of analgesic（3.4 ± 1.1 vs 1.0 ± 0.8, P = 0.001） and antiemetic （1.4 ± 0. 8 vs 0.4 ± 0.3, P = 0.005） were significantly more frequent in sodium nitroprusside group than those in chlorderazin and sodium nitroprusside group.Conclusion Intravenous Chlorderazin combined witn Sodium Nitroprusside is effective on treating aortic dissection-related hypertension.