硝普钠治疗慢性充血性心力衰竭临床用药及疗效

The administration and effect of nitroprusside in the treatment of chronic congestice heart faihure

目的进一步证实硝普钠治疗慢性充血性心力衰竭的有效性及其安全性。方法选择58例肝肾功能正常的心衰病人采取不同的治疗方案，比较硝普钠的疗效及毒副作用。分组方案为：A组为常规治疗组，以硝酸甘油或普洛林为扩血管药；B组为间断硝普钠治疗组，以硝普钠12．5～75mg／d，24小时间断静脉滴注；C组为连续硝普钠治疗组，以硝普钠100～300mg／d，24小时连续静脉滴注。各组加用强心、利尿等治疗。结果心功能改善显效率A组为46．9％（15／32），B组为90．5％（19／21），C组为100％。（12／12）。B、C两组较A组有显效性差异（P＜0．005、P＜0．005）。有效率分别为81．3％（26／36）、100％（21／21）、100％（12／12），无显著性差异（P＞0．05）。B、C两组病人的血压下降较A组有显著性差异（P＜0．025）。三组病人中，无一例病人出现严重的不良反应，结论硝普钠治疗慢性充血性心力衰竭优于常规方法，且使用安全，而连续静滴方案更值得推荐。

Objective To prove the effec tiveness and safety of nitroprusside (SNP) in the treatment of chronic congestive heart failure, 58 patients with heart failure and normal renal and hepatic function were divided into 3 groups and terated differently. Group A was treated as routine, with nitroglycerine or pururine as vasodilators; Group B was treated intermittently with SNP (12.5 ~ 75 mg/24hrs); Group C was treatd continuously with SNP (continuous infusion 100 ~ 300 mg/24 hrs).Positively inotropic agents and diuretic agents were used in each group. The results showed that the higlhy effective rates of the three groups were 46.9% (15/32), 90.5% (19/21) and 100% (21/12) respectively. The effective rates were 81 .3% (26/36),100% (21/21), 100% (12/12) respectively. The highly effective rates of group B and C were much higher than that of group A (P < 0.005, P <0.005). The reduction of blood pressure of group B and C was greater than that of group A (P < 0.025).Among the patients we studied, no body had severe side effects. We concluded that the use of SNP in the tertment of chronic congestive heart failure is safe, with better effect than routine treatment, and continuous infusion of SNP is the best choice.