佩尔地平与硝酸甘油输液泵输注治疗高血压急症的临床对照分析

目的比较佩尔地平与硝酸甘油用输液泵输注治疗高血压急症疗效及安全性。方法120例高血压急症患者随机分为佩尔地平组和硝酸甘油组，各60例。两组患者均使用微量泵静脉输注降压药。佩尔地平组：20mg佩尔地平稀释于生理盐水至50ml，起始剂量4ml／h。硝酸甘油组：50mg硝酸甘油稀释于生理盐水至50ml，起始剂量3ml／h。观察并记录两组患者用药前、用药5、10、30、60min后的血压、心率，据此调整药液泵入速度。比较两组患者用药后起效时间，用药60min后降压有效率及心率变化。结果佩尔地平较硝酸甘油起效快，差异有统计学意义（P〈0．05）。用药60min后，佩尔地平组全部患者血压降至目标值，硝酸甘油组48例患者血压降至目标值，降压有效率分别为100％和80％，差异有统计学意义（P〈0．05）。用药后两组患者心率均有增加，但佩尔地平组心率在30min时开始逐渐恢复，用药后60min后心率与用药前相比差异无统计学意义，硝酸甘油组用药后60min心率尚未恢复至用药前水平，与用药前相比差异有统计学意义（P〈0．05）。结论佩尔地平输液泵输注治疗高血压急症起效迅速、降压平稳、疗效确切，且对心率的影响较小，为急诊科治疗高血压急症的理想药物。

Objective To investigate the efficacy and safety of continuous intravenous pumping with nicardipine or nitroglycerin for hypertensive emergencies. Methods 120 patients with hypertensive emergencies admitted to our hospital from January 2010 to December 2011 were enrolled and divided into two groups. Patients in nicardipine group （ n=60 ） received continuous intravenous pumping with nicardipine while those in nitroglycerin group （ n=60 ） received nitroglycerin. Onset time of antihypertensive agents, effective rate 60min after drug administration, change of heart rate were observed and compared between the two groups. Results Onset time of nitroglycerin was slower than that of nicardipine, and there was significant difference between the two groups （ P〈0.05 ） . 60rain after drug administration, blood pressure of 60 patients in nicardipine group and 48 patients in nitroglycerin group returned to target value, the effective rate were 100% and 80% respectively, and there was significant difference between the two groups （ P〈0.05 ） . Before and 60rain after drug administration, there was no significant difference of change of heart rate in nicardipine group （ P〉0.05 ） , while significant difference in nitroglycerin group （ P〈0.05 ） . Conclusion Continuous intravenous pumping with nicardipine is effective for hypertensive emergencies with quick onset and no obvious heart rate increasing, which is worthy of further clinical application.