不同方案治疗高血压急症的疗效比较

目的探讨乌拉地尔联合硝酸甘油治疗高血压急症的临床效果。方法回顾性分析上海市普陀区利群医院急诊科自2008年9月～2011年9月收治的242例高血压急症患者的临床资料，按治疗方案不同随机分为硝酸甘油组（A组，n=81）、乌拉地尔组（B组，n=81）和硝酸甘油＋乌拉地尔组（C组，n=80）。A组：应用硝酸甘油针15mg加入5％葡萄糖溶液250mL中，以10μg／min开始，根据血压下降情况调整剂量，但最大剂量不易超过100Hg／min；B组：应用盐酸乌拉地尔注射液首剂125mg稀释于20mL生理盐水中于10min静脉注射完，继以625mg稀释于50mL生理盐水中视病情以10～20mg／h微量泵注射；G组：硝酸甘油和乌拉地尔同时治疗。观察患者在治疗后5、10、20、50、60及90min时血压改变情况，监测患者心率和临床症状、体征等变化情况，并记录不良反应情况。结果乌拉地尔联合硝酸甘油组用药后各时段血压较用药前均显著下降，总有效率明显升高，不良反应发生率低，差异有统计学意义（P＜0.05）。各组心率改变不明显，差异无统计学意义。结论乌拉地尔联合硝酸甘油治疗高血压急症较单用硝酸甘油和乌拉地尔有效，且不良反应少，值得推广。

Objective To investigate the efficacy ofurapidil combined with Nitroglycerin for hypertensive emergency treatment of hypertension nitroglycerin acute clinical effects. Methods The clinical efficacy data of 242 patients hypertensive emergency in our hospital from Sep.2008 to Sep.2011 were retrospectively analyzed. All cases were divided into nitroglycerin group （A group, n=81 ）, Urapidil group （B group, n=81） and urapidil combined with nitroglycerin group（C group, n=80）. A group： joined with the Nitroglycerin needle 15 mg in 250 ml 5% glucose solution, initially 10 μg/min, titrated with blood pressure, but it is not easy to exceed the maximum dose which was 100 μg/min. B group： joined with the urapidil 12.5 mg in 20 ml normal saline, initially 6.25 μg/min, titrated with blood pressure. C group： Treatment of urapidil combined with nitroglycerin group was given. The changes of blood pressure in the situation was observed in patients at the time which was after treatment 5, 10, 20, 30, 60 and 90 min, heart rate, adverse reactions ,clinical symptoms and signs were recorded. Results After treatment, blood pressure in C group was tower, total efficiency was significantly higher, incidence of adverse reactions was lower than that of other groups, the difference was significant, （P〈0.05）. The changes of heart rate in each group was not significant, the difference was not significant.Gonclulsion Urapidil combined treatment of hypertensive emergencies than nitroglycerin alone nitroglycerin and urapidil effective, and adverse reactions, it is worth promoting.