乌拉地尔与硝酸甘油注射液治疗高血压合并急性心力衰竭患者有效性及安全性研究

Efficacy and safety of urapidil and nitroglycerin injection in hypertensive patients with acute heart failure

目的比较乌拉地尔与硝酸甘油治疗高血压合并急性失代偿心力衰竭患者有效性及安全性的差异。方法选取2011年8月~2013年11月我国10个研究中心就诊的急性心力衰竭患者,各中心采用数字表法将患者随机分为硝酸甘油组及乌拉地尔组,其中硝酸甘油组125例,男性64例,女性61例,平均年龄（70.75±11.31）岁;乌拉地尔组123例,男性61例,女性62例,平均年龄（69.33±12.76）岁。比较2组患者治疗前及治疗后1d、2d、3d、7d各指标变化。结果治疗2d、7d后乌拉地尔组较治疗前左心室收缩末容积[（71.36±40.72）ml、（67.69±39.11）ml vs（75.23±42.69）ml,P=0.035]及左心室舒张末容积[（139.61±52.08）ml、（140.93±53.10）ml vs（150.27±54.89）ml,P=0.027]明显下降,LVEF明显升高[（52.09±11.41）%、（56.74±11.48）%vs（50.94±8.90）%,P=0.042],乌拉地尔组胆固醇下降幅度明显高于硝酸甘油组（P〈0.05）,2组患者7d及30d主要不良心血管事件的发生率无统计学差异（P〉0.05）,30d再住院或心功能恶化率明显低于硝酸甘油组（4.8%vs11.2%,P=0.000）。结论乌拉地尔为治疗高血压合并急性失代偿心力衰竭安全、有效的血管扩张剂。

Objective To compare the efficacy and safety of urapidil（UP）and nitroglycerin（NG）in hypertensive patients with acute heart failure（AHF）.Methods Two hundred and forty-eight hypertensive patients with AHF aged 70.75±11.31 years were randomly divided into NG treatment group（n=125）and UP treatment group（n=123）.Their parameters were compared before and on days 1,2,3and 7after treatment.Results The ESV and EDV of left ventricle were significantly lower in UP treatment group than in NG treatment group（71.36±40.72 ml vs 75.23±42.69 ml,67.69±39.11 ml vs 75.23±42.69 ml,P=0.035;139.61±52.08 ml vs 150.27±54.89 ml,140.93±53.10 ml vs 150.27±54.89 ml,P=0.027）.No significant differencearas between two groups in major adverse cardiovascular events on days 7and 30（P〉0.05）.The EF and serum TC level were significantly higher whereas the incidence of cardiac function deterioration was significantly lower in UP treatment group than in NG treatment group（52.09% ±11.41% vs50.94%±8.90%,56.74% ±11.48% vs 50.94% ±8.90%,P=0.042;4.8% vs 11.2%,P=0.000）.Conclusion UP is a safe and effective vasculardilator for hypertensive patients with AHF.