不同剂量右美托咪定联合硝普钠治疗高血压急症的效果

The Effect of Sodium Nitroprusside and Different Doses Dexmedetomidine for Patients with Hypertensive Emergency

目的:评估不同剂量右美托咪定联合硝普钠治疗高血压急症的临床效果。方法:选择符合高血压急症诊断标准,且排除硝普钠和右美托咪定使用禁忌的患者90例为研究对象,采取随机分为3组:A组:硝普钠,B组:硝普钠+右美托咪定0.6μg/(kg·h),C组:硝普钠+右美托咪定0.8μg/(kg·h),每组30例。所有患者硝普钠均以1.0μg/(kg·min)起始量持续静脉泵入,然后依据血压情况每5 min以1.0μg/(kg·min)速度增减硝普钠用量,B组和C组分别同时以0.6和0.8μg/(kg·h)持续静脉泵入右美托咪定,在2 h内将血压控制达标(收缩压≤180 mm Hg和舒张压≤120 mm Hg)。观察在用药前即刻(T0)、用药15 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)6个时相患者的收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)。结果:3组患者男女比例、年龄及T0时相的SBP、DBP和MAP均无明显差异(均P>0.05);3组用药后血压均呈线性下降[T0/T5收缩压(mm Hg):A组(210.2±14.2)/(162.4±9.2);B组(211.6±13.8)/(152.4±8.6);C组(214.2±12.8)/(150.0±7.8);舒张压(mm Hg):A组(112.0±13.2)/(86.8±6.8);B组(116.2±14.2)/(82.4±5.6);C组(118.4±13.8)/(83.1±4.8);均P<0.05]。从T3时相开始,B、C组血压下降幅度较A组大,T5时相更显著(T5/T0:A、B、C组收缩压下降各为22.74%、27.98%、29.97%;舒张压分别为22.05%、29.29%、29.81%;均P<0.05]。B和C组较A组达标时间短[(58.6±5.2)、(56.8±4.8)比(66.4±4.6)min,均P<0.05]。B和C组达标时硝普钠用量较A组少[(1080.2±34.6)、(960.8±22.6)比(1328.0±42.8)μg;均P<0.05]。结论:3种给药方式均能有效控制血压;硝普钠联合右美托咪定0.6-0.8μg/(kg·h)给药较单用硝普钠更有效控制高血压急症患者血压,且减少硝普钠用量及缩短血压达标时间。

Objective：To evaluate the clinical effect of sodium nitroprusside（SNP） and different doses dexmedetomidine for patients with hypertensive emergency. Methods：90 cases diagnosed hypertensive emergency and without contraindication for the use of SNP and dexmedetomidine were randomly divided into group A（SNP only）,group B [ SNP＋dexmedetomidine 0.6 μg /（kg·h） ]and group C [SNP ＋ dexmedetomidine 0.8 μg /（kg·h） ].SNP was administered intravenously at a initial speed of 1.0 μg /（kg·min）, and its dosages were then increased or decreased at a speed of 1.0 μg /（kg·h） according to blood pressures（BP）. In group B and C, subjects were given intravenously dexmedetomidine at a speed of 0.6 μg /（kg·h） and 0.8 μg /（kg·h） respectively at the same time. The goals of BP control were systolic BP（SBP） ≤180 mm Hg and diastolic BP（DBP） ≤120 mm Hg within 2 hours. SBP,DBP and mean aterial pressure（MAP） were observed before（T0） and 15 min（T1）, 30 min（T2）, 60 min（T3）, 90min（T4）and 120 min（T5） after treatment. Results ： BP was declined linearly in all groups [ T0 / T5 SBP（mm Hg） ：group A210.2 ±14.2 / 162.4 ±9.2,group B 211.6 ±13.8 / 152.4 ±8.6, group C 214.2 ±12.8 / 150.0 ±7.8, DBP（mm Hg） ：group A112.0±13.2 / 86.8±6.8, group B 116.2±14.2 / 82.4±5.6, group C 118.4±13.8 / 83.1±4.8, all P〈0.05 ]. The decline of BP was greater in group B and C than in group A from T3 phase,and lasted until T5（T5 / T0 ： SBP in group A,B and C decreased 22.74%,27.98%,29.97% respectively and DBP decreased 22.05%,29.29%,29.81% respectively,P〈0.05）. The time needed to control BP in group B and C was shorter than in group A [（ 58.6 ±5.2）,（56.8 ±4.8） vs（66.4 ±4.6）min,all P〈0.05 ]. SNP consumed in group B and C was less than in group A [（1080.2 ±34.6）,（960.8 ±22.6） vs（1328.0±42.8） μg,all P〈0.05]. Conclusion：Three drug-administered ways can control BP effectively. Compared with SNP alone, SNP combined with dexmedetomidine [0.6-0.8 μg /（kg·h） ] have a more effective BP control for hypertension emergency,which can decreases the dosage of SNP and shortens the time of BP control.