乌拉地尔治疗高血压伴急性心力衰竭疗效及其对心功能、血清N末端脑钠肽前体的影响

Effects of urapidil on heart function and NT-proBNP in treatment of patients with hypertension and acute heart failure

目的观察乌拉地尔治疗高血压伴急性心力衰竭疗效及其对心功能、血清N末端脑钠肽前体(NTproBNP)的影响。方法选择2014年3月—2016年3月陕西省安康市中心医院心内科—病区收治高血压伴急性心力衰竭患者92例作为研究对象,按照随机数字表法分为观察组46例和对照组46例,2组患者均给予常规综合治疗,对照组在此基础上给予硝酸甘油10 mg溶于0.9%氯化钠溶液50ml中静脉滴注,5~10μg/min滴注6 h,最大剂量≤20μg/min;观察组在此基础上给予盐酸乌拉地尔注射液100 mg溶于0.9%氯化钠溶液50 ml静脉滴注,50~100μg/min滴注6 h,最大剂量≥300μg/min;2组患者均连续给药48 h,根据患者血压、心功能改善情况,调整药物浓度,疗程为7 d。比较2组患者临床效果、心功能、血压、NT-proBNP,随访3个月记录不良事件发生情况。结果观察组总有效率为95.7%,显著高于对照组的82.6%(x^2=4.039,P=0.044);治疗后观察组心率、NT-proBNP、SBP、DBP明显低于对照组,LVEF、CI显著高于对照组(t=1.762、8.660、6.225、1.941、1.781、4.164,P=0.041、0.000、0.000、0.028、0.039、0.000),而治疗前后及2组间LVEDV、LVESV比较差异均无统计学意义(P>0.05);2组患者治疗期间主要不良反应包括低血压、心悸、头晕、心动过速、胃肠道反应、面色潮红等发生率明显低于对照组(x^2=4.099、4.395、6.183、4.395、4.789、6.718,P<0.05)。结论乌拉地尔用于高血压伴急性心力衰竭临床效果确切,心功能改善作用明显,有效降低NT-proBNP水平,不良反应发生率低,安全有效,值得临床推广。

Objective Investigate the effects of urapidil on heart function and NT-proBNP in treatment of patients with hypertension and acute heart failure. Methods 92 cases ofpatients with hypertension and acute heart failure were select- ed, which were treated in hospital from March 2014 to March 2016, and were divided into the observation group （46eases） and control group （46 cases）. The patients of two groups were all treated with routine comprehensive treatment, including the maintenance of airway, aerosol inhalation oxygen, diuretics, cardiac, anti-infection, asthma, phlegm and so on. The patients of control group were treated with nitroglycerin （ 10 mg dissolved in 50 ml 0.9% Naclsolution, intravenous infusion, infusion of 5 -10 μg/ rain within 6h, the maximum dose ≤20 μg/min） , while the patients of observation group were treated with urapidil hydrochloride injection （100 mg dissolved in 50 ml 0.9% NaCl solution, intravenous infusion, infusion of 50 - 100 μg / min within 6h, the maximum dose of ≤300 μg/min）. The patients in both two groups were given continuous administra- tion for 48 hours, the drug concentration was adjusted according to the patients blood pressure and cardiac function, and the course of treatment was seven days. Compare the clinical effects, cardiac function, blood pressure, NT-proBNP, incidence of side effects, adverse eventsat 3-month follow-up of two groups. Results After the appropriate treatment, the patients of the observation group got a total effective rate of 95.7% , which was significantly better than the 82.6% of the control group （ χ2 = 4. 039, P = 0. 044） ;The levels of heart rate, NT-proBNP, SBP, DBP of the observation group were significantly lower than those of the control group （ t = 1. 762,8. 660,6. 225,1. 941, P = 0. 041,0. 000,0. 000,0. 028 ） ; The levels of LVEF, CI of the observation group were significantly higher than those of the control group （ t = 1. 781,4. 164, P =0. 039,0. 000） ;But in the terms of LVEDV, LVESV, there was no significant difference before and after treatmentin both two groups （ t = 0. 679,0.632, P = 0.249,0. 264） ; There were hypotension, palpitations, dizziness, .tachycardia, gastrointestinal reactions, facial flushing, there were sudden cardiac death, cardiac function deterioration, non-fatal myocardial infarctionand other adverse reactions occurred in both two groups, and the incidence of adverse reactions in the observation group was significantly lower than that in the control group （ P 〉 0.05）. Conclusion With treating patients with hypertension and acute heart failure, nra- pidil can obtain the exact effect, significantly improve the cardiac function, reduce the levels of NT-proBNP, and with a low incidence of adverse reactions. It is safe, effective and worthy of clinical promotion.