硝普钠治疗高血压急症有效性和安全性的系统评价

摘要

目的:系统评价硝普钠治疗高血压急症的有效性和安全性.方法:计算机检索PubMed、EMbase 、ISI、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)、万方数据库及Cochrane图书馆,纳入硝普钠治疗高血压急症的随机对照试验(RCT),评价纳入研究的质量,采用Rev Man 5.0进行Meta分析.结果:共纳入13项研究,合计1 125例患者.Meta分析结果显示,硝普钠降低收缩压比乌拉地尔、非诺多巴、硝酸甘油疗效更好,与尼卡地平比较差异无统计学意义[MD=0.29,95％CI(-5.22,5.80),P=0.92]；硝普钠降低舒张压效果好于乌拉地尔,与非诺多巴、尼卡地平比较差异无统计学意义,但比硝酸甘油差；硝普钠的降压有效率与乌拉地尔[OR=1.13,95％CI(0.52,2.42),P=0.76]、硝酸甘油[OR=3.21,95％CI(0.86,12.01),P=0.08]比较差异无统计学意义；硝普钠的不良反应发生率高于乌拉地尔、尼卡地平[OR=1.71,95％CI(1.11,2.61),P=0.01],与硝酸甘油[OR=1.14,95％CI(0.41,3.15),P=0.8]比较差异无统计学意义.结论:硝普钠治疗高血压急症疗效确切,不良反应可接受,适合作为治疗高血压急症的基本药物.%OBJECTIVE: To evaluate the therapeutic efficacy and safety of sodium nitroprusside in the treatment of hypertensive emergency. METHODS: The database was retrieved from PubMed, Embase, ISI, CBM, CNKI, VIP, Wanfang database and Cochrane library. Randomized control trials on sodium nitroprusside in the treatment of hypertensive emergency were included for systematic review and Meta-analysis. The quality of the included studies was evaluated by Handbook 5.0 recommend standard of Cochrane library. Data were analyzed by using Rev Man 5.0 software. RESULTS: 13 RCTs met the inclusion criteria, including 1 125 patients. Results of Meta-analysis showed that reducing systolic blood pressure: the difference between sodium nitroprusside group and urapidil group, fenoldopam group, or nitroglycerin group was significant, and sodium nitroprusside had the better therapeutic efficacy. There was no difference between sodium nitroprusside group and nicardipine group [MD=0.29, 95%CI(— 5.22,5.80) ,P= 0.92]. Reducing diastolic blood pressure: the difference between sodium nitroprusside group and urapidil group was significant, and sodium nitroprusside had the better therapeutic efficacy. There was no difference between sodium nitroprusside group and fenoldopam group or nicardipine group. However, nitroglycerin had the better therapeutic efficacy than sodium nitroprusside, there was statistical significance. Reducing effective rate: there was no significant difference between sodium nitroprusside group and urapidil group [OR=1.13,95%CI(0.52,2.42),P=0.76] or nitroglycerin group [OR=3.21,95%CI(0.86,12.01), P=0.08]. Safety: the incidence of ADR in sodium nitroprusside group was higher significantly than in urapidil group or nicardipine group [OR=1.71,95%CI (1.11,2.61) ,P=0.01], and there was no significant difference between sodium nitroprusside group and nitroglycerin group [OR= 1.14,95%CI(0.41,3.15),P=0.8]. CONCLUSION: Based on the review, sodium nitroprusside is effective for the treatment of hypertensive emergency, while the ADRs are acceptable.