中老年高血压急症患者应用乌拉地尔和尼卡地平的疗效比较

摘要

Objective To compare the effects of urapidil and nicardipine in middle and old aged acute hypertension patients.Methods 100 middle and old aged acute hypertension patients from emergency department of the fifth affiliated hospital f Xinjiang Medical University between Dec.2013 to Dec.2013 were divided into four groups. Group A included middle-aged patients with urapidil (n=25); Group B included middle-aged patients with nicardipine (n=25); Group C included elderly patients with urapidil (n=25); Group D included elderly patients with nicardipine (n=25). The 24h ambulatory blood pressure (PP), the pulse pressure index (PPI), the heart rate (HR),the smoothness index (SI) of the systolic and diastolic blood pressures (SISBP and SIDBP) after treatment were collected. And level of norepinephrine, epinephrine, serum brain natriuretic peptide and angiotensin II were tested before and after treatment. The remission time of symptoms of hypertension was also recorded.Results Comparing with group A, 24h PP, PPI, HR and SI of group B were reduced significantly (P<0.05). Comparing with group D, the indexes above of group C were reduced significantly (P<0.05). NA and Adr levels in the peripheral blood of group A and C had no significant fluctuations (P>0.05). Serum NA and Adr levels were elevated in both group B and D (P<0.05). After treatment, the concentrations of BNP and AngII decreased in all groups. In elderly patients with urapidil, the change was more significant (P<0.05). In middle-aged patients with nicardipine, the change was more significant (P<0.05). The remission time of symptoms of hypertension in elderly patients with urapidil and middle-aged patients with nicardipine was shorter.Conclusion For better effects, elderly patients may choose urapidil, and middle-aged patients may use nicardipine.%目的：比较乌拉地尔与尼卡地平在中老年急性高血压患者中的疗效。方法选取2013年12月~2014年12月在新疆医科大学第五附属医院急诊治疗的急性高血压患者100例，其中男性54例，女性46例。中年患者随机分为A组（n=25）和B组（n=25），老年患者随机分为C组（n=25）和D组（n=25）。所有入选者依据病情给予基础治疗，在此基础上，A组和C组患者静脉推注乌拉地尔，B组和D组患者给予尼卡地平。检测治疗后动态血压、脉压指数、心率和24 h收缩压平滑指数及24 h舒张压平滑指数，检测治疗前后去甲肾上腺素（NA）、肾上腺素（Adr）、脑钠肽（BNP）和血管紧张素Ⅱ（AngⅡ）。记录症状缓解时间。结果与A组比较，B组收缩压、舒张压、动态血压、脉压指数、24 h舒张压平滑指数和心率均下降，差异有统计学意义（P均＜0.05）。与D组比较，C组血压各项指标均改善，差异有统计学意义（P均＜0.05）。A组和C组患者治疗后NA和Adr水平基本无明显波动，差异无统计学意义（P均＞0.05）；与本组治疗前比较，B组和D组患者治疗后血清 NA 含量和Adr水平均升高，差异有统计学意义（P均＜0.05）。比较四组各时间点BNP和AngII发现，应用尼卡地平和乌拉地尔后，BNP和AngII的浓度均明显下降，其中老年患者应用乌拉地尔下降更明显，中年患者应用尼卡地平则改善更明显，差异有统计学意义（P均＜0.05）。比较四组高血压症状的缓解时间发现，应用尼卡地平和乌拉地尔治疗后，四组高血压症状均缓解，在老年患者中乌拉地尔缓解时间更短，效果更佳；在中年患者中尼卡地平效果更佳。结论老年急性高血压患者应用乌拉地尔血压改善更明显，而中年患者应用尼卡地平血压改善更明显。