不同剂量右美托咪定联合硝普钠治疗高血压急症的效果

摘要

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（mmHg）：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 (mmHg):group A 210.2±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(mmHg):group A 112.0±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.