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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 different doses of dexmedetomidine combined with sodium nitroprusside in the treatment of hypertensive emergency. Methods: Ninety patients who met the diagnostic criteria of Hypertension and who were excluded from the taboo use of sodium nitroprusside and dexmedetomidine were selected and randomly divided into three groups: group A: sodium nitroprusside, group B: nitroprusside Sodium + dexmedetomidine 0.6μg / (kg · h), C group: sodium nitroprusside + dexmedetomidine 0.8μg / (kg · h), 30 cases in each group. All patients were intravenous infusion of sodium nitroprusside (1.0μg / (kg · min)), and the dosage of sodium nitroprusside was increased or decreased by 1.0μg / (kg · min) every 5 minutes according to the blood pressure. Group C received continuous intravenous infusion of dexmedetomidine at 0.6 and 0.8 μg / (kg · h), respectively, and achieved blood pressure control within 2 h (systolic blood pressure ≤180 mm Hg and diastolic blood pressure ≤120 mm Hg). The systolic blood pressure (SBP) of 6 patients at the time of T0, 15 min (T1), 30 min (T2), 60 min (T3), 90 min (T4) and 120 min (T5) , Diastolic blood pressure (DBP) and mean arterial pressure (MAP). Results: The ratio of SBP, DBP and MAP were not significantly different among the three groups (P> 0.05). The blood pressure of the three groups showed a linear decrease [T0 / T5 systolic pressure (mm Hg) A group (210.2 ± 14.2) / (162.4 ± 9.2); B group (211.6 ± 13.8) / (152.4 ± 8.6); C group (214.2 ± 12.8) / (150.0 ± 7.8); diastolic blood pressure Group (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]. From T3, the decrease of blood pressure in groups B and C was larger than that in group A and T5 (T5 / T0: The systolic blood pressure in groups A, B and C decreased by 22.74%, 27.98% and 29.97%, respectively; (58.6 ± 5.2), (56.8 ± 4.8) and (66.4 ± 4.6) min, respectively, P <0.05, respectively) 0.05] .The dosage of sodium nitroprusside in group B and C was less than that in group A (1080.2 ± 34.6), (960.8 ± 22.6) vs (1328.0 ± 42.8) μg, all P <0.05] Conclusion: Can effectively control blood pressure; sodium nitroprusside combined with dexmedetomidine 0.6-0.8μg / (kg · h) administration of sodium nitroprusside alone more effective control of blood pressure in patients with essential hypertension, and reduce the amount of sodium nitroprusside and shorten Blood pressure standard time.