乌拉地尔、硝苯地平、硝酸甘油对肿瘤急性术后高血压的疗效分析.docVIP

乌拉地尔、硝苯地平、硝酸甘油对肿瘤急性术后高血压的疗效分析 　　【摘要】目的 比较舌下含服硝苯地平、静脉注射乌拉地尔及微量泵入硝酸甘油治疗急性术后高血压（acute postoperative hypertension，APH）的疗效及安全性。方法 对2007年7月至2010年12月期间因肿瘤切除术后出现APH接受降压治疗的497名患者资料进行回顾性分析。入选患者因APH接受降压药物治疗，高血压发生在手术后24 h内，而且24 h内未接受任何长效降压药物治疗。既往冠心病、心律失常、脑卒中病史者以及数据不完整者除外。患者分为3组，硝苯地平组：10 mg 硝苯地平舌下含服；乌拉地尔组：12.5 mg乌拉地尔加入生理盐水20 mL稀释缓慢静脉注射；硝酸甘油组：25 mg硝酸甘油加入生理盐水40 mL稀释静脉微量泵入。应用χ2检验比较不同治疗方式对患者的疗效及安全性。结果 硝苯地平组收缩压平均下降5.8%，舒张压平均下降4.7%；乌拉地尔组收缩压平均下降11.1%，舒张压平均下降8.4%；硝酸甘油组收缩压平均下降13.1%，舒张压平均下降10.2% 。乌拉地尔和硝酸甘油的降压达标率差异无统计学意义（63.4% vs. 57.8%，P=0.506），均优于舌下含服硝苯地平（63.4% vs. 33.3%，P=0.000；57.8% vs. 33.3%，P=0.001）。乌拉地尔和硝苯地平的心脑血管并发症发生率差异无统计学意义（6.9% vs. 4.7%，P=0.345），均明显低于硝酸甘油（24.4% vs. 6.9%，P=0.001；24.4% vs. 4.7%，P=0.000）。结论 综合考虑药物的疗效和安全性，静脉注射乌拉地尔比舌下含服硝苯地平和微量泵入硝酸甘油更适合APH的治疗。 　　【关键词】乌拉地尔；硝苯地平；硝酸甘油；急性术后高血压；肿瘤；疗效；安全性；回顾性分析 　　Efficacy of urapidil， nifedipine and nitroglycerin for the treatment of postoperative hypertension after tumorectomy Wand Daofeng， Wang Zhi，Lou Ning. Department of ICU， State Key Laboratory of Oncology in South China/Cancer center， Sun Yat-sen University ，Guangzhou 510060， China 　　Corresponding author： Lou Ning， Email：louning@sysucc.org.cn 　　【Abstract】Objective To compare the clinical efficacy and safety of sublingual nifedipine， intravenous urapidil and micropump nitroglycerin in the treatment of APH （acute postoperative hypertension）. Methods A retrospective study was conducted to analyze clinical data of 497 patients with AHP undergoing tumor resection from July 2007 through December 2010. Patients received antihypertensive treatment for APH； hypertension occurred within 24 hours after surgery； patients received no long-acting antihypertensive agents within 24 hours. Patients with a previous history of coronary heart disease， arrhythmia， stroke and incomplete clinical data were excluded. All patients were divided into three groups. Nifedipine group， 10 mg nifedipine tablet was administered sublingually； urapidil group， 12.5 mg of urapidil was diluted in 20 ml normal sal