佩尔地平与硝酸甘油输液泵输注治疗高血压急症的临床对照分析

目的比较佩尔地平与硝酸甘油用输液泵输注治疗高血压急症疗效及安全性。方法120例高血压急症患者随机分为佩尔地平组和硝酸甘油组,各60例。两组患者均使用微量泵静脉输注降压药。佩尔地平组：20mg佩尔地平稀释于生理盐水至50ml,起始剂量4ml／h。硝酸甘油组：50mg硝酸甘油稀释于生理盐水至50ml,起始剂量3ml／h。观察并记录两组患者用药前、用药5、10、30、60min后的血压、心率,据此调整药液泵入速度。比较两组患者用药后起效时间,用药60min后降压有效率及心率变化。结果佩尔地平较硝酸甘油起效快,差异有统计学意义（P〈0．05）。用药60min后,佩尔地平组全部患者血压降至目标值,硝酸甘油组48例患者血压降至目标值,降压有效率分别为100％和80％,差异有统计学意义（P〈0．05）。用药后两组患者心率均有增加,但佩尔地平组心率在30min时开始逐渐恢复,用药后60min后心率与用药前相比差异无统计学意义,硝酸甘油组用药后60min心率尚未恢复至用药前水平,与用药前相比差异有统计学意义（P〈0．05）。结论佩尔地平输液泵输注治疗高血压急症起效迅速、降压平稳、疗效确切,且对心率的影响较小,为急诊科治疗高血压急症的理想药物。     

佩尔地平治疗高血压急症的临床观察

佩尔地平是一种新型钙拮抗剂,可迅速有效地降压,对防止或和逆转高血压引起的终末器官损害,抢救高血压急症患者的生命和改善预后具有重要意义。本文通过对２０例高血压急症进行观察,以探讨合适剂量,起效时间,降压效果及不良反应。１资料与方法１１一般资料本组２０...     

尼卡地平注射剂治疗高血压急症临床观察

目的观察静脉滴注尼卡地平治疗高血压急症的降压疗效及安全性。方法多中心入选54例高血压急症并接受静脉滴注佩尔治疗12h,观察临床症状、不良反应、血压和心率变化。结果总有效率100%,用药后5min血压即明显下降,30min达显效水平,1.5h达最大降压效应并平稳维持至用药结束;达目标血压的药物滴速、累积量、时间分别为55±28μg/min、2.10±1.52mg、38±19min,维持目标血压的药物滴速为49±25μg/min,12h总量为35.5±10.2mg;副反应发生率为9.3%,包括头痛5.6%、心悸5.6%、面红3.7%、血压下降过快1.9%。心率增快≥5bpm和≥10bpm的发生率分别为59%和39%,停药后很快恢复正常;用药后未发生心律失常、心肌缺血的ST段改变及血生化指标异常。结论静脉滴注尼卡地平能快速、有效、安全地控制高血压急症的血压水平。     

静脉推注硝酸甘油治疗高血压急症的临床研究

目的 探讨静脉推注(静推)硝酸甘油治疗高血压急症的疗效和安全性.方法 将106例高血压急症患者随机分组,两组基础治疗相同;硝酸甘油组(50例)加用1 mg硝酸甘油+10 ml葡萄糖注射液15 min内静推(66.7 μg/min)完毕后,以10～40 μg/min静脉滴注(静滴)维持;尼卡地平组(56例)则给予尼卡地平2 mg+10 ml葡萄糖注射液10 min内静推(200 μg/min)完毕后,以0.5～2.5 μg·kg-1·min-1静滴维持.记录给药前及给药后即刻、5、10、30、60 min的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),并记录不良反应发生情况.结果 与尼卡地平组比较,硝酸甘油组起效较快,且给药后即刻、5 min、10 min时SBP、DBP、MAP 下降幅度均较尼卡地平组大,差异有统计学意义(P均<0.05),而30 min、60 min时两组比较差异则无统计学意义.硝酸甘油组给药后心率变化大于尼卡地平组.两组均未发现严重不良反应.结论 静推硝酸甘油治疗高血压急症是有效和安全的,给药后60 min内其效果和尼卡地平相似.     

硝酸甘油治疗高血压急症

硝酸甘油治疗高血压急症福建医科大学附属协和医院心内科（３５０００１）洪华山，王一波，杨岚高血压急症分高血压特急状态和高血压紧急状态两类。前者过去一般首选硝普钠治疗，但硝普钠具氰化物中毒的危险性及必须避光使用的缺点；而后者，一般用口服或舌下含服心痛定或...     

尼卡地平与酚妥拉明治疗高血压急症的疗效对比

对２２例患高血压急症的病人，分别应用尼卡地平及酚妥拉明作对比研究，评价其疗效及安全性。结果表明，两组起铲时间５－１５分钟显效时间分别为１５分钟及３０分钟及，显效率达１００％，最大效应时间均为１小时。两组时间各时段血压下降值差异无显著性意义。     

尼卡地平治疗高血压急症临床观察--附91例报告

尼卡地平是第二代二氢吡啶类钙拮抗剂,为探讨其静脉制剂的降压作用,自2000年以来,对91例高血压急诊病人分别静脉给予尼卡地平及硝普钠治疗进行对比观察,看到尼卡地平具有与硝普钠相同的临床疗效.     

尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响

目的对比尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响。方法采取随机、对照、双盲的方法将40例行颅内动脉瘤夹闭术的患者分成尼卡地平(Ⅰ)组和硝酸甘油(Ⅱ)组,每组20人。打开硬脑膜行控制性降压,并于打开硬脑膜即刻(T0)、瘤体分离结束(T1)、夹闭完毕(T2)、停止控制性降压20min(T3)四个时点行桡动脉及颈内静脉球血气分析,记录PaO2、PjvO2、SaO2、SjvO2、Hab、Hjvb值,并计算Da-jvO2、COER值。结果两组患者在控制性降压效果上无明显统计学差异(P>0.05),降压期间心率均增快(P<0.01);Ⅰ组患者在T1、T2时点SjvO2值较T0、T3时点明显升高(P<0.05或P<0.01),而Da-jvO2、COER值明显降低(P<0.01);Ⅱ组患者T1、T2时点SjvO2、Da-jvO2、COER值与T0、T3时点比较无明显统计学差异(P>0.05);Ⅰ组患者在T1、T2时点SjvO2值对应Ⅱ组明显升高(P<0.05),而Da-jvO2、COER值明显降低(P<0.05)。结论硝酸甘油与尼卡地平均可安全用于颅内动脉瘤夹闭术的控制性降压,但后者能有效降低脑氧代谢,改善脑氧合,脑保护作用更优越。     

小剂量硝酸甘油对妇科腹腔镜手术合并高血压患者氧化应激的影响

目的 研究小剂量硝酸甘油对合并高血压并行腹腔镜妇科手术的患者氧化应激及apelin-12水平的影响。方法 选取腹腔镜下行全子宫切除术的高血压患者80例,采用随机数表法分为硝酸甘油组和对照组。硝酸甘油组在气腹开始至手术结束泵注小剂量硝酸甘油[0.10~0.25 μg/（kg·min）],对照组泵注等量生理盐水。于术前（T0）,气腹开始30 min（T1）及手术结束后1 h（T2）抽取外周肘静脉血,比较2组患者血清血管紧张素-Ⅱ（Ang-Ⅱ）、IL-6及apelin-12水平变化和ST-T改变。结果 组内相比,随着气腹时间的增加,血清Ang-Ⅱ、IL-6水平逐渐升高,apelin-12水平逐渐降低;同对照组相比,硝酸甘油组T1、T2时间点的血清Ang-Ⅱ和IL-6水平上升幅度明显降低,apelin-12水平下降幅度也明显降低,差异均有统计学意义（P均< 0.05）。2组ST-T异常发生率比较差异无统计学意义（P > 0.05）。结论 小剂量硝酸甘油可以缓解腹腔镜下行子宫全切术合并高血压患者的应激反应,apelin-12可能协同一氧化氮延缓氧化应激的发生发展。     

硝酸甘油贴膜与硫酸镁联合治疗早产的随机对照试验

目的:研究联合应用硝酸甘油贴膜与硫酸镁治疗早产的疗效及其新生儿的预后。方法:选入孕28～37周之间的先兆早产患者共213例,随机分组分别接受联合用药或单一用药。联合用药组给予硝酸甘油贴膜及静脉滴注硫酸镁,单一用药组仅用硫酸镁。观察比较两组妊娠延长的时间及新生儿的发病率和死亡率。结果:两组入选病例的临床特征相似。联合用药组发生在孕32周前的早产减少,新生儿发病率明显降低(P<0.05)。但硝酸甘油贴膜有一定的副作用。结论:联合应用硝酸甘油贴膜与硫酸镁治疗早产更为有效,可降低新生儿的发病率。     

Randomized,comparative, double-blind study of amlodipine vs. nicardipine as a treatment of isolated systolic hypertension in the elderly

A 90-day, multicenter, randomized, double-blind, parallel-group study was conducted to compare the efficacy of amlodipine (once a day) with nicardipine (two to three times a day), in the treatment of isolated systolic hypertension (ISH) in the elderly. Patients (n = 133) aged > or = 60 years, with ISH were randomized to receive either amlodipine 5 mg/day, or nicardipine 60 mg/day (titrated if necessary to 10 mg/day and 100 mg/day, respectively) for 90 days. Efficacy was assessed by measuring office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM). The two treatments substantially and comparably reduced office systolic blood pressure (SBP) and pulse pressure (PP), and also produced a slight decrease in diastolic blood pressure (DBP). Amlodipine reduced SBP, as assessed by ABPM, to a significantly greater extent than nicardipine. Both treatments were well-tolerated. The sustained effect of amlodipine, compared with nicardipine, was reflected in its significantly greater antihypertensive activity, particularly during the nocturnal period, as assessed by ABPM. The study demonstrates that once a day dose of amlodipine is an effective antihypertensive treatment for elderly ISH patients.     

Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial

Headache is a very common medical complaint. Four to six percent of the population will have a debilitating headache in their lifetime; and 1-2% of all Emergency Department (ED) visits involve patients with headaches. Although promethazine is used frequently, it has never been studied as a single-agent treatment in undifferentiated headache. We hypothesized that promethazine would be superior to prochlorperazine in the treatment of headache. We conducted a prospective, double-blinded, randomized, controlled trial on patients presenting to our ED between May and August 2005 with a chief complaint of headache. Each subject was randomized to receive either intravenous promethazine 25 mg or prochlorperazine 10 mg, and graded the intensity of their headache on serial 100-mm visual analog scales (VAS). Patients with dystonic reactions or akathesia were treated with diphenhydramine. Adequate pain relief was defined as an absolute decrease in VAS score of 25 mm. After discharge from the ED, patients were queried regarding the recurrence of headache symptoms, the need for additional pain medications, and the occurrence of any side effects since discharge. Thirty-five patients were enrolled in each group. Both drugs were shown to be effective in treatment of headaches. Prochlorperazine provided a faster rate of pain resolution and less drowsiness when compared to promethazine. Both medications were individually effective as abortive therapy for headache. Prochlorperazine was superior to promethazine in the rate of headache reduction and rate of home drowsiness, with similar rates of akathesia, nausea resolution, patient satisfaction, and headache recurrence within 5 days of discharge.     

头孢丙烯与头孢克洛随机对照治疗下呼吸道感染患者的临床评价

目的　评价头孢丙烯与头孢克洛随机对照治疗下呼吸道感染的疗效和安全性。方法　轻、中度下呼吸道感染患者 12 0例随机分成两组 ,头孢丙烯组 6 2例予头孢丙烯 5 0 0mg ,口服 ,2次 /d ;头孢克洛组 5 8例予头孢克洛5 0 0mg ,口服 ,3次 /d。两组均以 7～ 14天为 1个疗程。结果　头孢丙烯组与头孢克洛组的临床有效率分别为 91.9%与 89.7% (P >0 .0 5 ) ,细菌消除率为 89.8%与 88.9% (P >0 .0 5 ) ,两组均无明显不良反应。结论　头孢丙烯可作为治疗轻、中度下呼吸道感染有效和安全的抗生素     

硝酸甘油介入核素心肌灌注显像评价原发性高血压患者心肌微血管损伤的研究

目的：描述原发性高血压病患者心肌微血管损伤在心肌灌注断层显像（MPI）中的影像特征,探讨影像特征与高血压严重程度的关系。方法：应用99Tcm-甲氧基异丁基乙腈（MIBI）MPI定性与半定量计分法,描述102例原发性高血压患者静息MPI（R-MPI）结果与硝酸甘油（NTG）介入MPI（NTG-MPI）特点。结果：①冠状动脉造影（CAG）正常组反向再分布68个节段,占NTG-MPI异常节段数的11.5%; CAG异常组反向再分布170个节段,占NTG-MPI异常节段数的28.8%;两组相比χ2=10.53,P<0.001。②Ⅰ级高血压患者R-MPI和NTG-MPI结果无明显差异（t=1.81,P＞0.05）;Ⅱ、Ⅲ级高血压患者NTG-MPI心肌缺血节段与R-MPI相比,有显著性差异（t=8.23、7.55,P<0.001）。③随着高血压病情的加重,SRS、SSS、SDS分别从（2.83±1.25）分、（5.67±2.29）分、（-4.35±2.11）分上升到（15.32±6.54）分、（24.19±7.36）分、（-14.62±3.82）分;各项指标三组相比F值分别为25.77、27.69、26.34,P<0.05、0.01、0.01;而且,每个级别高血压同组的SSS与SRS之间也具有非常显著性差异,t=4.35、7.78、6.17,P<0.001。结论：①NTG-MPI中心肌缺血节段的数量和严重程度在一定程度上能够反映高血压患者冠状循环微血管损伤程度;②反向再分布是冠状循环微血管损伤在MPI中的特征性影像表现。     

Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine.

Approximately 30% of women afflicted with migraine have menstrually associated attacks. These migraines are often refractory to treatment. Evidence suggests estrogen and progestin fluctuations may influence menstrual migraine. Phytoestrogens have demonstrated estrogenic effects in some tissues, but are without stimulation of the endometrium, suggesting decreased risk with long-term use. This study was undertaken to assess the efficacy of a phytoestrogen combination in the prophylactic treatment of menstrual migraine. Forty-nine patients were randomized to receive either placebo, or a daily combination of 60 mg soy isoflavones, 100 mg dong quai, and 50 mg black cohosh, with each component standardized to its primary alkaloid. Patients received study medication for 24 weeks. Average frequency of menstrually associated migraine attacks during weeks 9-24 was reduced from 10.3 +/- 2.4 (mean +/- s.e.m.) in placebo treated patients to 4.7 +/- 1.8 (P < 0.01) in patients treated with the phytoestrogen preparation.     

Automated infusion of nitroglycerin to control arterial hypertension during cardiac surgery

Objective To evaluate the feasibility of closed-loop blood pressure control during cardiac surgery.Design A closed-loop system regulated peroperative hypertension by controlling the infusion rate of the vasodilator nitroglycerin (NTG). The controller consisted of a regulator which was monitored by a supervisory computer program. Mean arterial pressure (MAP) was calculated every 5 s from measurements of the radial artery pressure signal. The regulator calculated an NTG infusion rate with each new MAP measurement. The supervisory computer program monitored the regulator's actions and adapted or overruled the regulator when required.Setting The cardiac surgery operating room.Patients 46 patients who were scheduled for cardiac surgery and who developed peroperative hypertension.Interventions Patients were scheduled for either bypass or valve replacement surgery. The closedloop system was used to control hypertension before and after cardiopulmonary bypass. The use of the closed-loop system did not require deviation from the protocol normally used during cardiac surgery. All patients received standard continuous anaesthesia with opioids.Measurements and results Initial automatic control was achieved in 9.4 (4.1 SD) min. The percentage of time that MAP remained in a range around the target MAP of ±10 and ±20 mmHg was 74 and 94%, respectively. The mean NTG infusion rate while MAP was within 5 mmHg of target MAP was 1.14 (0.84 SD)g kg^–1 min^–1. Target MAP was set between 65 and 90 mmHg. There was a small group of patients (6 out of 46) who did not respond to NTG and required alternative drug therapy.Conclusions The controller provided fast and stable control in all patients. The expert knowledge implemented through the supervisory computer program enabled the controller to respond adequately to the rapid changes in arterial pressures commonly associated with cardiac surgery. We conclude that closed-loop control of arterial pressure is feasible not only in the cardiac surgical care unit but also during cardiac surgery.