拉贝洛尔治疗妊娠高血压危象疗效观察

目的：观察静脉使用拉贝洛尔治疗妊娠高血压危象的疗效。方法：妊娠高血压危象55例患者分为两组,A组（30例）使用拉贝洛尔注射液,以（0．5-1）mg／min速度静脉微泵输入,2h左右血压达安全范围,再予（70-208）ug／min静脉维持;B组（25例）采用硝苯地平10mg口服,q8h,两组同时使用硫酸镁预防子痫发生。在此期间监控血压,心电变化。结果：A组用药2h后显效23例,有效6例,显效率76．7％,总有效率96．7％。36h平均血压为（106±13）mmHg（1mmHg=0．133kPa）。B组用药2h后显效8例,有效l0例,显效率32％,总有效率72％。36h平均血压为（118．9±10．2）mmHg,出现心动过速8例。结论：拉贝洛尔治疗妊娠高血压急症疗效确切,降压平稳,未见有严重不良反应。     

心率86次/min可能是鉴别高血压急症或高血压亚急症的简易临床指标

目的  分析在急诊科首诊的高血压危象的患者的心率及血压参数,探讨心率在高血压急症与高血压亚急症的不同变化。 方法  选取2019年1~12月于我院急诊科首诊的高血压危象患者186例,根据是否存在急性靶器官损害将患者分为高血压急症组(n=82)及高血压亚急症组(n=104),分析两组间的临床特点、服用药物种类及数量、服药依从性、血压参数与心率的差异;分析主要不同类型的高血压急症患者的血压参数和心率的组间差异;分析高血压急症组及高血压亚急症组中存在差异的因素对高血压危象中高血压急症患者的预测价值及心率对高血压危象患者中高血压急症的诊断价值。 结果  186例急诊科首诊的窦性心律并高血压急象患者中,高血压急症占44.1%,高血压亚急症占55.9%。女性平均心率高于男性(93±16.7次/min vs 85±18.2次/min,P=0.002)。高血压急症组的平均心率高于亚急症组(98±20.5次/min vs 82 ±12.7次/min,P < 0.001)。与亚急症组相比,高血压急症组中合并糖尿病比例高、服药依从性较差;两组收缩压、舒张压、平均动脉压、脉压差等血压参数比较,差异均无统计学意义(P>0.05)。糖尿病史与心率对高血压危象患者发生高血压急症存在预测价值,心率诊断高血压急症的最佳切点为86次/ min,曲线下面积为0.813。 结论  高血压急症特别是合并急性心衰的患者的平均心率高于高血压亚急症的平均心率,以心率86次/min为阈值可能是鉴别高血压危象中高血压急症或亚急症的简易临床指标,特别适合急诊科诊治思维特点;合并糖尿病的高血压危象患者,更易发生高血压急症。     

Treatment of hypertensive crisis in children with nifedipine

We report 31 episodes of hypertensive crises in children, managed with sublingual nifedipine at the following dosages: 10 mg in children with body weight (BW) higher than 20 kg, 5 mg in children with BW between 10 and 20 kg, and 2.5 mg in children with BW below 10 kg. The mean initial blood pressures were 161.41 mm Hg for the systolic pressure (mSBP) and 111.25 mm Hg for the diastolic pressure (mDBP). After nifedipine, both the mSBP and the mDBP decreased, with onset of effect five minutes after dosage and maximum decrease at 60 min (mSBP 134.93 mm Hg, mDBP 79.23 mm Hg, for decreases of 16.4 and 28.7%, respectively), and this effect persisted for 180 min. Blood pressure increased again from min 240 to min 360, yet without reaching the initial levels. One case did not respond to the first dose of nifedipine and required a second one. The effect of nifedipine was more pronounced on the DBP than on the SBP, and greater reductions of both pressures were achieved in the cases with higher initial readings. No side of medication were observed in our patients.     

尼卡地平和拉贝洛尔对妊娠高血压危象控制有效性临床研究

[摘要]目的：观察比较静脉使用尼卡地平和拉贝洛尔对妊娠高血压危象有效性控制。方法：妊娠高血压危象58例分为两组,A组（28例）使用尼卡地平注射液,以0．5～5μg／（kg·min）速度静脉泵人;B组（30例）使用拉贝洛尔以0．25～2mg／min静脉泵人,两组同时常规使用硫酸镁预防子痫发生,在此期间观察血压心率变化。结果：A组用药4h、24h后安全达标率为96％、48h后目标血压达标率为93％,平均血压为（105±9.1）mmHg（1mmHg=0．133kPa）,11例需联合降压治疗。B组用药4h、24h后安全达标率为90％,48h后目标血压达标率分别为73％,平均血压为（118±10．0）mmHg,23例需联合降压治疗,3例换尼卡地平静脉控制。两组在48h降压疗效差异有统计学意义（P〈O．05）。两组用药前后心率变化无统计学意义。结论：尼卡地平治疗妊娠期高血压危象在降压4h、24h疗效与拉贝洛尔疗效相似,48h控制血压疗效优于拉贝洛尔组,未见有严重不良反应。     

Nifedipine in the management of hypertensive emergencies: Report of two cases and review of the literature

Calcium channel blockers are assuming increasingly important roles in the practice of emergency medicine. Two cases and a review of the literature relating to treatment of hypertensive emergencies with nifedipine are presented. Nifedipine has a rapid onset of action (buccal, 10-15 minutes; oral, 30-45 minutes) and peak effect (buccal, 30 minutes, oral, 60 minutes). The duration of effects is four to six hours regardless of the route of administration, with a mean arterial pressure reduction of 21.6% (248/134 mm Hg to 165/87 mm Hg). In patients with severe hypertension and left ventricular failure, a consistent reduction in systemic vascular resistance (2,088 dynes/sec/cm-5 to 1242 dynes/sec/cm-5) and cardiac index (2.76 l/min/m2 to 3.77 l/min/m2) has been reported. The patients in this study had severe hypertension (systolic blood pressure greater than 180 mm Hg, diastolic blood pressure greater than 120 mm Hg) and end organ involvement (including heart failure, left ventricular strain, headache, confusion, dizziness, and shortness of breath). Nifedipine (10 mg) was administered buccally with prompt reduction of blood pressure and resolution of the patients' symptoms. Nifedipine appears to be a safe, effective agent for the management of hypertensive emergencies. Its pharmacokinetic profile and routes of administration make it particularly valuable in the practice of emergency medicine.     

药物联合综合性心理干预治疗高血压对照研究

目的探讨药物联合综合性心理干预治疗高血压患者伴焦虑、抑郁情绪的临床疗效。方法将80例高血压伴焦虑、抑郁情绪患者随机分为两组各40例,两组均给予常规降压药物治疗,研究组联合综合性心理干预,观察1a。于治疗前及治疗1a末采用焦虑自评量表、抑郁自评鬣表评定焦虑抑郁情绪,定期测血压,并进行对比分析。结果治疗1a末,研究组焦虑自评麓表、抑郁自评量表评分均较治疗前显著下降（P均〈0．01）,较对照组下降显著（P均〈0．01）;研究组收缩压、舒张压均较治疗前显著下降（P均〈0．01）,对照组有不同程度下降（P〉0．05）;研究组收缩压较对照组下降明显（P〈0．01）,舒张压两组无显著性差异（P〉0．05）。结论药物联合综合性心理干预能有效改善高血压患者的焦虑、抑郁情绪,控制高血压指数。     

Clinical implications of cardiac troponin-I in patients with hypertensive crisis visiting the emergency department

ObjectivesCardiac troponin-I (cTnI) is a representative marker of myocardial injury. Elevation of cTnI is frequently observed in patients with hypertensive crisis, but few studies have examined its prognostic significance in hypertensive crisis. We aimed to determine whether cTnI could predict all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED).MethodsThis observational study included patients aged ≥18 years who visited an ED between 2016 and 2019 for hypertensive crisis, defined as systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥110 mmHg. Among 6467 patients, 3938 who underwent a cTnI assay were analysed.ResultsAmong the 3938 patients, 596 (15.1%) had cTnI levels above the 99th percentile upper reference limit (elevated cTnI >40 ng/L) and 600 (15.2%) had cTnI levels between the detection limit (≥10 ng/L) and the 99th percentile upper reference limit (detectable cTnI). The 3-year all-cause mortality in the elevated, detectable and undetectable cTnI groups were 41.6%, 36.5% and 12.8%, respectively. After adjusting for confounding variables, elevated cTnI patients (adjusted hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.61–2.52) and detectable cTnI patients (adjusted HR, 1.64; 95% CI, 1.32–2.04) showed a significantly higher risk of 3-year all-cause mortality than did patients with undetectable cTnI.ConclusionsIn patients with hypertensive crisis, elevated cTnI levels provide useful prognostic information and permit the early identification of patients with an increased risk of death. Moreover, putatively normal but detectable cTnI levels also significantly correlated with a higher risk of all-cause mortality. Intensive treatment and follow-up strategies are needed for patients with hypertensive crisis with elevated and detectable cTnI levels.

Key messages

1. Cardiac troponin-I level was an independent prognostic factor for all-cause mortality in patients with hypertensive crisis.
2. Detectable but normal range cardiac troponin-I, which was considered clinically insignificant, also had a prognostic impact on all-cause mortality comparable to elevated cardiac troponin-I levels.

     

硝苯地平治疗早产的疗效观察

目的:观察硝苯地平对早产的治疗作用及不良反应。方法:将62例妊娠28~36周先兆早产的孕妇随机分为两组,分别口服硝苯地平和沙丁胺醇,观察两组用药后保胎效果、新生儿结局及不良反应。结果:口服硝苯地平后抑制宫缩显效时间为(38.54±11.54)m in,保胎成功率为83.33%,与沙丁胺醇组比较同样有效。主要不良反应为一过性血压降低、潮热、恶心、头痛等,占35.5%(11/31)。结论:硝苯地平治疗早产有效,且无明显不良反应。     

硝苯地平对妊娠期高血压病患者胰岛素抵抗的作用

目的：探讨硝苯地平对妊娠期高血压病（pregnancy—inducedhypertension,PIH）患者的胰岛素抵抗（insulinresistance,IR）的作用。方法：2008年8月2010年6月采用前瞻性随机对照研究方法,将143例妊娠期高血压病患者随机分为硝苯地平组（n=73）与对照组（n=70）。硝苯地平组给予硝苯地平10mgrid口服,2～3周;对照组给予盐酸拉贝洛尔片100mgbid口服,2～3周。采用稳态胰岛素抵抗指数（homeostasismodelassessmentofinsulinresistanceindex,HOMA—IR）评价胰岛素抵抗程度。结果：硝苯地平组与对照组患者的基线临床特征相似,具有可比性。与治疗前相比,两组HOMA—IR均显著降低（P〈0．05）。硝苯地平组HOMA—IR降低值大于对照组[（0．10±0．06）比（0．07±0．05）,P=0．0021。结论：硝苯地平能改善PIH患者的胰岛素抵抗。     

硝苯地平治疗肾输尿管绞痛42例疗效观察

目的 观察硝苯地平治疗肾绞痛的疗效和不良反应.方法 肾或输尿管绞痛患者42例分为硝苯地平组(n=22)和阿托品加盐酸哌替啶组(n=20),观察比较硝苯地平和阿托品加盐酸哌替啶缓解肾、输尿管绞痛的效果及不良反应.结果 两组显效率和总有效率比较差异均无统计学意义(P＞0.05);硝苯地平组出现嗜睡、头痛、口干、心悸等不良反应均低于阿托品联用盐酸哌替啶组(P＜0.05).结论 硝苯地平有较强的缓解肾、输尿管绞痛的作用,且见效快、安全性较高、不良反应少.     

Labetalol infusion in hypertensive emergencies

The antihypertensive effects of labetalol infusion (2 mg/min; maximal dose 150 mg) were evaluated in 22 subjects requiring rapid lowering of blood pressure because of severe hypertension, a hypertensive crisis after surgery, or before angiographic examination. Overall systolic and diastolic blood pressures were reduced from 201 +/- 4 to 164 +/- 4 mm Hg and from 123 +/- 3 to 107 +/- 3 mm Hg, respectively. By the end of the infusion, diastolic blood pressure in 16 (73%) subjects was lowered to less than or equal to 110 mm Hg. No adverse effects were encountered, but one subject had a transitory hypotensive episode that did not require treatment. Intravenous labetalol appears effective and well tolerated in the control of blood pressure in hypertensive emergencies.     

CT立体定位引导微创穿刺颅内血肿清除术与开颅手术治疗高血压脑出血的疗效观察

目的：探讨采用CT立体定位引导微创穿刺颅内血肿清除术与开颅血肿清除术治疗高血压脑出血（HICH）患者的疗效。方法：选取住院治疗的182例高血压脑出血患者,随机分为CT立体定位引导微创穿刺颅内血肿清除术组（微创穿刺组）与开颅手术组,每组91例,分别采用CT立体定位引导微创穿刺颅内血肿清除术和开颅手术治疗,对两组术后神经功能恢复情况、有效率、平均住院日及平均住院费用进行比较。结果：CT立体定位引导微创穿刺颅内血肿清除术术后格拉斯哥昏迷评分（GCS）、神经功能缺损评分、治疗总有效率及神经功能缺损恢复时间优于开颅手术组,差异有统计学意义（P〈0．05）,CT立体定位引导微创穿刺颅内血肿清除术平均住院日较开颅手术组短（P〈0．05）,平均住院费用少于开颅手术组（P〈0．05）。结论：CT立体定位引导微创穿刺颅内血肿清除术治疗高血压脑出血安全有效。     

钙拮抗剂硝苯吡啶对大鼠心肌缺血再灌注损伤的作用

目的研究钙拮抗剂(Calcium antagonists)硝苯吡啶(Nifedipine)对离体大鼠心肌缺血再灌注损伤的作用。方法 30只体重在260-300g的Wistar雄性大鼠随机分为三组:对照组、模型组、Nifedipine组(1μmmol/L)。大鼠麻醉后取出心脏,悬挂于Langendorff灌流装置上行主动脉逆行灌流,制备大鼠离体心脏缺血30min、再灌注120min模型;对照组行150min正常灌流。测定心肌梗死面积,检测SOD(Superoxidedismutas超氧化物歧化酶)及MDA(mal-onaldehyde丙二醛)的含量,免疫组化方法行PKCδ(The protein kinase C蛋白激酶C)的测定,用RT-PCR法测定NCX(Na+/Ca2+exchanger钠钙交换体)及SERCA2α(Sareoplasmie reticulum calcium adenodine triphosphatase肌浆网钙泵)的表达。结果硝苯吡啶组心肌梗死面积较模型组明显缩小(P<0.01);冠脉灌流液中SOD活性明显升高(P<0.01);MDA含量显著下降(P<0.01);药物组的PKC含量水平较模型组增多(P<0.05),药物组NCX mRNA的表达水平较模型组降低,存在显著差异(P<0.05)。结论钙拮抗剂Nifedipine对大鼠心肌缺血再灌注损伤有保护作用。     

嗜铬细胞瘤病人术前发生高血压危象的诱因分析及护理对策

[目的]分析嗜铬细胞瘤病人术前发生高血压危象的诱因,探讨其护理对策。[方法]回顾性分析5例嗜铬细胞瘤术前发生高血压危象病人的临床资料。[结果]情绪变化、过度疲劳及降压药服用不当、刺激挤压瘤体、腹压增高是发生高血压危象的诱因。[结论]针对诱因进行相应的护理及治疗是防治嗜铬细胞瘤病人术前发生高血压危象的关键。     

Spectrum of hypertensive emergencies in pregnancy

Hypertension in pregnancy represents a spectrum of clinical entities, including pregnancy-induced hypertension (PIH), preeclampsia, eclampsia, and hemolysis, elevated liver enzyme levels, low platelet count syndrome. Although hypertension is a common denominator in this group of disorders, the pathogenesis, clinical features, and clinical course of these disorders is variable and somewhat distinct. Therapy must be tailored to the clinical entity and the patient. The incidence and prevalence of preeclampsia and eclampsia is decreasing worldwide. This decrease partly may be caused by the improved treatment of PIH and improved obstetrical services.     

高血压脑出血内外科治疗的死因对照分析

对３５７例高皿压脑出血患者手术和保守治疗的死因进行对比分析。结果：意识状态对病死率有很大影响，清醒者手术组和保守组病死率分别为１１．０％、５．６０％；嗜睡～浅昏迷者两组病死率分别为３２．０％、６２．５％；中度昏迷者两组病死率分别为６３．０％、１００．０％；深昏迷者两组病死率分别为８５．０％、１００．０％。手术组和保守组肺部感染者的病死率分别为５２．３％、７２．７％；消化道出血者两组病死率分别为４３％、６６．６％；脑疝两组病死率分别为５４石％、７５．０％。二次手术和保守组再出血的病死率分别为４０．０％、１００．０％。从而表明，除清醒者外，手术可降低病死率。小脑、皮质下、基底节、脑室出血者手术疗效好、病死率低，基底节出血量＞３０ｍ１者病死宰低于保守组。