硝苯地平治疗房室阻滞的观察

继在硝苯地平治疗病态窦房结综合征研究之后，又进行硝苯地平用于治疗房室传导阻滞（ＡＶＢ）的观察。观察对象共１４例（Ⅲ度及高度ＡＶＢ共１２例，Ⅱ度Ⅱ型ＡＶＢ２例）。其中１０例ＡＶＢ恢复窦性心律，症状消失，并维持稳定，判断为有效。另４例无效，但其中３例症状未再出现。本结果提示硝苯地平对ＡＶＢ似具一定治疗作用。     

硝苯啶长期应用对肝硬变肝血流及肝功的影响

目的研究钙通道阻滞剂硝苯啶（ＮＦＰ）长期口服对３２例肝硬变门脉高压患者肝血流及肝功的影响．方法采用无创伤性核多功能仪首次通过法观察肝血流，同时记录服药前后体循环及肝功等变化．结果ＮＦＰ口服４周以上，总体患者及Ｃｈｉｌｄ＿Ｐｕｇｈ分级的各级患者均显示可明显减少门脉血流（ｋｖ），使肝动脉血流（ｋａ）增加，而不影响肝脏的总血流（ｋａ＋ｋｖ）；对平均动脉压（ＭＡＰ）及心率（ＨＲ）等体循环的影响甚小，并可改善血清白蛋白、胆红素及ＡＬＴ水平．结论ＮＦＰ可长期用于临床降低肝硬变门脉高压，预防食管曲张静脉破裂出血     

依那普利和硝苯地平控释片对早期糖尿病肾病合并高血压的疗效比较

目的　观察依那普利和硝苯地平控释片对早期糖尿病肾病合并高血压患者血压及尿白蛋白排泄率 (UAER)的影响。方法　随机将 44例病人分为 2组 :依那普利组 (10 mg,2次 /d,2 2例 ) ;硝苯地平控释片组 (30 mg,1次 /d,2 2例 )。疗程 6个月 ,观察治疗前后血压及 UAER的变化。结果　两组治疗后均能明显降低血压 (P <0 .0 1)及 UAER,由 90 .2和 86 .0分别降至 6 7.4和70 .8,下降 2 9.1%和 2 3.5 % ,P值均 <0 .0 1,但两组比较差异无显著性 (P>0 .0 5 )。两组治疗后U AER下降幅度与收缩压、舒张压下降幅度之间比较无显著相关性 (P值均 >0 .0 5 )。结论　依那普利和硝苯地平控释片均能有效降低血压 ,减少尿蛋白的排泄 ,保护肾脏功能     

特布他林与硝苯地平用于产时胎儿宫内复苏:前瞻性随机对照研究

目的初步探索特布他林与硝苯地平用于产时胎儿宫内复苏(intrauterine fetal resuscitation,IUFR)的安全性及有效性。方法本研究采用随机对照方法,前瞻性将2021年1月至2021年4月在广州市妇女儿童医疗中心分娩中出现不可靠胎心监护图形(non-reassuring fetal heart rate tracing,NRFHT)的110例孕产妇随机分为特布他林组(硫酸特布他林0.25 mg皮下注射,n=55)和硝苯地平组(硝苯地平10 mg口服,n=55)。收集2组孕妇使用药物前及用药后5、15、30 min的血压、心率、血氧饱和度等血流动力学变化,以及IUFR的成功率、药物起效时间、产后出血率等指标,采用t检验、χ²检验、Fisher精确概率法及秩和检验对数据进行统计学分析。结果特布他林组和硝苯地平组孕妇用药前后平均动脉压及血氧饱和度比较差异均无统计学意义(P值均>0.05);硝苯地平组孕妇用药前后心率无明显变化(P>0.05),而特布他林组孕妇心率在用药后5、15、30 min均快于用药前[(97.0±20.2)、(99.2±13.8)、(91.8±12.6)与(81.7±11.3)次/min,P值均<0.001],但心率增快效应在30 min开始下降,与用药后15 min相比,心率下降了6.4次/min(95%CI:1.5~11.2,P<0.05)。所有孕产妇均未发生需要医疗干预的不良反应。特布他林组有78.2%(43/55)复苏成功,与硝苯地平组的70.9%(39/55)比较差异无统计学意义(χ²=0.77,P=0.381);特布他林组药物起效时间明显快于硝苯地平组[2 min(1~6 min)与6 min(1~10 min),U=2348.50,P<0.001]。2组孕产妇因NRFHT行剖宫产及阴道助产、1 h内再次使用宫缩抑制剂等方面比较差异均无统计学意义(P值均>0.05)。2组产后出血量、产后出血率、新生儿低Apgar评分(≤7分)、低脐动脉pH值(pH<7.2)、新生儿窒息率及新生儿重症监护病房入住率等方面差异均无统计学意义(P值均>0.05)。结论特布他林用于产时IUFR暂未发现明显不良反应;其起效速度快,可作为处理产时紧急IUFR的选择方案。     

四磨汤对胃窦平滑肌的影响及钙通道在其中的作用

目的研究四磨汤对SD大鼠离体胃窦纵、环行平滑肌条收缩活动的影响及钙通道在其中的作用。方法正常SD大鼠离体胃窦纵、环行平滑肌条置于盛有Krebs液的组织浴槽中,记录其等长收缩活动,观察四磨汤累积量加入(1μL、5μL、25μL、50μL、100μL、150μL、200μL)对大鼠胃窦纵、环行平滑肌条收缩活动的影响,以及钙通道阻断剂硝苯地平(30 nmol/L)对四磨汤引起的胃窦平滑肌条收缩活动的影响。结果四磨汤剂量依赖性引起大鼠胃窦纵、环行平滑肌条收缩活动增加,硝苯地平可部分阻断四磨汤对胃窦纵、环行平滑肌条的兴奋作用;硝苯地平对于四磨汤诱导的纵行肌兴奋的抑制效应明显强于环行肌。结论四磨汤对大鼠胃窦平滑肌的收缩活动具有明显的兴奋作用,这一兴奋作用部分通过钙通道介导,纵行肌较环行肌更多的依赖于外钙内流。     

高血压患者硝苯地平治疗前后血浆内皮素和降钙素基因相关肽的变化

目的观察硝苯地平降压治疗对血浆内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）水平的影响。方法３１例原发性高血压（ＥＨ）患者口服硝苯地平控释片４０ｍｇ／ｄ×１４，用放免法直接测定治疗前后的血浆ＥＴ和ＣＧＲＰ水平。结果ＥＨ患者血浆ＥＴ水平明显高于对照组（８５．６±２１．０ｖｓ４２．１±２０．３ｐｇ／ｍｌ，Ｐ＜０．００１）；ＣＧＲＰ水平明显低于对照组（２３．０±８．１ｖｓ５５．４±１７．８ｐｇ／ｍｌ，Ｐ＜０．００１）。舒张压与ＥＴ水平呈正相关（ｒ＝０．５３０２，Ｐ＜０．００５），ＥＴ与ＣＧＲＰ呈弱的负相关（ｒ＝０．３７０７，Ｐ＜０．００５）。治疗后，血压和ＥＴ水平明显下降（Ｐ均＜０．００１），ＣＧＲＰ水平显著增高（Ｐ＜０．００１）。结论硝苯地平是一种有效的降压药，它可通过调节ＥＨ时多种血管活性多肽之间的平衡关系，对器官保护具有重要作用     

Acute effects of nifedipine, diltiazem and their combination in patients with chronic stable angina: a double-blind, randomized, cross-over, placebo-controlled study

We evaluated the acute therapeutic effects of the oral administrationof n (10mg) and diltiazem (120 mg) alone and in combinationin 16 patients with effort angina. The 16 patients (13 men andthree women; mean age 59±7 years) performed a symptom-limitedbicycle exercise stress test 3 h after placebo or active substanceadministration. Maximal work load, exercise duration and timeto 1 mm ST segment depression were significantly increased andST depression at peak exercise was significantly decreased bythe combination of drugs. N and diltiazem alone similarly improvedexercise duration as markedly as their combination. One patientstopped the test after all three treatments for angina associatedwith ST depression > 2mm. The combination of drugs yieldedthe best symptomatic effect: only four patients complained ofangina in comparison to eight and seven patients after diltiazemand n respectively. Nifedipine and diltiazem are effective and safe antianginaldrugs. Some patients respond better to one drug than to theother. Patients who remain symptomatic in spite of maximal dosesof a single drug may derive some benefit from combination therapy.     

Nifedipine for local use in conservative treatment of anal fissures

PURPOSE: This study was performed according to a prospective, randomized, double-blind, multicenter design. The aim was to test the efficacy of local application of nifedipine gel ^a in healing acute anal fissure by relaxing the internal anal sphincter. METHODS: Two hundred eighty-three patients who gave informed consent were recruited; they received a clinical examination. A questionnaire to evaluate the symptoms and the pain was administered, and a proctoscopy and anorectal manometry were performed. Patients treated with nifedipine (n=141) used topical 0.2 percent nifedipine gel every 12 hours for three weeks. The control group, consisting of 142 patients, received topical 1 percent lidocaine and 1 percent hydrocortisone acetate gel during therapy. Manometry was performed before and on Days 14 and 21. Anal pressures were measured by recording resting and squeeze pressures. RESULTS: Results obtained were as follows: total remission from acute anal fissure was achieved after 21 days of therapy in 95 percent of the nifedipine-treated patients (P<0.01), as opposed to 50 percent of the controls (P<0.01), and previously elevated maximum resting anal pressures decreased from a mean value ± standard deviation of 72.5±10.07 mmHg to 50.5±10.03 mmHg in the nifedipine group. This represents a mean reduction of 30 percent (P<0.01). We also observed a significant decrease in squeeze pressures in nifedipine-treated patients (from a mean ± standard deviation of 130.5±19.25 mmHg to 108.5±18.55 mmHg, a mean reduction of 16.8 percent;P<0.01). No changes in anal pressures were observed in the control group. We did not observe any systemic side effect or significant anorectal bleeding in patients treated with nifedipine. CONCLUSIONS: Our study clearly demonstrates that the therapeutic use of nifedipine, which at present is used only in cardiovascular pathologies, should be extended with local use to the conservative treatment of anal fissures.International patent pending.Address reprint requests to Dr. Antropoli: Via IV Novembre, 11, 81020 Capua (Caserta), Italy.     

Slow-Release Nifedipine as a Single or Additional Agent in the Treatment of Essential Hypertension—A Placebo-Controlled Crossover Study

The efficacy and safety of a new slowrelease formulation of nifedipine (“Adalat Retard”) were assessed in a double-blind cross-over trial in 19 subjects with essential hypertension (14 male, 5 female—ages: 34–72 years), 14 of whom continued previous antihypertensive medication. There were two 6 week treatment phases in which nifedipine 20 mg twice daily and placebo tablets twice daily were administered in random order. Supine mean blood pressure was 115 ± 2 mm Hg during the placebo phase and 105 ± 2 mm Hg during the nifedipine phase (p < 0.001); and standing mean blood pressure was 121 ± 2 mm Hg after placebo and 110 ± 2 mm Hg after nifedipine (p < 0.001). The magnitude of the blood pressure difference between the two phases was not related either to age or to the placebo phase blood pressure. The hypotensive effect of nifedipine was observed when administered as a single agent or in combination with diuretic and/or beta blocker. Heart rate was increased after nifedipine ?75 ±2 beats/minute compared with 71 ± 2 beats/minute after placebo (p < 0.01). In this dose nifedipine (as “Adalat Retard”) is an effective hypotensive agent which is a useful addition to presently available therapy.     

Nifedipine in Hypertensive Crises of Infants and Children

Nifedipine given by the sublingual route has been used in the treatment of 30 hypertensive emergencies in 20 children suffering from renal disease. The mean dosage of nifedipine was 0.33 mg/kg body weight. In 20 hypertensive crises occurring in 16 patients a single dose of nifedipine was sufficient to lower systolic as well as diastolic blood pressure significantly within 90 min. for a period of 4 to 12 hours. No side effects were noted with the exception of a transient flush in one patient. Nifedipine proved to be suitable for the primary treatment of hypertensive emergencies in children suffering from renal hypertension. The advantages of nifedipine compared to other drugs used for treating hypertensive crises is the rapid onset of the antihypertensive action without need for an intravenous form of administration.