地尔硫对动脉导管未闭术后硝普钠难以控制的高血压的作用

目的探讨静脉应用地尔硫对动脉导管未闭术后硝普钠难以控制的高血压的效果。方法对动脉导管未闭术后发生反应性高血压的患者进行回顾性分析。术后31例患者仅用硝普钠静脉泵入即可控制反应性高血压,设为硝普钠组;20例患者使用硝普钠控制高血压效果不佳,改为静脉泵入地尔硫,设为地尔硫组。比较硝普钠组和地尔硫组2组患者的临床特征,术前与术后0、1、2、4、6 h平均动脉压,心率,药物用量和不良反应等情况。结果 2组患者术前在性别、年龄、身高、体重、手术时间、围手术期液体入量及术后各时间段动脉平均压之间无显著差异(P>0.05)。地尔硫组患者动脉导管的直径(7.4±2.5)mm大于硝普钠组(4.4±1.4)mm(P<0.01)。地尔硫组术后各时间段心率均低于硝普钠组(P<0.01);不良反应的总发生率低于硝普钠组(52%vs.20%,P<0.05)。硝普钠组术后各时段间的剂量有显著差异(P<0.01),硝普钠剂量随时间延长逐步增加,而地尔硫组各时段之间剂量无显著差异(P>0.05)。结论静脉应用地尔硫可安全有效地控制动脉导管未闭术后硝普钠难以控制的反应性高血压。

Effects of diltiazem on postoperative hypertension after surgical closure of patent ductus arteriosus when sodium nitroprusside failed to control

AIM To evaluate the curative effects of diltiazem on postoperative hypertension after surgical closure of patent ductus arteriosus(PDA)when sodium nitroprusside failed to control.METHODS A retrospective study was performed in 51 patients with postoperative hypertension after surgical closure of PDA in our center.Thirty-one patients,who received sodium nitroprusside for postoperative hypertension,were enrolled in the sodium nitroprusside group.Twenty patients,who received diltiazem when sodium nitroprusside failed to achieve satisfactory blood pressure control,were included in the diltiazem group.Clinical data,the mean blood pressure,heart rates before and 0,1,2,4,6 hours after the surgery,the drug doses and adverse drug reactions were compared between the two groups.RESULTS There were no significant differences in gender,age,weight,height,operation time and perioperative infusion volume between the two groups(P > 0.05).The diameter of PDA in the diltiazem group was larger than that in the sodium nitroprusside group((7.4 ± 2.5)mm vs.(4.4 ± 1.4)mm,P < 0.01).The heart rates at different time points in the diltiazem group were lower than those in the sodium nitroprusside group(P < 0.01).The overall incidence of adverse drug reactions in the diltiazem group was lower than that in the sodium nitroprusside group(52% vs.20%,P < 0.05).There was significant difference(P < 0.01)in drug doses at different time interval in the sodium nitroprusside group with time-dependent trend,while there was no significant difference in the diltiazem group(P > 0.05).CONCLUSION Intravenous diltiazem is effective and safe in postoperative hypertension after surgical closure of PDA when solium nitroprusside failed to control.