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目的探讨抢救治疗高血压急性左心衰的常规首选药物,评价硝普钠在高血压急性左心衰中的临床疗效。方法将入选的108例高血压急性左心衰病人,男68例,女40例,随机分为治疗组64例(其中有10例为对照组治疗效果差而加入治疗组),对照组44例。治疗组在吸氧、镇静、坐位、利尿基础上使用硝普钠25-50 mg加入5％葡萄糖250 ml中静点,按50-100μg/min速度点滴(用输液泵推速为30-60 ml／h)。待血压下降为140-160／80-90 mm Hg(1 mm Hg=0．133 kPa)后,如呼吸急促等缓解,则减慢滴速,保持血压在110-160／60-90 mm Hg。对照组使用硝酸甘油20-50mg加入5％葡萄糖250 ml中静点,同样根据血压调整滴数。观察两组在临床症状,缓解例数、缓解率及缓解时间,用药前后呼吸、血压、心率变化。结果治疗组无论从呼吸、心率、血压、临床症状、缓解率和缓解速度均比对照组效果好,差异有高度统计学意义(P<0．01)。结论硝普钠通过扩血管降压,降低心脏前后负荷,缓解肺水肿疗效确且迅速,明显优于硝酸甘油。可作为抢救高血压急性左心衰的首选用药。
Objective To investigate the conventional drugs of choice for rescue and treatment of acute left heart failure associated with hypertension and evaluate the clinical efficacy of sodium nitroprusside in the treatment of acute left heart failure associated with hypertension. Methods A total of 108 patients with acute left heart failure with hypertension were enrolled in this study. They were randomly divided into treatment group (64 males and 68 females and 40 females) (10 of them were treated poorly in the control group and 44 in the control group) . In the treatment group, sodium nitroprusside 25-50 mg was added to 250 ml medium point of 5% glucose on the basis of oxygen inhalation, sedation, sitting position and diuresis, and then dripped at the speed of 50-100 μg / min / H). When the blood pressure dropped to 140-160 / 80-90 mm Hg (1 mm Hg = 0.133 kPa), such as shortness of breath and other relief, then slow down the drip rate, to maintain blood pressure at 110-160 / 60-90 mm Hg. The control group using nitroglycerin 20-50mg added 5% glucose 250 ml in the static point, the same adjustment according to blood pressure drops. Two groups were observed in the clinical symptoms, the number of relief cases, remission rate and remission time, before and after treatment of respiration, blood pressure, heart rate changes. Results The treatment group was better than the control group in respiration, heart rate, blood pressure, clinical symptoms, remission rate and mitigation rate, the difference was highly statistically significant (P <0.01). Conclusions Sodium nitroprusside is effective in reducing pulmonary edema by vasodilator vasodilation, reducing the heart anterior and posterior load, and is superior to nitroglycerin obviously. Can be used as rescue treatment of acute left heart failure of choice.