标题：乌拉地尔与硝酸甘油治疗高血压性急性左心衰竭疗效比较

      作者：谢桥根，沈晨辰    (如皋博爱医院心内科，江苏 如皋 226500)

      卷次： 2018年29卷21期

      【摘要】 目的 评价静脉泵入乌拉地尔注射液与静脉泵入硝酸甘油注射液治疗高血压性急性左心衰竭的有效性及安全性。方法 选取如皋博爱医院2015年1月至2017年12月收治伴有血压升高的急性左心衰竭患者96例，采用随机数表法分为对照组和观察组，每组48例，对照组患者常规抗心衰同时采用硝酸甘油注射液10 mg加入48 mL 0.9%氯化钠注射液中静脉泵入治疗，观察组患者在常规抗心衰治疗同时采用乌拉地尔注射液50 mg加入40 mL 0.9%氯化钠注射液中静脉泵入，症状缓解后将两药逐渐减量至停用，使用时间不超过24 h；于治疗60 min后比较两组患者的临床治疗总有效率及治疗前后的血压、心率、呼吸、血氧饱和度(SpO2)水平，同时比较治疗后5 min、30 min、60 min、120 min血压、心率、呼吸、SpO2变化，120 min后比较两组患者治疗前后的B型利钠肽(BNP)水平。结果 治疗60 min后观察组患者的治疗总有效率为97.92%，明显高于对照组的83.33%，差异有统计学意义(P<0.05)；两组患者治疗后不同时间的收缩压、舒张压、心率、呼吸、SpO2均改善，与治疗前比较差异均有统计学意义(P<0.05)；观察组治疗后5 min开始起效，5 min、30 min、60 min、120 min的血压和心率改善优于对照组，差异均有统计学意义(P<0.05)；治疗后5min，两组患者的呼吸、SpO2比较差异均无统计学意义(P>0.05)，30 min、60 min和120 min后，观察组患者的呼吸、SpO2改善优于对照组，差异均有统计学意义(P<0.05)；治疗后120 min，两组患者的BNP水平较治疗前均明显改善，且观察组BNP水平较对照组下降更为明显，差异均有统计学意义(P<0.05)。结论 乌拉地尔治疗高血压性急性左心衰竭起效快，可有效改善临床症状，改善心脏功能，不良反应轻微，疗效优于硝酸甘油，具有临床推广使用价值。
      【关键词】 乌拉地尔；硝酸甘油；治疗；高血压性急性左心衰竭；疗效
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2018）21—2986—04

Comparison of the efficacy of urapidil and nitroglycerin in the treatment of hypertensive acute left heart failure.XIE Qiao-gen, SHEN Chen-chen.
Department of Cardiology, Rugao Boai Hospital, Rugao 226500, Jiangsu, CHINA
【Abstract】 Objective To evaluate the efficacy and safety of intravenous infusion of urapidil injection and nitro-glycerin injection in the treatment of hypertensive acute left heart failure. Methods A total of 96 patients of acute leftheart failure with elevated blood pressure were admitted in Rugao Boai Hospital from January 2015 to December 2017.They were divided into the control group and the observation group accroding to the random number table, with 48 casesin each group. Patients in control group were treated with intravenous infusion of nitroglycerin injection 10 mg and48 mL 0.9% sodium chloride injection on the basis of the conventional anti-heart failure. Patients in the observationgroup were treated with conventional urapidil injection 50 mg and 40 mL 0.9% sodium chloride injection on the basis ofthe routine anti-heart failure. After the symptoms were relieved, the dose of two drugs were gradually reduced to zero.The use time of the two days was less than 24 hour. After 60 min of treatment, the total effective rate between the twogroups and the changes of blood pressure, heart rate, respiration and oxygen saturation (SpO2) before and after treatmentwere compared. The changes of blood pressure, heart rate, respiration and SpO2 were compared at 5 min, 30 min, 60 minand 120 min after treatment. After 120 minutes, the changes of B-type natriuretic peptide (BNP) before and after treat-ment were compared between the two groups. Results After 60 min of treatment, the total effective rate of the observa-tion group was 97.92%, which was significantly higher than 83.33% of the control group (P<0.05). Compared with be-fore treatment, the systolic blood pressure, diastolic blood pressure, heart rate, respiration and SpO2 were improved aftertreatment, and the difference was statistically significant (P<0.05). The observation group began to take effect 5 min af-ter treatment, and the improvement in blood pressure and heart rate of the observation group at 5 min, 30 min, 60 min,and 120 min were better than that in the control group, with statistically significant difference (P<0.05). There was nosignificant difference in respiratory and SpO2 between the two groups at 5 min after treatment (P>0.05). The improve-ment of respiratory and SpO2 in the observation group was better than that in the control group at 30 min, 60 min, and120 min, with statistically significant difference (P<0.05). The levels of BNP between the two groups were significantlyimproved compared with those before treatment. The BNP level in the observation group was significantly lower thanthat in the control group, and the difference was statistically significant (P<0.05). Conclusion Urapidil has a rapid ef-fect of treatment for hypertensive acute left heart failure, which can effectively improve clinical symptoms, and cardi