| BackgroundAcute hypertension pathogenesis is due to excessive blood pressure regulation in response to cerebral blood vessels, causing cerebral arteriolar spasm, ischemia, and then the expansion, exudation, cause acute brain dysfunction, renal blood flow decreased, renal ischemia, hypoxia, activation of the renin-angiotensin system (RAS), the blood pressure rises further.If can depressurize rapidly and cut off the vicious spiral,can improve the prognosis of patients, reduce the mortality rate.But if inappropriate buck also can cause hemodynamic negative reaction, the clinical appearance of adverse consequences.Normal mean arterial pressure (MAP) decreased to<60mmHg, can appear the target organ ischemic damage.Especially in elderly patients with vascular compliance is poor, dropping speed, low pressure amplitude can lead to heart, brain, kidney, blood flow to reduce the excessive, resulting in the symptoms.Therefore to correct selection of antihypertensive drugs.On the basis of acute hypertension pathogenesis and progress, in the therapy of hypertensive emergency process should pay attention to the appropriate antihypertensive degree, can avoid over heart, cerebrovascular autoregulation ability, so as to avoid further induced renal, cerebral or coronary ischemia.Treatment of initial goal was in a few minutes-2hour blood pressure decreased by25%, and then in2-6hours down to160mmHg.In the past the traditional treatment of hypertensive emergency, sodium nitroprusside as a quick, short term effect of vasodilators, on arterial and venous smooth muscle have a direct action of expansion, it can make the peripheral vascular resistance decreased, and reduce the heart before, after the load, so that the cardiac output improvement.While nicardipine for two dihydropyridine calcium antagonist, can inhibit transmembrane calcium influx does not alter the concentration of calcium, in vascular smooth muscle function is strong, so the vascular selectivity.It also can be selectively dilated coronary vascular smooth muscle, and no negative inotropic effect, not on arrhythmia and ventricular contractile force influence.It can reduce the peripheral vascular resistance, role in hypertensive patients than in normotensive subjects, but also reduce the myocardial oxygen consumption and total peripheral resistance, increased coronary collateral circulation coronary blood flow increased, so that.Also can block calcium influx in vascular smooth muscle cells, resulting in the expansion of blood vessels, blood pressure drop.And can delay and reverse the result of hypertension induced myocardial hypertrophy disease course and can prevent the occurrence of cerebral apoplexy. In addition, nicardipine and good expansion of vertebral artery, coronary artery, renal arteries, and can increase the heart, brain, kidney and other important organs blood; also can smooth muscle relaxation; in addition to improve renal blood flow and increased glomerular filtration function. With the further development of the treatment of hypertensive emergencies, recent studies have found that in a wide variety of antihypertensive drugs, nicardipine hypotensive effect of more sustained, stable, and long-term medication without resistance, and has fast acting, buck, Buck smooth easy to grasp the characteristics of relative efficacy, and discovery of nicardipine after discontinuing not easy to rebound the clinical side effects, the advantages of fewer.While the SNP as traditional potent antihypertensive drugs, over the years is the first choice of treatment of hypertensive emergency and one of the most widely used agents. It can balance the dilation of arterioles and venules, reduce left ventricular filling pressure and front and rear load, increased left ventricular emptying, so that the left ventricular volume and ventricular wall tension reduction, reducing cardiac oxygen consumption. The use of sodium nitroprusside must pay attention to monitoring of blood pressure by sodium nitroprusside depressor, speed, pressure amplitude. ObjectiveFor the further study of hypertensive emergency clinical medication safety, reliability and rationality. Knowing what drugs in the therapy of hypertensive emergency has more advantages; and the understanding of nicardipine in the treatment of hypertensive emergency with respect to clinical features, and now the hypertensive emergency clinical first-line drug of choice for clinical comparison, sodium nitroprusside,2005February to2012February are selected in the emergency observation room for treatment of163cases of hypertension patients, divided into the treatment group and the control group, the effect of nicardipine and sodium nitroprusside in the treatment of hypertensive emergency antihypertensive efficacy were comparied.Methods163cases of hypertension patients, divided into two groups randomly, male82cases, female81cases.The treatment group nicardipine (n=82), control group (n=81), sodium nitroprusside during intravenous infusion of nicardipine and sodium nitroprusside in the treatment of2-4hours, observation of clinical symptoms, adverse reaction, blood pressure and heart rate and blood pressure changes after stopping the rebound situation.The two groups before treatment of age, gender, via T orx,2test,P>0.05.The treatment nicardipine group from0.5ug/(kg.Min) starting speed, according to the blood pressure by0.5μg/kg/min increment, maximum dose of60ug/(kg.min) of the infusion speed, according to blood pressure adjustment of dosage.The control group of sodium nitroprusside in0.5μg/kg/min starting dose. According to treatment response to0.5μg/kg per minute increments, gradually adjusted dose, dose of3μg/kg/min of maximum perminute, according to the weight of10μg/kg. During the treatment, the clinical symptoms were observed adverse reactions, blood pressure and heart rate and blood pressure changes after stopping the rebound problem. ResultsNicardipine of treatment group total effectiveness94%, after administration of5min,and30min the blood pressure level was markedly decreased,at1.5h reached the maximum hypotensive effect and the stable maintenance to medication. After20min had no obvious change, the incidence of side effects was8%, for rush face in5%,heart palpitation in1.2%, headache in1%, numbness of limbs in1%, heart rate increased unsignificantly,30min after administration of medication after the restoration, electrocardiogram and blood biochemical index have no changes. And sodium nitroprusside group total effective rate97%, after administration of5min the blood pressure decreased,30min was decreased significantly,1.5h reached maximum hypotensive effect and stable maintenance to medication. After the medication cessation oabout10min,20min the blood pressure significantly rebound, the maximum amplitude of up to20%.The incidence of side effects was14%, including: due to decreased blood pressure too fast and vertigo in4%, headache in2%, reflex tachycardia or arrhythmic heartbeat2%,1.5%allergic dermatitis, symptoms have realation to intravenous delivery speed, and have no relationship with total count. After medication without ECG and blood biochemical indexes have changes. Through the contrast observation of two drugs, found in the treatment group of nicardipine during antihypertensive treatment, the treatment is effective and safety, and the control group with sodium nitroprusside did not differ significantly(P>0.05), and in the course of treatment, the incidence of adverse reactions about nicardipine group is low (8%), and sodium nitroprusside contrast group the bad reaction rate is high (14%), the two group were significantly differences (P<0.05)Conclusion1.Nicardipine in the treatment of hypertensive emergency is more fast, effective, safe, with less adverse reactions and not easy to rebound;2.The nicardipine has more advantages compared with sodium nitroprusside for treating hypertensive emergencies. |
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