摘要
目的对比尼卡地平与乌拉地尔在脑出血（intracerebral hemorrhage，ICH）急性期血压管理中的有效性与安全性。方法回顾分析2013年3月至2016年3月深圳市人民医院急诊重症监护病房（EICU）收治的ICH患者，根据初始选用降压药物不同（尼卡地平或乌拉地尔），分为尼卡地平组和乌拉地尔组。比较两组间的24h内血压达标率、目标血压到达时间、血压变异系数、24h内再出血率、7d内脑状态指数（cerebral stateindex，CSI）和28d病死率。不良反应指标包括心动过缓、心动过速和低血压发生率。计量资料比较采用独立样本￡检验，计数资料比较采用x^2检验，7d内CSI动态比较采用重复测量方差分析。结果共77例病例纳入分析，尼卡地平组42例，乌拉地尔组35例。尼卡地平组24h内血压达标率（94±5）％，优于乌拉地尔组（86±11）％（P〈0．01）。尼卡地平组的目标血压到达时间（35±28）min快于乌拉地尔组（52±37）min（P=0．02），血压变异系数小于乌拉地尔组[（11．23±2．38）和（13．16±3．15），P=0．003]；24h内再出血率和28d病死率差异无统计学意义（P〉0．05）。重复测量方差分析显示，尼卡地平组CSI恢复比乌拉地尔组更快（F=1581．115，P〈0．01）。组间低血压、心动过缓和心动过速的发生率差异无统计学意义（P〉0．05）。结论与乌拉地尔比较，尼卡地平在ICH急性期血压管理中具有起效快、血压控制平稳、血压达标率高等优点。此外，尼卡地平可能会更快改善ICH急性期的CSI。
Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure （BP） management during the acute phase of intracerebral hemorrhage （ICH）. Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People ＇ s Hospital from March, 2013 through March, 2016 were retrospectively studied. Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission. The differences in rate of patients reached the goal BP within the first 24 h, time required for getting goal BP, blood pressure variability （ BPV）, rebleeding or hematoma expansion during the first 24 h, cerebral state index （CSI） within 7 days and 28-day mortality were compared between the two groups. The differences in adverse events including bradycardia, tachycardia and hypotension were also compared between two groups. An independent t test and X2 test were performed to compare different variables. An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups. Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group. Rate of patients getting goal BP in nicardipine group was （94 ± 5） % and （86 ± 11 ） % in urapidil group （P 〈 0. 01 ）. Time required to get goal BP was （35 ± 28 ） min in nieardipine group and （ 52 ± 37 ） min in urapidil group （ P = 0. 02）. BPV was （ 11.23 ± 2. 38 ） in nicardipine group and （ 13. 16 ± 3.15 ） in urapidil group （ P = 0. 003 ）. Rebleeding or hematoma expansion rate during the first 24 h and 28-day mortality rate were comparable between the two groups （ P 〉 0. 05）. Through analysis of variance of repeated measurement, CSI in nicardipine group improves more rapidly than that in urapidil group （F = 1 581.115, P = 0. 000）. Hypotension, bradycardia and taehycardia were also comparable between groups （P 〉 0. 05 ）. Condtmion Compared with urapidil, nicardipine produces effec
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第7期779-783,共5页
Chinese Journal of Emergency Medicine
基金
深圳市科技计划项目（JCYJ20160422152608675）
深圳市卫生计生系统科研项目（201601013）
关键词
乌拉地尔
尼卡地平
血压
脑出血
急性期
脑状态指数
Urapidil
Nieardipine
Blood pressure
Verebral hemorrhage
Acute phase
Cerebral state index
