Hirschl M M, Schreiber W, Woisetschläger C, Kaff A, Raab H
Abt. für Notfallmedizin Universität Wien, Osterreich.
Z Kardiol. 1999 Mar;88(3):208-14. doi: 10.1007/s003920050277.
In a prospectively designed randomized study, we compared the efficacy of sublingual nitroglycerine and intravenous enalaprilat in the out-of-hospital treatment of 46 hypertensive patients with pulmonary edema (defined as rales over both lungs and systolic blood pressure > 200 mm Hg and diastolic blood pressure > 100 mg). The out-of-hospital treatment consists of oxygen (6 Ll/min) via a face mask, furosemide 80 mg i.v., opioids 10 mg s.c., and either sublingual nitroglycerine (n = 23; initial dose: 0.8 mg; repetitive application of 0.8 mg every 10 min until a cumulative dose of 3.2 mg) or intravenous enalaprilat (initial dose: 2.5 mg; repetitive application of 2.5 mg every 30 min until a cumulative dose of 10 mg). The aim of the antihypertensive treatment was a reduction of systolic blood pressure below 160 mm Hg and diastolic blood pressure below 90 mm Hg until admission to the emergency department. In the emergency room, an arterial and venous blood sample was taken to determine the respiratory (pO2, pCO2) and metabolic status (pH value; base-excess; serum lactate) of the patient. Successful antihypertensive treatment was observed in 13/23 (57%) patients of the enalaprilat group and 15/23 (65%) patients of the nitroglycerine group (p = 0.54). Systolic and diastolic blood pressure on admission were similar in both treatment groups (systolic RR: enalaprilat: 179 [31] mm Hg; nitroglycerine: 184 [38] mm Hg; p = 0.59; diastolic RR: enalaprilat: 96 [14] mm Hg; nitroglycerine: 101 [14] mm Hg; p = 0.12). No significant differences were observed between the enalaprilat and the nitroglycerine groups concerning respiratory and metabolic parameters on admission (pO2: 67 [15] vs. 64 [17] mm Hg; p = 0.50; pCO2: 46 [9] vs. 47 [13]; p = 0.75; pH value: 7.27 [0.12] vs. 7.27 [0.09]; p = 0.98; BE: -4.2 [3.7] vs. -5.7 [4.1]; p = 0.23; lactate: 4.2 [3.3] vs. 4.2 [2.7]; p = 0.98). Intravenous enalaprilat did not exhibit any advantage compared to nitroglycerine in terms of blood pressure reduction or respiratory and metabolic parameters on admission to the emergency room. We conclude that enalaprilat is no substitute for nitroglycerine in the out-of-hospital treatment of hypertensive patients with pulmonary edema.
在一项前瞻性设计的随机研究中，我们比较了舌下含服硝酸甘油和静脉注射依那普利拉对46例高血压性肺水肿患者（定义为双肺闻及啰音，收缩压>200 mmHg且舒张压>100 mmHg）进行院外治疗的疗效。院外治疗包括通过面罩吸氧（6 L/分钟）、静脉注射呋塞米80 mg、皮下注射阿片类药物10 mg，以及舌下含服硝酸甘油（n = 23；初始剂量：0.8 mg；每10分钟重复应用0.8 mg，直至累积剂量达3.2 mg）或静脉注射依那普利拉（初始剂量：2.5 mg；每30分钟重复应用2.5 mg，直至累积剂量达10 mg）。降压治疗的目标是在患者进入急诊科之前将收缩压降至160 mmHg以下，舒张压降至90 mmHg以下。在急诊室，采集动脉和静脉血样以测定患者的呼吸（pO2、pCO2）和代谢状态（pH值；碱剩余；血清乳酸）。依那普利拉组13/23（57%）的患者和硝酸甘油组15/23（65%）的患者降压治疗成功（p = 0.54）。两个治疗组入院时的收缩压和舒张压相似（收缩压RR：依那普利拉组：179 [31] mmHg；硝酸甘油组：184 [38] mmHg；p = 0.59；舒张压RR：依那普利拉组：96 [14] mmHg；硝酸甘油组：101 [14] mmHg；p = 0.12）。依那普利拉组和硝酸甘油组入院时在呼吸和代谢参数方面未观察到显著差异（pO2：67 [15] vs. 64 [17] mmHg；p = 0.50；pCO2：46 [9] vs. 47 [13]；p = 0.75；pH值：7.27 [0.12] vs. 7.27 [0.09]；p = 0.98；碱剩余：-4.2 [3.7] vs. -5.7 [4.1]；p = 0.23；乳酸：4.2 [3.3] vs. 4.2 [2.7]；p = 0.98）。在急诊室入院时，静脉注射依那普利拉在降低血压或呼吸和代谢参数方面与硝酸甘油相比未显示出任何优势。我们得出结论，在高血压性肺水肿患者的院外治疗中，依那普利拉不能替代硝酸甘油。
