Dorman T, Thompson D A, Breslow M J, Lipsett P A, Rosenfeld B A
Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Clin Anesth. 2001 Feb;13(1):16-9. doi: 10.1016/s0952-8180(00)00231-2.
To evaluate the effectiveness of nicardipine and nitroprusside for breakthrough hypertension following carotid endarterectomy.
Prospective, randomized, double-blind, controlled effectiveness trial.
University-based surgical intensive care unit.
60 ASA physical status I, II, III, and IV patients experiencing breakthrough hypertension at the time of admission to the intensive care unit (ICU).
Patients received either nicardipine (n = 29) and placebo or nitroprusside (n = 31) and placebo for up to 6 hours postoperatively. Loading doses of nicardipine were provided, but placebo was used as a load for patients randomized to nitroprusside.
Rapidity and variability of blood pressure (BP) control were assessed. During the first 10 minutes, 83% of nicardipine patients compared to 23% of nitroprusside-treated patients, achieved BP control (p < 0.01). Following initial control, 12 nicardipine- and 24 nitroprusside-treated patients required additional titration of their infusions to maintain blood pressure within the targeted range (p < 0.05). No patient suffered a stroke, myocardial infarction, or was returned to the operating room (OR) for bleeding.
Nicardipine administration produced more rapid BP control, most likely related to the administration of a loading dose. In addition to more rapid control, nicardipine-treated patients had less variability in BP and required significantly fewer additional interventions. Although no patient suffered a major event during this study, this study was not powered sufficiently to assess safety.
评估尼卡地平与硝普钠治疗颈动脉内膜切除术后高血压危象的有效性。
前瞻性、随机、双盲、对照有效性试验。
大学附属医院外科重症监护病房。
60例美国麻醉医师协会（ASA）身体状况分级为I、II、III和IV级，入住重症监护病房（ICU）时出现高血压危象的患者。
患者术后接受尼卡地平（n = 29）加安慰剂或硝普钠（n = 31）加安慰剂治疗，持续6小时。给予尼卡地平负荷剂量，但随机分配至硝普钠组的患者使用安慰剂作为负荷剂量。
评估血压（BP）控制的速度和变异性。在最初10分钟内，83%的尼卡地平治疗患者实现了血压控制，而硝普钠治疗患者为23%（p < 0.01）。初始控制后，12例接受尼卡地平治疗和24例接受硝普钠治疗的患者需要额外调整输注剂量以维持血压在目标范围内（p < 0.05）。无患者发生中风、心肌梗死或因出血返回手术室（OR）。
使用尼卡地平能更快地控制血压，这很可能与给予负荷剂量有关。除了控制更快外，尼卡地平治疗的患者血压变异性更小，且需要的额外干预显著更少。尽管本研究中无患者发生重大事件，但该研究的样本量不足以评估安全性。
