Powroznyk A V V, Vuylsteke A, Naughton C, Misso S L, Holloway J, Jolin-Mellgård A, Latimer R D, Nordlander M, Feneck R O
Papworth Hospital, Department of Anaesthesia, Papworth Everard, Cambridge, UK.
Eur J Anaesthesiol. 2003 Sep;20(9):697-703. doi: 10.1017/s0265021503001133.
We set out to compare the efficacy of clevidipine and sodium nitroprusside infusions in the control of blood pressure and the haemodynamic changes they produce in hypertensive patients after operation for elective coronary bypass grafting.
Thirty patients were randomly allocated to receive either clevidipine or sodium nitroprusside after their mean arterial pressure (MAP) had reached > 90 mmHg for at least 10 min in the postoperative period. The MAP was continuously measured and related to time. Thus, the efficacy of the drugs in controlling arterial pressure could be inversely related to the total area under the MAP-time curve outside a target MAP range of 70-80 mmHg normalized per hour (AUC(MAP) mmHg min h(-1)). Haemodynamic variables and the number of dose-rate adjustments required to maintain MAP were also studied.
There was no statistically significant difference in the efficacy (AUC(MAP) mmHg min h(-1)) of clevidipine (106 +/- 25 mmHg min h(-1)) compared with sodium nitroprusside (101 +/- 28 mmHg min h(-1)). Nor was any significant difference found in the total number of dose adjustments required to control MAP within the target range. The heart rate in patients receiving clevidipine increased less than in those given sodium nitroprusside. Stroke volume, central venous pressure and pulmonary artery pressure were significantly reduced upon administration of sodium nitroprusside but not of clevidipine.
There was no significant difference between clevidipine and sodium nitroprusside in their efficacy in controlling MAP. The haemodynamic changes, including tachycardia, were less pronounced with clevidipine than with sodium nitroprusside.
我们旨在比较在择期冠状动脉搭桥术后高血压患者中，使用左西孟旦和硝普钠输注控制血压的疗效以及它们所引起的血流动力学变化。
30例患者在术后平均动脉压（MAP）≥90 mmHg至少10分钟后，随机分配接受左西孟旦或硝普钠治疗。持续测量MAP并记录时间。因此，药物控制动脉压的疗效与每小时标准化的MAP-时间曲线在70-80 mmHg目标MAP范围外的总面积（AUC(MAP) mmHg min h(-1)）呈负相关。还研究了血流动力学变量以及维持MAP所需的剂量率调整次数。
左西孟旦（106±25 mmHg min h(-1)）与硝普钠（101±28 mmHg min h(-1)）在疗效（AUC(MAP) mmHg min h(-1)）上无统计学显著差异。在目标范围内控制MAP所需的总剂量调整次数也无显著差异。接受左西孟旦治疗的患者心率增加幅度小于接受硝普钠治疗的患者。给予硝普钠后，每搏输出量、中心静脉压和肺动脉压显著降低，而给予左西孟旦后则无此现象。
左西孟旦和硝普钠在控制MAP的疗效上无显著差异。与硝普钠相比，左西孟旦引起的包括心动过速在内的血流动力学变化不那么明显。
