Ruegg P C, David D, Loria Y
Cardiovascular Research, Sandoz Pharma, Basel, Switzerland.
Eur J Anaesthesiol. 1992 Jul;9(4):293-305.
In a randomized trial, a calcium antagonist, isradipine (ISR) and sodium nitroprusside (SNP) were compared in the management of hypertension in the early period following coronary artery bypass grafting (CABG). Patients with a mean arterial pressure (MAP) of greater than 100 mmHg were treated with a 6 h i.v. infusion of ISR (n = 98) or SNP (n = 100). Mean MAP at baseline was 113 (ISR) and 112 mmHg (SNP). Blood pressure control (MAP less than or equal to 90 mmHg within 25 min) was achieved in 92% (ISR) and 84% (SNP), within a mean of 12 and 15 min, respectively (P less than 0.01 between groups). At 25 min, mean percentage changes from baseline for ISR and SNP were: MAP -24.3% vs. -21.4% (P less than 0.05), heart rate +4.1% vs. +8.4% (P less than 0.01), rate-pressure-product -16.9% vs. -10.6% (P less than 0.001), cardiac index +19.2% vs. +4.6% (P less than 0.001), stroke volume index +16.1% vs. -1.9% (P less than 0.001), and peripheral vascular resistance -35.4% vs. -22.0%, (P less than 0.001). Treatment was discontinued before 6 h in 24 patients in each group because of low blood pressure. Hypotension (MAP less than 70 mmHg) and tachycardia were less frequent with ISR than with SNP. In conclusion, ISR is effective and well tolerated in the treatment of hypertension following CABG, and has a haemodynamic profile which may be more favourable than that seen after treatment with SNP.
在一项随机试验中，比较了钙拮抗剂伊拉地平（ISR）和硝普钠（SNP）对冠状动脉旁路移植术（CABG）后早期高血压的治疗效果。平均动脉压（MAP）大于100 mmHg的患者接受6小时静脉输注ISR（n = 98）或SNP（n = 100）治疗。基线时ISR组的平均MAP为113 mmHg，SNP组为112 mmHg。分别在平均12分钟和15分钟内，ISR组92%、SNP组84%的患者实现了血压控制（25分钟内MAP≤90 mmHg）（组间P<0.01）。25分钟时，ISR组和SNP组相对于基线的平均百分比变化为：MAP -24.3% 对 -21.4%（P<0.05），心率 +4.1% 对 +8.4%（P<0.01），速率-压力乘积 -16.9% 对 -10.6%（P<0.001），心脏指数 +19.2% 对 +4.6%（P<0.001），每搏量指数 +16.1% 对 -1.9%（P<0.001），外周血管阻力 -35.4% 对 -22.0%（P<0.001）。由于低血压，每组各有24例患者在6小时前停止治疗。与SNP相比，ISR导致的低血压（MAP<70 mmHg）和心动过速发生率更低。总之，ISR在治疗CABG后高血压方面有效且耐受性良好，其血流动力学特征可能比SNP治疗后更有利。
