Levy Jerrold H, Mancao Miguel Y, Gitter Richard, Kereiakes Dean J, Grigore Alina M, Aronson Solomon, Newman Mark F
Cardiothoracic Anesthesiology and Critical Care, Emory University Hospital, Atlanta, Georgia 30322, USA.
Anesth Analg. 2007 Oct;105(4):918-25, table of contents. doi: 10.1213/01.ane.0000281443.13712.b9.
Clevidipine is an ultrashort-acting, third-generation IV dihydropyridine calcium channel blocker that exerts rapid and titratable arterial blood pressure reduction, with fast termination of effect due to metabolism by blood and tissue esterases. As an arterial-selective vasodilator, clevidipine reduces peripheral vascular resistance directly, without dilating the venous capacitance bed. In this randomized, double-blind, placebo-controlled multicenter trial we evaluated the efficacy and tolerability of clevidipine in treating preoperative hypertension.
One-hundred-fifty-two patients scheduled for cardiac surgery with current or recent hypertension were randomized to receive clevidipine or placebo preoperatively. One-hundred-five patients met postrandomization entrance criteria (systolic blood pressure [SBP] > or =160 mm Hg after inserting an arterial catheter) for reduction by > or =15% from baseline in SBP. The patients thus received infusions of clevidipine (0.4-8.0 microg x kg(-1) x min(-1)) or 20% lipid emulsion (placebo) for at least 30 min. Treatment failure was defined as failure to reduce SBP by > or =15% from baseline or discontinuance of drug for any reason.
Patients treated with clevidipine demonstrated a 92.5% rate of treatment success and a significantly lower rate of treatment failure (7.5%, 4 of 53) than patients receiving placebo (82.7%, 43 of 52; P < 0.0001). Clevidipine achieved target blood pressures (SBP reduced by > or =15%) at a median of 6.0 min (95% confidence interval 6-8 min). A modest increase in heart rate from baseline occurred during clevidipine administration. Adverse events for each treatment group were similar.
Clevidipine was effective in rapidly decreasing blood pressure preoperatively to targeted blood pressure levels and was well tolerated in patients scheduled for cardiac surgery.
左西孟旦是一种超短效的第三代静脉用二氢吡啶类钙通道阻滞剂，能快速、可滴定地降低动脉血压，因其可被血液和组织酯酶代谢，作用迅速终止。作为一种动脉选择性血管扩张剂，左西孟旦直接降低外周血管阻力，而不扩张静脉容量血管。在这项随机、双盲、安慰剂对照的多中心试验中，我们评估了左西孟旦治疗术前高血压的疗效和耐受性。
152例计划进行心脏手术且患有当前或近期高血压的患者被随机分为术前接受左西孟旦或安慰剂组。105例患者符合随机分组后的入选标准（插入动脉导管后收缩压[SBP]≥160mmHg），SBP需从基线降低≥15%。这些患者因此接受左西孟旦（0.4 - 8.0μg·kg⁻¹·min⁻¹）或20%脂质乳剂（安慰剂）输注至少30分钟。治疗失败定义为SBP未能从基线降低≥15%或因任何原因停药。
接受左西孟旦治疗的患者治疗成功率为92.5%，治疗失败率（7.5%，53例中的4例）显著低于接受安慰剂的患者（82.7%，52例中的43例；P < 0.0001）。左西孟旦在中位时间6.0分钟（95%置信区间6 - 8分钟）达到目标血压（SBP降低≥15%）。在输注左西孟旦期间，心率较基线有适度增加。每个治疗组的不良事件相似。
左西孟旦能有效在术前迅速将血压降至目标血压水平，且在计划进行心脏手术的患者中耐受性良好。
