Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Neurocrit Care. 2013 Feb;18(1):13-9. doi: 10.1007/s12028-012-9782-1.
Nicardipine and labetalol are two commonly used antihypertensives for treating elevated blood pressures in the setting of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). There are no studies comparing these two agents as continuous infusions.
A retrospective chart review was conducted of patients admitted between November 2009 and January 2011 with ICH and SAH to compare effectiveness and safety between both agents. Percent time spent at goal was set as the primary outcome. The secondary outcomes included blood pressure variability, time to goal, incidence of bradycardia, tachycardia, and hypotension.
A total of 81 patients were available for analysis, 10 initiated on labetalol (LAB), 57 on nicardipine (NIC), and 14 required the combination of these agents (COMB) to reach goal. We found no difference between NIC, LAB, and the COMB groups in the median percent time at goal [88 % (61-98); 93 % (51-99); 66 % (25-95), (p = NS)]. Median percentage of blood pressure variability, hypotension, and bradycardia were also comparable between groups, however, more tachycardia was observed in the COMB group versus both LAB and NIC groups (45 vs. 0 vs. 3 %; p < 0.001). Mean time to goal SBP in 24 patients who had BP readings available at 1st h of initiation was 32 ± 34 min in the NIC group and 53 ± 42 min in the LAB group (p = 0.03).
Both agents appear equally effective and safe for blood pressure control in SAH and ICH during the initial admission hours. A prospective study is needed to validate these findings.
尼卡地平（Nicardipine）和拉贝洛尔（Labetalol）是两种常用于治疗脑出血（ICH）和蛛网膜下腔出血（SAH）患者血压升高的降压药。目前尚无比较这两种药物作为连续输注的研究。
对 2009 年 11 月至 2011 年 1 月期间因 ICH 和 SAH 入院的患者进行回顾性图表审查，比较两种药物的有效性和安全性。目标时间的百分比作为主要结果。次要结果包括血压变异性、达到目标的时间、心动过缓、心动过速和低血压的发生率。
共有 81 例患者可用于分析，10 例患者开始使用拉贝洛尔（LAB），57 例患者开始使用尼卡地平（NIC），14 例患者需要联合使用这两种药物（COMB）才能达到目标。我们发现，NIC、LAB 和 COMB 组在达到目标的中位数时间百分比[88%（61-98）；93%（51-99）；66%（25-95），（p=NS）]方面没有差异。各组之间血压变异性、低血压和心动过缓的中位数百分比也相似，但 COMB 组比 LAB 和 NIC 组观察到更多的心动过速（45%比 0%比 3%；p<0.001）。在有血压读数的 24 例患者中，NIC 组达到目标收缩压的平均时间为 32±34 分钟，LAB 组为 53±42 分钟（p=0.03）。
在最初的住院期间，两种药物在控制血压方面似乎同样有效和安全，适用于 SAH 和 ICH。需要进行前瞻性研究来验证这些发现。
