静脉注射尼卡地平降低急性脑出血患者血压：急性脑出血的卒中急性管理与紧急风险因素评估及改善研究

Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study.

作者信息

Koga Masatoshi, Arihiro Shoji, Hasegawa Yasuhiro, Shiokawa Yoshiaki, Okada Yasushi, Kimura Kazumi, Furui Eisuke, Nakagawara Jyoji, Yamagami Hiroshi, Kario Kazuomi, Okuda Satoshi, Tokunaga Keisuke, Takizawa Hotake, Takasugi Junji, Sato Shoichiro, Nagatsuka Kazuyuki, Minematsu Kazuo, Toyoda Kazunori

机构信息

Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.

出版信息

J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2780-2787. doi: 10.1016/j.jstrokecerebrovasdis.2014.06.029. Epub 2014 Oct 12.

DOI:10.1016/j.jstrokecerebrovasdis.2014.06.029

PMID:25314943

Abstract

BACKGROUND

Intravenous nicardipine is commonly used to reduce elevated blood pressure in acute intracerebral hemorrhage (ICH). We determined factors associated with nicardipine dosing and the association of dose with clinical outcomes in hyperacute ICH.

METHODS

Hyperacute (<3 hours from onset) ICH patients with initial systolic blood pressure (SBP) greater than 180 mm Hg were included. All patients initially received 5 mg/hour of intravenous nicardipine. The dose was adjusted to maintain SBP between 120 and 160 mm Hg. Associations of maximum hourly and total doses with early neurologic deterioration (END), hematoma expansion (>33%), and modified Rankin Scale score 4-6 at 3 months were assessed.

RESULTS

Two hundred six patients (81 women, 65.8 ± 11.8 years) were studied. Initial SBP was 201.9 ± 15.9 mm Hg. Maximum and total nicardipine doses were 9.1 ± 4.2 mg/hour and 123.7 ± 100.2 mg/day, respectively. Multivariate analyses revealed that men (standardized regression coefficient [β] = .20, P = .0030 for maximum dose; β = .25, P = .0002 for total dose), age (β = -.28, P = .0002; β = -.25, P = .0005), and initial SBP (β = .19, P = .0018; β = .18, P = .0021) were independently associated with both maximum and total doses. Body weight (β = .20, P = .0084) was independently associated with total dose. After multivariate adjustment, maximum dose (per 1 mg/hour; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.09-1.45) was independently, and total dose (per 10 mg/day; OR, 1.06; 95% CI, .998-1.132) tended to be independently, associated with END. Nicardipine dose was not associated with hematoma expansion or 3-month outcome.

CONCLUSIONS

Nicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration.

摘要

背景

静脉注射尼卡地平常用于降低急性脑出血（ICH）时升高的血压。我们确定了与尼卡地平给药相关的因素以及超急性ICH中剂量与临床结局的关联。

方法

纳入发病初始收缩压（SBP）大于180mmHg的超急性（发病3小时内）ICH患者。所有患者最初均接受5mg/小时的静脉尼卡地平治疗。调整剂量以维持SBP在120至160mmHg之间。评估最大每小时剂量和总剂量与早期神经功能恶化（END）、血肿扩大（>33%）以及3个月时改良Rankin量表评分4 - 6分的关联。

结果

共研究了206例患者（81名女性，年龄65.8±11.8岁）。初始SBP为201.9±15.9mmHg。尼卡地平的最大剂量和总剂量分别为9.1±4.2mg/小时和123.7±100.2mg/天。多因素分析显示，男性（标准化回归系数[β]=0.20，最大剂量P = 0.0030；β = 0.25，总剂量P = 0.0002）、年龄（β = - 0.28，P = 0.0002；β = - 0.25，P = 0.0005）和初始SBP（β = 0.19，P = 0.0018；β = 0.18，P = 0.0021）与最大剂量和总剂量均独立相关。体重（β = 0.20，P = 0.0084）与总剂量独立相关。多因素调整后，最大剂量（每1mg/小时；比值比[OR]，1.25；95%置信区间[CI]，1.09 - 1.45）与END独立相关，总剂量（每10mg/天；OR，1.06；95%CI，0.998 - 1.132）倾向于与END独立相关。尼卡地平剂量与血肿扩大或3个月结局无关。