目的 比较厄贝沙坦与硝苯地平控释片对中老年高血压合并主动脉夹层(aortic dissection,AD)患者经皮主动脉覆膜支架置入术后血压的控制效果,为临床治疗提供参考依据.方法 选取本院2014年5月至2016年5月收治的94例中老年高血压合并AD患者为研究对象,按照随机数表法将其分为厄贝沙坦组和硝苯地平组,每组各47例,所有患者均行经皮主动脉覆膜支架置入术治疗.术前除 β 受体阻滞剂外,停用一切抗高血压药治疗(两组患者 β 受体阻滞剂用法用量相同:口服美托洛尔,每日1次,每次47.5 mg).厄贝沙坦组患者加用厄贝沙坦片,硝苯地平组患者加用硝苯地平控释片治疗,两组患者均治疗4周,治疗期间均不应用其他影响血压的药物.比较术前、术后1天及术后4周两组患者的血压和心率,术后4周疗效,术前、术后1天、术后3天炎性指标水平变化及术前、术后1周、术后4周左室肥厚相关参数变化,探讨两种药物的治疗效果.结果 术后1天,厄贝沙坦组患者收缩压、舒张压、平均动脉压、睡-醒晨峰值、睡-谷晨峰值较术前均显著上升(P<0.05);术后4周,两组患者血压指标较术前均显著改善(P<0.05),硝苯地平组患者血压指标改善更显著(P<0.05);手术前后两组患者心率均未见明显变化(P>0.05).硝苯地平组患者临床总有效率为93.6%,显著高于厄贝沙坦组(72.3%)(P<0.01).术后1天,两组患者炎性指标水平均显著升高,术后3天有所恢复,但仍显著高于术前水平(P<0.05);同一时期两组患者炎性指标比较均无显著差异(P>0.05).厄贝沙坦组、硝苯地平组患者术后感染率分别为6.4%(3/47)、4.3%(2/47),组间比较无显著差异(P>0.05).术后1周至术后4周,两组患者室间隔厚度、左室后壁厚度、左室舒张末期内径及左室质量指数较术前均显著降低(P<0.05),同一时期两组患者心脏超声参数比较均无显著差异(P>0.05).两组患者治疗期间均未见明显不良反应.结论 与厄贝沙坦比较,硝苯地平控释片对中老年高血压合并AD患者经皮主动脉覆膜支架置入后血压控制的效果更显著,且不会导致明显不良反应,其确切的疗效和良好的安全性值得肯定.%Objective To compare the efficacy of Irbesartan and Nifedipine controlled-release tablets in the control of blood pressure after percutaneous transluminal aortic stent implantation in middle-aged and elderly patients with hypertension and aortic dissection (AD), and to provide reference for clinical treatment of hypertension. Method A total of 94 elderly patients with AD were enrolled in our hospital from May 2014 to May 2016. According to the random number table, the patients were divided into irbesartan group (n = 47) and nifedipine group (n = 47). Besides beta blockers, all hypertensive medications were deactivated before operation (the same dosage of beta blockers in both groups of patients: Metoprolol, once daily, each time 47.5 mg). Irbesartan group patients were treated with irbesartan orally once a day, and 150 mg each time.Nifedipine group patients were treated with Nifedipine controlled-release tablets once a day, and 30 mg each time. Treatment lasted for 4 weeks, during treatment, other drugs that affected blood pressure should not be used. Before operation, 1 day and 4 weeks after operation, the changes of blood pressure and heart rates were compared between the two groups. The curative effect of hypertension between the two groups after 4 weeks of operation were evaluated. Before operation, 1 day and 3 days after operation, the inflammatory parameters were compared between the two groups. Before operation, 1 week and 4 weeks after operation, the correlative parameters of left ventricular hypertrophy were compared between the two groups. The therapeutic effects of the two drugs were compared. Result The systolic blood pressure, diastolic blood pressure, mean arterial pressure, peak value of sleep-wake and peak value of sleep-morning peak significantly increased in irbesartan group 1 day after operation (P < 0.05). After 4 weeks of operation, blood pressure significantly improved compared with preoperative in two groups, Nifedipine group improved more significantly (P < 0.05). There were no significant differences of the change of heart rates before and after 4 weeks between the two groups of patients (P > 0.05). The total effective rate of Nifedipine group was 93.6%, which was significantly higher than Irbesartan group (72.3%) (P<0.01). Inflammatory indexs increased significantly at 1 day after operation, and recovered at 3 days after operation, but were still significantly higher than preoperative level (P < 0.05). There were no significant differences between the two groups in the same period of inflammatory indexes (P > 0.05). The infection rates of Irbesartan group and Nifedipine group were 6.4% (3/47) and 4.3% (2/47) respectively. There was no significant difference between the two groups (P > 0.05). The interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end diastolic dimension, left ventricular mass decreased in the two groups from 1 week to 4 weeks after operation (P < 0.05). There were no significant differences in the ultrasonographic parameters during the same period between the two groups of patients (P > 0.05). There was no obvious adverse reaction during the treatment of the two groups of patients. Conclusion Compared with Irbesartan, Nifedipine controlled-release tablets are more effective in controlling the blood pressure of middle-aged and elderly patients with AD and tuberculous aortic stent implantation, and do not cause the increase of adverse reactions, the exact efficacy and good safety is worthy of recognition and proposing wide range of applications.
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