降压:可以舌下含服硝苯地平控释片吗?

2018-03-05 郭艺芳 郭艺芳心前沿

这个问题的回答是否定的,不宜舌下含服硝苯地平控释片用于快速降压。

这个问题并非空穴来风,临床上真有人这样用药!

这个问题的回答是否定的,不宜舌下含服硝苯地平控释片用于快速降压。理由如下:

1. 高血压急症与亚急症均不宜舌下含服药物:由于不伴靶器官损害,高血压亚急症患者一般无需过于激进的降压治疗,血压下降速度过快或幅度过大对患者可能弊大于利。

一般情况下,高血压亚急症患者血压可在24~48h内缓慢降至160/100mmHg。多数患者可通过口服降压药控制,一般不需要静脉应用降压药物。对于血压较高,但无并发症的患者,不宜予以过度治疗。静脉或大剂量口服负荷量降压药可产生严重低血压或其他不良反应,对患者产生不利影响,故应避免。

与高血压亚急症不同,高血压急症患者病情更为危重,应更为积极谨慎的处理。理想的药物应能预期降压的强度和速度,便于根据患者血压控制情况及时调整降压强度,因而应首选静脉途径的短效降压药物。由于已经存在靶器官损害,过快或过度降压容易导致组织灌注压降低,诱发缺血事件,故应逐级、分步将血压降到相对安全的水平。

2. 不宜舌下含服硝苯地平普通片剂:该药起效迅速,舌下含服后可在数分钟后发挥降压作用。基于前文所述的高血压急症和亚急症的处理原则,可以看出舌下含服硝苯地平不适用于紧急降压治疗。这种用药方法可能对患者产生不利影响甚至导致严重后果,其机制包括:(1)重度高血压患者在短时间内血压迅速而显着地降低,可导致重要生命器官的血液灌注压明显下降、血流量明显减少;(2)含服硝苯地平后可导致全身血流重新分布,外周血管血流量增加而心脏与脑血管血流量相对减少。

近30余年来,国内外已有很多报道提示舌下含服硝苯地平可以导致急性卒中、急性心肌梗死甚至猝死,因此1985年美国食品药品监督管理局认为高血压患者不应舌下含服硝苯地平。美国高血压预防、检测、评估与治疗全国联合委员会第6次报告也明确指出舌下含服硝苯地平是“不可接受的”。《中国高血压防治指南(2009年基层版)》也指出,高血压急症患者慎用或不用舌下含服硝苯地平。

3. 不宜舌下含服硝苯地平控释片:控释剂型采用特殊技术生产。其核心技术有两点,一是吸水膨胀的推动层(推拉渗透泵),二是激光释放小孔。该药口服后,在消化道内吸收水分,使得推动层吸水膨胀,推动药片内活性药物通过激光小孔缓慢恒速释放出来,呈现零级释放速率。因此一种合格的控释剂型是不适于舌下途径给药的。以硝苯地平控释片为例:一片药物内含有30mg硝苯地平,按照零级释放速率计算,舌下含服1分钟所释放出的硝苯地平约为0.02mg,这一剂量显然不能发挥有效的降压作用。

当然,如果控释技术不过关则另当别论。有人建议舌下含服硝苯地平控释片时嚼碎药片,这是一种非常危险的做法,相当于一次含服30 mg普通剂型的硝苯地平,有可能导致血压在短时间内迅速而显着地降低,会导致严重的血液动力学后果,绝对不应提倡。

综上所述,无论是硝苯地平普通剂型还是控释剂,均不宜舌下含服,这样做或者导致血压急剧降低而诱发不良后果,或者不能发挥有效的降压作用。

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  7. 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topicList=[TopicDto(id=73536, encryptionId=0bb7e35362c, topicName=硝苯地)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Mon Apr 23 18:59:00 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=295079, encodeId=df3d2950e911, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Sun Mar 11 06:56:10 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291956, encodeId=26f5129195635, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Wed Mar 07 14:59:00 CST 2018, time=2018-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1455852, encodeId=0e781455852f9, content=<a href='/topic/show?id=61e3e3537e9' target=_blank style='color:#2F92EE;'>#硝苯地平#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73537, encryptionId=61e3e3537e9, topicName=硝苯地平)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2aa55745904, createdName=smlt2010, createdTime=Wed Mar 07 14:59:00 CST 2018, time=2018-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1584981, encodeId=58f51584981a4, content=<a href='/topic/show?id=4d9a8654388' target=_blank style='color:#2F92EE;'>#舌下含服#</a>, beContent=null, objectType=article, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=17142285166, createdName=121d4001m66暂无昵称, createdTime=Tue Mar 06 23:41:59 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293528, encodeId=8684293528d5, content=学习了谢谢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Tue Mar 06 09:38:01 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293483, encodeId=f8f82934832b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Mar 06 07:36:29 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-07 chunjianf

    学习了.谢谢分享

    0

  8. 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objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Mar 06 07:36:29 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-06 121d4001m66暂无昵称

    学习了.请问可以含服卡托普利吗?

    0

  9. 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objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Mar 06 07:36:29 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-06 186****0580(小山羊)

    学习了谢谢了

    0

  10. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=17142285166, createdName=121d4001m66暂无昵称, createdTime=Tue Mar 06 23:41:59 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293528, encodeId=8684293528d5, content=学习了谢谢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Tue Mar 06 09:38:01 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293483, encodeId=f8f82934832b, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Mar 06 07:36:29 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-06 明月清辉

    谢谢分享.学习了

    0

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