Intoxicación por cianuro posterior a infusión prolongada de Nitroprusiato de sodio: a propósito de un caso / Cyanide poisoning following prolonged infusion of Sodium Nitroprusside: A case report / Intoxicação por cianeto após infusão prolongada de nitroprussiato de sódio: a propósito de um caso

El nitroprusiato de sodio fue aprobado desde 1974 como medicamento para las crisis hipertensivas. Desde entonces existe controversia sobre el potencial tóxico del mismo. La toxicidad por cianuro es una complicación poco común del nitroprusiato de sodio, que puede ser difícil de diagnosticar en pacientes críticamente enfermos. Dentro de los factores de riesgo está la utilización de infusiones prolongadas y dosis altas, por lo que se sugiere que la dosis no exceda 2 µg/kg/min. A continuación, se reporta el caso de un paciente de 49 años que ingresa a un servicio de urgencias después de un síndrome cerebrovascular y una emergencia hipertensiva que requirió infusión de nitroprusiato de sodio, seguida de signos y síntomas, los cuales sugirieron toxicidad. Entre dichos síntomas predominaban los cambios neurológicos, por lo cual fue manejado con hiposulfito de sodio y hubo una buena respuesta. El objetivo de este reporte de caso es sensibilizar al personal de salud sobre la necesidad de un uso adecuado del nitroprusiato y sobre la importancia de sospechar toxicidad en paciente con factores de riesgo.

Sodium Nitroprusside has been approved since 1974 as a medication for hypertensive crises. However, there has been ongoing controversy regarding its potential toxicity. Cyanide toxicity is a rare complication of Sodium Nitroprusside, which can be challenging to diagnose in critically ill patients. Risk factors include prolonged infusions and high doses; hence it is suggested that the dose should not exceed 2 µg/kg/min. Here, we present the case of a 49-year-old patient who entered the emergency department after a cerebrovascular event and a hypertensive emergency that required Sodium Nitroprusside infusion, followed by signs and symptoms suggestive of toxicity. Neurological changes were predominant among these symptoms, and the patient was managed with sodium thiosulfate, resulting in a good response. The objective of this case report is to raise awareness among healthcare professionals about the need for appropriate use of Sodium Nitroprusside and the importance of suspecting toxicity in patients with risk factors.

O nitroprussiato de sódio foi aprovado desde 1974 como medicamento para crises hipertensivas. Desde então tem havido controvérsia sobre o seu potencial tóxico. A toxicidade por cianeto é uma complicação rara do nitroprussiato de sódio, que pode ser difícil de diagnosticar em pacientes gravemente enfermos. Entre os fatores de risco está o uso de infusões prolongadas e altas doses, por isso sugere-se que a dose não ultrapasse 2 µg/kg/min. Relata-se a seguir o caso de uma paciente de 49 anos admitida em pronto-socorro após síndrome cerebrovascular e emergência hipertensiva com necessidade de infusão de nitroprussiato de sódio acompanhada de sinais e sintomas sugestivos de toxicidade. Dentre esses sintomas, predominaram as alterações neurológicas, para as quais foi tratado com hipossulfito de sódio e apresentou boa resposta. O objetivo deste relato de caso é sensibilizar os profissionais de saúde sobre a necessidade do uso adequado do nitroprussiato e sobre a importância de suspeitar de toxicidade em pacientes com fatores de risco.

Sodium nitroprusside combined with hyaluronidase and urokinase in treatment of superficial epigastric arterial embolization in Sprague-Dawley rats / 中华医学美学美容杂志

Objective:To explore the effect of intravascular sodium nitroprusside (SNP) combined with hyaluronidase (HAase) plus urokinase (UK) in treating rat abdominal wall skin flap ischemia caused by HA induced artery embolism, and to compare the difference between thrombolysis with and without addition of sodium nitroprusside.Methods:Forty male Sprague-Dawley rats were injected with 10 μl of hyaluronic acid (HA) into the left inferior epigastric arteries, constructing the superficial epigastricl artery skin flap ischemic model in rats. The rats were randomly divided into four groups: a control group, and experimental groups A, B and C. Control and experimental groups A, B and C were treated with the following solutions 45 minutes after hyaluronic acid injection: physiological saline plus glucose was injected into the rats (control group); hyaluronidase (HAase) plus glucose injection was injected into the rats (experimental group A), hyaluronidase (HAase) plus urokinase (UK) was injected into the rats (experimental group B), hyaluronidase (HAase), urokinase (UK) plus sodium nitroprusside were injected into the rats (experimental group C). The changes of flaps were observed at 0 min, 3 days, 5 days and 7 days after operation. The difference of the area percentage of unperfused flap in the four groups was compared 7 days after operation. This study was carried out from July 2020 to March 2021 in the Medical Laboratory Animal Center of Weifang Medical University.Results:The unperfused area of flaps for the control group, experimental groups A, B and C were (100.00±0.00) %, (44.68±7.90)%, (34.01±8.77)% and (24.12±4.58)%, respectively. In the experimental group C, the scabby necrosis area was smaller than that of the experimental group A ( P<0.05); in the experimental group C, the scabby necrosis area was smaller than that of the experimental group B ( P<0.05); in the experimental group B, the scabby necrosis area was smaller than that of the experimental group A ( P<0.05). HE staining revealed that size and density of the embolus was significantly decreased after the addition of sodium nitroprusside. Conclusions:Sodium nitroprusside combined with hyaluronidase and urokinase can effectively improve the ischemia of the flap caused by HA induced artery embolism, increase the tissue perfusion, and reduce the necrotic area of the flap.

Comparative study on the effects of urapidil and sodium nitroprusside on blood pressure in patients with hypertensive intracerebral hemorrhage / 中国医师进修杂志

Objective To compare the effects of urapidil and sodium nitroprusside on blood pressure and prognosis in patients with hypertensive intracerebral hemorrhage. Methods One hundred and fifty patients with hypertensive intracerebral hemorrhage from January to December 2017 were divided into urapidil group and sodium nitroprusside group according to the medication, each group with 75 patients. The changes of blood pressure, heart rate, hematoma size and neurological function were compared between the two groups. Results At 10 and 30 min after treatment, the systolic blood pressure and diastolic blood pressure of patients in urapidil group were lower than those in sodium nitroprusside group (P＜0.05). At 60 min after treatment , there was no significant difference on blood pressure between the two groups (P＞0.05). At 10, 30, 60, 120 and 240 min after treatment, the heart rate of patients in urapidil group were significantly lower than those in sodium nitroprusside group (P＜0.05). At 24 and 72 h after treatment, there was no notable difference in the size of hematoma between the two groups (P＞0.05). At 1 month after treatment, the neurological scores between the two groups were significantly different: (10.1 ± 2.1) scores vs. (13.8 ± 5.9) scores, P＜0.05. Conclusions Urapidil can effectively control blood pressure in patients with hypertensive intracerebral hemorrhage. Moreover, it exerts better long-term neuroprotective effect, compared with sodium nitroprusside.

Effects of aqueous leaf extract of Tridax procumbens on contractile activity of corpus cavernosum in N-nitro-l-arginine methyl ester-induced hypertensive male rats / 中西医结合学报

<p><b>OBJECTIVE</b>This study investigated the effects of aqueous leaf extract of Tridax procumbens (ALETP) on contractile activity of corpus cavernosum in N-nitro-l-arginine methyl ester (l-NAME)-induced hypertensive male rats.</p><p><b>METHODS</b>Twenty normal, adult male rats (130-150 g) were divided into four groups of five rats each. Group I (control) was given normal saline (0.6 mL/kg) and group II was given l-NAME (40 mg/kg) for 6 weeks. Groups III and IV also received l-NAME (40 mg/kg) for 6 weeks but were further co-treated with 100 and 200 mg/kg of ALETP, respectively, from week 4 to week 6. All treatments were given orally. Strips of corpus cavernosum from each of the four groups were exposed to increasing concentrations of acetylcholine (ACh) and sodium nitroprusside (SNP) (10-10mol/L) after contraction with phenylephrine (10 mol/L) to test for a dose-response effect. Response to potassium and calcium was also measured after cumulatively adding potassium and calcium (10-50 mmol/L) to potassium- and calcium-free organ chamber. Isometric contractions were recorded through an Ugo Basile data capsule acquisition system.</p><p><b>RESULTS</b>Mean arterial blood pressure was significantly reduced in the ALETP co-treated group compared to the control and l-NAME-only groups (P < 0.05). Cavernosa strips from ALETP co-treated rats exhibited significant inhibition of contraction in response to phenylephrine, potassium chloride, and calcium chloride (P < 0.05). Relaxation in response to Ach and SNP was also significantly impaired in cavernosa strips from the l-NAME-only treated group (P < 0.05), while ALETP co-treated groups showed enhanced percentage relaxation.</p><p><b>CONCLUSION</b>ALETP treatment of l-NAME-induced hypertensive rats promotes a relaxant effect on isolated cavernosa strips. ALETP shows potential in correcting erectile dysfunction in hypertension.</p>

Effects of sodium nitroprusside in the prevention of schizophrenia-like symptoms induced by ketamine - A translational double-blind study

Abstract Background: Recent evidence has shown improvements in schizophrenia symptoms after the infusion of sodium nitroprusside (SNP), a nitric oxide (NO) donor. In the rat model of schizophrenia using ketamine injection, pretreatment with SNP seems to prevent behavioral changes associated with positive symptoms for up to one week. Objective: We investigated whether SNP would have preventative effects on psychogenic symptoms induced by ketamine in healthy subjects. Methods: Healthy subjects (N = 38) were assigned to distinct groups that received SNP in different doses (0.15, 0.25, and 0.5 mcg/kg/min). First, participants received an infusion of SNP or placebo over 75 minutes. After 10 minutes, they were injected for 1 minute with a bolus of 0.26 mg/kg of ketamine and a maintenance dose was started 5 minutes later, with 0.25 mg/kg/h of ketamine for 50 minutes. Results: Ketamine-induced psychopathological alterations induced were reduced by SNP, as assessed with the Brief Psychological Rating Scale. Scores in the objective subscale of the Clinician-Administered Dissociative States Scale were also lower in SNP sessions compared to placebo. SNP had protective effects against deterioration in facial emotion and identity recognition tasks induced by ketamine. Discussion: Our findings support the view that SNP has preventative properties against psychotic manifestations.

Effect of exogenous nitric oxide on antioxidants from mice infected with Trichinella spiralis / 中国血吸虫病防治杂志

Objective To study the effect of exogenous nitric oxide donor sodium nitroprusside(SNP)on antioxidant en?zymes activities and lipid peroxidation of mice infected with Trichinella spiralis. Methods BALB/c mice were infected with T. spiralis separated by the digestion method. Forty?two days post?infection,the peripheral blood and hepatic tissue from the in?fected or normal mice were collected. Then 4 groups were set:liver homogenate from infected mice+SNP(Group A),liver ho?mogenate from normal mice+SNP(Group B),peripheral blood from infected mice+SNP(Group C),and peripheral blood from normal mice+SNP(Group D). The final concentrations of SNP in each group were set as 0(blank control),2,5,10μmol/L and 30μmol/L,respectively. After reacting with SNP at 37℃for 30 min,the superoxide dismutase(SOD),glutathi?one peroxidase(GSH?Px),catalase(CAT)activities,and malondialdehyde(MDA)concentration were examined and com?pared. Results The levels of SOD,CAT,GSH?Px and MDA concentration in the liver and the blood from the mice infected with T. spiralis were significantly higher than those of the normal ones(all P < 0.05). When reacted with 10 μmol/L and 30 μmol/L SNP,the SOD,GSH?Px,and CAT activities in Group A and B decreased significantly(all P<0.05),while the liver MDA concentration reacted with 2-30μmol/L SNP increased obviously(all P<0.05). As reacted with 30μmol/L SNP,the ac?tivities of blood SOD,GSH?Px,and CAT in Group C and D decreased,while the MDA concentration in blood still increased (all P<0.01). When the SNP concentration was in the range of 2-30μmol/L,there were a negative correlation between the SNP concentrations and SOD,GSH?Px,and CAT activities,as well as a positive correlation with the MDA concentration in the liver and blood from the mice infected with T. spiralis(all P<0.05). Conclusions T. spiralis infection could cause oxidative damage to mice,and increase SOD,GSH?Px,and CAT activities. Nitric oxide released from SNP can decrease antioxidase activ?ities,and inhibit the antioxidant capacity of mice infected with T. spiralis.

Clinical analysis of sodium nitroprusside on the treatment of senile heart failure with pulmonary edema / 中国生化药物杂志

Objective To investigate the clinical efficacy of sodium nitroprusside on the treatment of pulmonary edema in elderly patients with heart failure. Methods 50 elderly cases with heart failure and pulmonary edema From January 2015 to January 2017 were divided into the control group and the observation group according to the different treatment methods. The control group were received conventional therapy, the observation group were given conventional drug combined with sodium nitroprusside. The experimental data was recorded and compared. To investigate the effect of sodium nitroprusside on the rescue of elderly heart failure and pulmonary edema. Results The clinical effect in the observation group is better than that in the control group. The protein related indexes about heart failure and pulmonary edema were significantly improved (P<0.05). The difference of adverse reaction rate in the two groups has no statistically significat. Conclusion Conventional drug therapy combined with sodium nitroprusside were used on the treatment of elderly patients with heart failure, pulmonary edema, which can improve the clinical symptoms, related serum protein, without increasing the incidence of adverse reactions, it is worthy of clinical application.

Therapeutic effects of sodium nitroprusside combined verapamil for no-reflow during percutaneous coronary intervention / 心血管康复医学杂志

Objective:To explore therapeutic effects of sodium nitroprusside (SNP) combined verapamil on no-reflow during percutaneous coronary intervention (PCI).Methods: A total of 106 patients, who suffered from no-reflow during PCI in our department from Jan 2011 to Dec 2013, were selected.According to random number table method, patients were divided into SNP group (n=55, received SNP based on routine treatment) and combined treatment group (n=51, received verapamil based on SNP group).Cardiac troponin I (cTnI) level before and 16h~18h after PCI, cardiac function indexes after 12-month follow-up, incidence of major adverse cardiovascular events (MACE) were measured and compared between two groups.Results: Compared with before PCI, there were significant rise in cTnI level in both groups on 16~18h after PCI, P=0.001 both;compared with SNP group, there were significant reductions in cTnI level [(1.31±0.44)μg/L vs.(0.11±0.02)μg/L] and percentage of cTnI>0.10μg/L (94.5% vs.54.9%) in combined treatment group, P=0.001 both.Compared with SNP group after 12 months, there was significant rise in left ventricular ejection fraction [(62.29±3.06)% vs.(65.65±3.94)%], and significant reductions in left ventricular end-diastolic dimension[(50.24±3.73)mm vs.(47.60±4.72)mm] and left ventricular end-systolic dimension [(33.29±2.11)mm vs.(31.00±4.33)mm] in combined treatment group, P<0.05 all.There were no significant adverse reactions during hospitalization and follow-up in both groups.Conclusion: When no-reflow occurs during PCI, intracoronary injection of SNP combined verapamil can improve cardiac function, and its safety is good, which is worth extending.

Rh-BNP combined with sodium nitroprusside in acute decompensated heart failure patients with loss of blood flow dynamics, the effects on heart function and circulating factor level / 中国生化药物杂志

Objective To investigate the effect of rh-BNP combined with sodium nitroprusside in acute decompensated heart failure patients with loss of blood flow dynamics, the effects on heart function and circulating factor levels.MethodsSelect Wenzhou Institute of Physiology from February 2014 to January 2016 admitted during the period of 120 cases of acute decompensated heart failure patients, according to random number table method to all of the patients were randomly divided into two groups, control group and test group with the control group patients were given conventional treatment of heart failure treatment, while the experimental group patients give tome sodium nitrate joint treatment with recombinant human brain natriuretic peptide, compare two groups of patients 12 h level of circulating factors, cardiac function and hemodynamics.ResultsTwo groups of patients after the hemodynamics after 24 h treatment was significantly lower than that after the treatment of 12h(P<0.05), the control group of patients after treatment of 12h and 24h after pulmonary capillary wedge pressure and right atrial pressure and central venous pressure index were significantly higher than those in the test group (P<0.05) for the treatment of 24h.After the control group of patients with left ventricular GSRa, GSRe, GSRs, ROTR, ROT, GCS, GLS levels were significantly lower than those in the test group (P<0.05).After treatment of 12h patients in the control group were hsCRP, ST2, IL-6 and blood The levels of cTn I and NT-proBNP were significantly higher than those in the experimental group (P<0.05).ConclusionRh-BNP combined with sodium nitroprusside in patients with acute decompensated heart failure treatment can effectively optimize the circulation of patients with factor level and heart function and hemodynamics, it is worth to be popularized in clinical use.

Sodium nitroprusside has leishmanicidal activity independent of iNOS

Abstract: INTRODUCTION: Leishmaniasis is a zoonotic disease caused by protozoa of the genus Leishmania . Cutaneous leishmaniasis is the most common form, with millions of new cases worldwide each year. Treatments are ineffective due to the toxicity of existing drugs and the resistance acquired by certain strains of the parasite. METHODS: We evaluated the activity of sodium nitroprusside in macrophages infected with Leishmania (Leishmania) amazonensis . Phagocytic and microbicidal activity were evaluated by phagocytosis assay and promastigote recovery, respectively, while cytokine production and nitrite levels were determined by ELISA and by the Griess method. Levels of iNOS and 3-nitrotyrosine were measured by immunocytochemistry. RESULTS: Sodium nitroprusside exhibited in vitro antileishmanial activity at both concentrations tested, reducing the number of amastigotes and recovered promastigotes in macrophages infected with L. amazonensis . At 1.5µg/mL, sodium nitroprusside stimulated levels of TNF-α and nitric oxide, but not IFN-γ. The compound also increased levels of 3-nitrotyrosine, but not expression of iNOS, suggesting that the drug acts as an exogenous source of nitric oxide. CONCLUSIONS: Sodium nitroprusside enhances microbicidal activity in Leishmania -infected macrophages by boosting nitric oxide and 3-nitrotyrosine.

Cyanide toxicity during cardiopulmonary bypass with small dose of nitroprusside: a case report / 대한마취과학회지

Sodium nitroprusside (SNP) is an anti-hypertensive drug, commonly used to decrease the systemic vascular resistance and lower the blood pressure. When the amount of cyanide generated by the SNP exceeds the metabolic capacity for detoxification, cyanide toxicity occurs. Under general anesthesia and cardiopulmonary bypass (CPB), it may be difficult to detect the development of cyanide toxicity. In cardiac surgical patients, hemolysis, hypothermia and decreased organ perfusion, which emphasize the risk of cyanide toxicity, may develop as a consequence of CPB. In particular, hemolysis during CPB may cause an unexpected overproduction of cyanide due to free hemoglobin release. We experienced a patient who demonstrated SNP tachyphylaxis and cyanide toxicity during CPB, even though the total amount of SNP administered was much lower than the recommended dose. We therefore report this case with a review of the relevant literature.

Clinical research of recombinant human brain natriuretic peptide combined with sodium nitroprusside in the treatment of acute decompensated heart failure / 中国基层医药

Objective To investigate the effects of recombinant human brain natriuretic peptide and sodium nitroprusside in the treatment of acute decompensated heart failure.Methods 82 patients with acute decompensated heart failure were randomly divided into observation group and control group,41 cases in each group.The control group was given sodium nitroprusside intravenous infusion therapy on the basis of routine treatment.The observation group was given recombinant human brain natriuretic peptide infusion treatment on the basis of control group treatment.The clinical efficacy was compared between the two groups.Results The total effective rate of the observation group was 95.12％,which was significantly higher than 75.61％ of the control group (x2 =5.33,P ＜ 0.05).After treatment,the left ventricular diastolic end diameter in the observation group [(67.38 ± 6.82) mm] was significantly lower than before treatment and control group after treatment (t =4.12,3.23,all P ＜ 0.05).After treatment,the left ventricular shot ejection fraction in the observation group [(48.91 ± 7.42)％] was significantly higher than before treatment and control group after treatment (t =3.92,3.77,all P ＜ 0.05).The incidence rate of adverse reactions in the observation group was 9.76％,which of the control group was 7.32％.,the difference was not statistically significant (P ＞ 0.05).Conclusion Recombinant human brain natriuretic peptide combined with sodium nitroprusside could significantly improve the clinical curative effect of acute decompensated heart failure,improve heart function of patients,and inhibit myocardial remodeling.It had good security.

Effects of tirofiban combined with nitroprusside injection through the rapid exchange balloon catheter on no-reflow phenomenon during elective PCI / 重庆医学

Objective To investigate the effects of tirofiban combined with nitroprusside injection through the rapid exchange balloon catheter with self-made side holes on no-reflow (NR)phenomenon during elective percutaneous coronary intervention (PCI).Methods A total of 49 patients with NR phenomenon were randomly divided into the balloon catheter group (n=25)and the guiding catheter group (n=24).Tirofiban combined with nitroprusside were used in both groups.Thrombolysis in myocardial infarction (TIMI)grade and corrected TIMI frame count (CTFC)of target coronary artery at 10 minutes after administration were assessed.Results At 10 minutes after drugs injection,there were 21 (84.0%)patients with target of coronary TIMI 3 grade in the balloon catheter group,and 13 (54.2%)patients in the guiding catheter group.The CTFC was (33.5±12.5)frame in the balloon catheter group,and (41.9±1 5.3)frame in the guiding catheter group.The difference in TIMI and CTFC between the two groups was significantly (P <0.05).Conclusion Injection tirofiban combined with nitroprusside through the rapid exchange balloon cathe-ter with self-made side holes in NR patients during elective PCI might be feasible and effective.

Effect of sodium nitroprusside sustained release on cognitive function, S-100βprotein and visinin-like protein 1 in pituitary tumor surgery patients / 中国生化药物杂志

Objective To investigate the effect of sodium nitroprusside sustained release on cognitive function, S-100βprotein and VILIP-1 in pituitary tumor surgery patients.Methods 156 cases of pituitary tumor patients were selected and divided into two groups according to random number table method,78 patients in each group.All patients underwent general anesthesia induction,the experimental group treated with 0.5~6 μg ( kg· min) infusion of sodium nitroprusside induced hypotension by micro pump at the beginning of operation.MMSE was used to determine the cognitive function of 2 groups of patients 1 day before operation and 2 days after operation,S-100βand VILIP-1 content were determined by ELISA before anesthesia,after surgery,and 0,12,24,48 h after operation.Results There was no statistical significance between the 2 groups in the incidence of postoperative cognitive dysfunction.Compared with control group, the operation time, bleeding volume and the recovery time of the experiment group were lower(P<0.05).S-100βprotein and VILIP-1 showed increased at first and then decreased at the peak of 24h;compared with the normal group, the levels of S-100βprotein and VILIP-1 of the cognitive impairment were higher ( P <0.05 ).Compared with the control group, the levels of S-100βprotein and VILIP-1 of the experiment group were lower(P <0.05).Conclusion Sodium nitroprusside sustained release controlled hypotension can reduce the level of cognitive disorder, patients of S-100βprotein and visinin-like protein 1 and has certain directive significance to the clinical.

Establishment of Silybum marianum cell suspension culture system and effects of different factors on silybin content / 中草药

To establish the suspension culture system of Silybum marianum cell and study the effects of different factors on silybin content. Orthogonal test was adopted to determine S. marianum cell suspension culture system and HPLC to silybin content.. The best growth cycle of cell suspension culture was defined when cultured in liquid MS medium with 6-BA 1.5 mg/L + NAA 1.0 mg/L + ZT 1.5 mg/L, light 12 h/d, pH value = 7, revolution = 110 r/min. The effects of salicylic acid, chitosan, and sodium nitroprusside on cell suspension culture were investigated. When the concentration of three impact factors were 0.05, 3, and 1 μ g/L, respectively, the growth amount of S. marianum cell reached the maximum, i. e. At the same time, the silybin content also reached the maximum. The established cell suspension culture system is suitable to use for the rapid propagation of S. marianum. Chitosan and sodium nitroprusside at proper concentration are benifit to the growth of suspensious cells and accumulation of silybin.

Stability of sodium nitroprusside for injection in two different dissolvants / 药学实践杂志

Objective To study the stability of sodium nitroprusside for injection in 5% glucose injection and 0 .9%sodium chloride injection ,and provide reference for clinical rational drug use .Methods The content of sodium nitroprusside for injection in different dissolvants(5% glueose ,sodium chloride injection) within 26 h was determined by HPLC .The change of micro particle was measured by light blockage method in accordance with China pharmacopeia(2010 edition) ,and the appearance and UV visible absorption spectroscopy and pH ,the osmotic pressure of the mixtures were observed as well .Results The changes in appearnace ,UV visible absorption spectroscopy ,pH value ,content and microparticle were not significant .Conclusion Sodium nitroprusside for injection were stable within 26 h after mixing with different dissolvants (5% glueose ,sodium chloride injection) .

Clinical Observation of Nitroprusside Combined with Dopamine in the Treatment of Acute Heart Failure / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of nitroprusside combined with dopamine in the treatment of acute heart failure(AHF). METHODS:96 patients with AHF were randomly divided into control group and research group. All patients were given ACEIs,digoxin,diuretics,statins,aspirin and other conventional treatment. On this basis,control group was given nitroprusside 12.5-25.0 mg,adding into 5% Glucose solution 50 ml by micro pump and started at 6.25 μg/min,and then maintained at 12.5-50.0 μg/min based on the blood pressure adjustment;research group was given dopamine 100 mg based on the treatment of control group,adding into 5% Glucose solution 50 ml at rate of 2 μg/(kg·min)by pump,and maintained at 2-10 μg/(kg·min). The course of both was 5-7 d. The clinic data was observed,including clinical efficacy,hemodynamic parameters(cen-tral venous pressure,pulmonary artery systolic pressure,heart rate and cardiac output index)before and 0.5,3,12,24 and 48 h af-ter treatment,renal functions(serum potassium,blood urea nitrogen,serum creatinine and 24 h urine)before and 24,48 and 72 h after treatment,and the incidence of adverse reaction. RESULTS:The total effective rate in research group was significantly higher than control group,with significant difference(P0.05). There were no significant differences in the incidence of adverse reactions(P>0.05). CONCLUSIONS:Nitroprusside combined with dopamine has more obvious efficacy than only nitroprusside in the treatment of AHF,and can obviously reduce the cardiac stress,increase cardiac output and improve renal function,with similar safety.

Sodium nitroprusside and SOD decrease the expression of DNA-PKcs and Ku70/80 of rats cardiomyocytes / 基础医学与临床

Objective To determine the effects of Sodium Nitroprusside ( SNP) , superoxide dismutase ( SOD) and catalase ( CAT ) on the expression of catalytic subunit of the DNA-dependent protein kinase ( DNA-PKcs ) and Ku70/80 heterodimer in cardiomycyte H9C2, as well as their expression in the myocardial tissues of SD rats . Methods H9C2 cells were co-cultured with SNP at concentreations of 10, 20 and 40 mmol/L for 6 hours, SD rats were injected with normal saline , SNP, SNP+SOD, SNP+CAT or SNP+SOD+CAT.Western blot and immuno-histochemistry assay were used to examine DNA-PKcs and Ku70/80 protein expression respectively .Results The expression of DNA-PKcs and Ku70/80 increased in H9C2 cells co-cultured with SNP when compared with control group, but they were be decreased when treated with SOD or/and CAT.The expression of DNA-Pkcs and Ku70/80 in myocardial tissues of experimental groups were higher than the control .Conclusions Radical scavengers may play a role as a protective effect for sodium nitroprusside related injury in cardiac myocytes .

Effect observation of sodium nitroprusside and dopamine injected by micro pump for ;the treatment of refractory heart failure / 中国医学装备

Objective: To observe the clinical effect of sodium nitroprusside and dopamine injected by micro pump for the treatment of refractory heart failure. Methods:One hundred and six cases of patients with refractory heart failure were chosen as the research object, which were cardiac functionⅢ~Ⅳlevel. All patients were treated with sodium nitroprusside and dopamine injected by micro pump. Starting dose of sodium nitroprusside was 6.25 μg/min. At same time pumping dopamine, starting dose of 2 g/kg·min, the dose was increased gradually until blood pressure dropped to 90~100 mm Hg, continuous 7~10 d, the signs and symptoms after treatment and parameters of cardiac function and adverse reactions were observed. Results: 1)In 106 cases of patients with refractory heart failure after treatment, the total effective rate 85.85%(91/106). 2)The heart rate, blood pressure, cardiothoracic ratio, left ventricular short axis reduced rate,cardiac output, each index of cardiac,indexes of left ventricular ejection fraction were improved significantly after treatment. Conclusion:The clinical effect for the treatment of refractory heart failure by using the micro pump injection of small doses of sodium nitroprusside combined dopamine would be obvious, have less adverse reactions, worthy of clinical popularization and application.

Clinical effect of continuous intravenous infusion of sodium nitroprusside combined with dopamine in the treatment of the elderly patients with refractory heart failure / 中国综合临床

Objective To investigate the clinical effect and safety of continuous intravenous pumping of sodium nitroprusside and dopamine on treating elderly patients with refractory heart failure. Methods Two hundred and seventy elderly patients with refractory heart failure were selected as our subjects and they were randomly divided into sodium nitroprusside group,dopamine group and the combined group( 90 cases for each group). All the patients were given the corresponding symptomatic treatment,including oxygen,diuretics, angiotensin converting enzyme inhibitors,digitalis,aldosterone receptor antagonist,etc. Patients in sodium nitroprusside group,dopamine group were treated sodium nitroprusside or dopamine respectively,and patients in combined group were given both of sodium nitroprusside and dopamine by continuous intravenous pumping. Serum brain natriuretic peptide( BNP ),left ventricular ejection fraction( LVEF ),LV end systolic volume index(LVESVI),left ventricular end diastolic volume index(LVEDVI),left ventricular diastolic early, late filling velocity ratio( E/A ),mean arterial pressure and heart rate( HR ) level were measured or recorded. Results The levels of BNP,LVEF,LVESV,LVEDV,E/A,mean arterial pressure and the level of HR among three group before treatment were no significant differences( F =4. 000,1. 434,0. 503,3. 622,3. 589, 4. 135,2. 752;P﹥0. 05). After treatment,the levels of BNP,LVEF,LVESV,LVEDV and HR in combined group were(201. 6 ±66. 8)pg/L,(45 ± 4)%,(29. 8 ± 4. 8)ml/m2,(45. 1 ± 7. 3)ml/m2,(73. 2 ± 11. 2)times/min,in sodium nitroprusside group were( 298. 6 ± 75. 3 ) pg/L,( 37 ± 4 )%,( 35. 5 ± 4. 6 ) ml/m2 ,( 51. 8 ±7.5)ml/m2,(92.9 ±11.5)times/min,and in dopamine group were(293.7 ±78.2)pg/L,(37 ±3)%, (35. 6 ± 5. 8)ml/m2,(52. 1 ± 7. 3)ml/m2,(93. 6 ± 12. 3)times/min respectively,and the differences were significant(F=41. 683,129. 400,43. 600,28. 800,328. 600;P﹤0. 05). The total effective rate in combination group was 97. 8%( 88/90 ),significantly higher than that of sodium nitroprusside group( 86. 7%,8/90 ) or dopamine group( 88. 9%,80/90 ),and the differences were statistically significant(χ2 =7. 683,P ﹤0. 05). There were 3 cases(3. 3%)with adverse reaction in combination group after treatment,including 1 cases of headache and 2 cases of nausea and vomiting. All above symptoms disappeared after stopping drugs. There was 1 cases(1. 1%)with adverse reaction in sodium nitroprusside group,1 cases(1. 1%)in dopamine group,and there was no significant differences seen among three groups(χ2 =1. 630,P﹥0. 05). Conclusion Continuous intravenous infusion of sodium nitroprusside combined with dopamine on cardiac function in elderly patients with refractory heart failure can improve clinical effect and enhance the medication security.