Sodium nitroprusside in 2014: A clinical concepts review.
Sodium nitroprusside in 2014: A clinical concepts review.
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DOI：
10.4103/0970-9185.142799
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Belani KG
中科院分区：
文献类型：
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作者：
Hottinger DG;Beebe DS;Kozhimannil T;Prielipp RC;Belani KG
硝普钠作为动脉和静脉血管扩张剂在临床应用已有 40 年历史。这种前药与生理性巯基反应释放一氧化氮，引起血管快速舒张，并急剧降低血压。它在临床上用于心脏手术、高血压危象、心力衰竭、血管手术、小儿手术和其他急性血流动力学应用。在某些实践中，较新的药物已取代硝普钠，因为它们更有效，或者因为它们具有更有利的副作用。然而，有效且有力的疗效研究很少，并且无法确定适合所有适应症的优越药物。与硝普钠给药同时发生的氰化物阴离子释放与潜在的氰化物蓄积和严重毒性有关。改善氰化物不良影响的试剂在实用性和有效性方面受到各种问题的限制。一种新的口服生物可用解毒剂是硫烷酸钠，它有望逆转这种毒性。硝普钠作为一种能够快速控制血压的滴定剂的独特功效可能会在可预见的未来保持其在临床实践中的应用。进一步的研究将完善并可能扩大硝普钠的适应症，同时并行研究将继续开发氰化物中毒的有效解毒剂。
Sodium nitroprusside has been used in clinical practice as an arterial and venous vasodilator for 40 years. This prodrug reacts with physiologic sulfhydryl groups to release nitric oxide, causing rapid vasodilation, and acutely lowering blood pressure. It is used clinically in cardiac surgery, hypertensive crises, heart failure, vascular surgery, pediatric surgery, and other acute hemodynamic applications. In some practices, newer agents have replaced nitroprusside, either because they are more effective or because they have a more favorable side-effect profile. However, valid and adequately-powered efficacy studies are sparse and do not identify a superior agent for all indications. The cyanide anion release concurrent with nitroprusside administration is associated with potential cyanide accumulation and severe toxicity. Agents to ameliorate the untoward effects of cyanide are limited by various problems in their practicality and effectiveness. A new orally bioavailable antidote is sodium sulfanegen, which shows promise in reversing this toxicity. The unique effectiveness of nitroprusside as a titratable agent capable of rapid blood pressure control will likely maintain its utilization in clinical practice for the foreseeable future. Additional research will refine and perhaps expand indications for nitroprusside, while parallel investigation continues to develop effective antidotes for cyanide poisoning.