大剂量地尔硫卓在致心肌梗死的严重冠脉痉挛患者中的疗效分析

目的 分析大剂量盐酸地尔硫卓在致心肌梗死的严重冠脉痉挛患者中的临床疗效和安全性。 方法 回顾分析了10例冠脉造影提示冠脉痉挛导致心肌梗死的患者的临床资料，患者在扩冠、调脂、抗血小板聚集等常规治疗基础上，均接受大剂量盐酸地尔硫卓360 mg/d治疗，治疗后4周采用西雅图心绞痛量表评价患者的生活质量和心绞痛发作情况。随访1年后观察是否再次发生心肌梗死。 结果 治疗4周后与治疗前比较，患者西雅图心绞痛量表评分较基线水平明显提高，差异有统计学意义（P<0.05）。1例患者因服用地尔硫卓360 mg/d，4个月后出现头晕、心动过缓，将地尔硫卓减量为180 mg/d，该患者再次出现心肌梗死。其余9例患者无明显不良反应，耐受性良好。 结论 大剂量地尔硫卓治疗严重冠脉痉挛患者可以明显减少心绞痛发作，预防冠脉痉挛导致的再次心梗，患者耐受性良好，可作为严重冠脉痉挛患者的选择。

Efficacy of high dose diltiazem in patients with myocardial infarction caused by severe coronary spasm

AIM To investigate the clinical efficacy and safety of high dose diltiazem in patients with myocardial infarction induced by severe coronary spasm. METHODS The clinical data of 10 patients with myocardial infarction caused by severe coronary artery spasm were retrospectively analyzed. All patients were treated with guideline-directed medical therapy and high-dose diltiazem 360 mg/d. The quality of life and the number of episodes of angina pectoris after treatment were assessed by Seattle Angina Questionnaire. All the patients were followed up for at least 1 year to observe whether the recurrence of myocardial infarction happened. RESULTS After 4 weeks of treatment, the Seattle Angina Pectoris Scale score was significantly higher than the baseline level (P<0.05). One patient experienced dizziness and bradycardia after taking diltiazem 360 mg/d for 4 months. The dose of diltiazem was reduced to 180 mg/d for this patient and the patient had a recurrence of myocardial infarction. The remaining 9 patients had no recurrence of myocardial infarction and no obvious side effects and the dose used was well tolerated. CONCLUSION In patients with severe coronary spasm, high dose diltiazem significantly reduces angina pectoris and prevents the recurrence of myocardial infarction induced by coronary artery spasm. Treatment with high dose diltiazem is significantly effective and safe in patients with severe coronary spasm.