中医中药治疗女性冠心病顽固性心绞痛15例疗效观察

顽固性心绞痛是指传统的抗心绞痛药物无效，又不适合做冠状动脉内介入治疗和冠状动脉搭桥术的心绞痛。顽固性心绞痛的确定必须符合两个标准：①病人存在客观的心肌缺血的依据（经运动试验、激发试验证实）并产生严重的心绞痛；②经应用低分子肝素，硝酸酯类药物等治疗不稳定心绞痛的药物治疗无效，经冠状动脉造影不适合做冠状动脉内介入治疗或冠状动脉搭桥术。我院自2006年2月-2007年6月使用中医中药配合传统的抗心绞痛药物治疗顽固性心绞痛15例取得满意疗效。现报告如下：     

心绞痛治疗中的几个问题

心绞痛是内科常见病,一般情况下诊治无困难,但临床工作中常遇到一些棘手问题,如顽固性心绞痛、心绞痛伴发病和抗心绞痛药物停药综合征处理及某些药物对心绞痛的影响等问题,给治疗工作带来困难,影响疗效甚至出现病情加重。应引起临床工作者注意。一、顽固性心绞痛的处理顽固性心绞痛是指经过内科积极治疗不能控制的心绞痛。包括不稳定型心绞痛高危期,卧位型心绞痛和心梗后心绞痛。1.一般治疗:减少外界刺激,防止情绪激动对顽固型心绞痛尤为重要。因为疼痛和焦虑都可激     

尼可地尔对顽固性心绞痛患者心绞痛发作与心电图的影响探究

目的:探讨尼可地尔对顽固性心绞痛患者心绞痛发作与心电图的影响。方法:按照随机数字表法将2016年2月-2017年7月84例顽固性心绞痛患者分组。对照组采取β受体阻滞剂、抗血小板凝集等药物治疗,尼可地尔组在对照组基础上增加尼可地尔治疗。比较两组顽固性心绞痛疗效;治疗副作用发生率;干预前后患者心绞痛发作与心电图情况。结果:尼可地尔组顽固性心绞痛疗效高于对照组,P0.05;两组患者副作用发生率无存在显著差异,P0.05;干预前两组心绞痛发作与心电图情况相近,P0.05;干预后尼可地尔组心绞痛发作与心电图情况优于对照组,P0.05。结论:尼可地尔对顽固性心绞痛患者心绞痛发作与心电图有改善作用,可缩短心绞痛持续时间和降低发作频率,促进心电图ST-T段改善。     

尼可地尔联合前列地尔注射液治疗顽固性心绞痛的疗效分析

目的 探讨尼可地尔联合前列地尔注射液治疗顽固性心绞痛临床疗效。方法 选择2015年12月至2107年4月徐州市中心医院顽固性心绞痛120例,采用简单随机化分组的方式分为尼可地尔组(n=42),前列地尔注射液组(n=38)以及尼可地尔联合前列地尔注射液组(n=40)。三组病人在常规心绞痛药物治疗基础上,分别加用尼可地尔、前列地尔注射液、尼可地尔联合前列地尔注射液,观察三组病人用药前后心绞痛发作情况及6 min步行试验改善情况。结果 2周治疗后,三组病人心绞痛发作情况及6 min步行试验较用药前均有显著改善,尼可地尔联合前列地尔注射液组在心绞痛有效率上改善较明显(87.50%比57.89%,87.50%比64.29%,χ²=8.681、5.987,均P＜0.017),6 min步行试验上改善明显(F=17.614,P＜0.001),差异有统计学意义。结论 对于顽固性心绞痛病人,在常规抗心绞痛药物治疗的基础上,联合使用尼可地尔和前列地尔注射液可改善心绞痛发作及提高运动耐量。     

抗心绞痛药物构效关系的研究进展

抗心绞痛药物的发展始于19世纪50年代的亚硝酸异戊酯，该系列化合物治疗心绞痛已有100多年的历史。随着钙拮抗剂和β受体阻滞剂的发展，心绞痛的治疗有了更多的选择，硝苯地平和普萘洛尔分别是此两类药物的典型代表。近年来，雷诺嗪等新型药物的研发使抗心绞痛治疗药物更加丰富。本文综述了近年来各类抗心绞痛药物的构效关系研究进展。     

硝酸酯类抗心绞痛药的新进展

近年来,冠心病病人心绞痛的药物治疗进展较快。本文试对硝酸酯类抗心绞痛药的作用机理新观点、新剂型作一综述。硝酸甘油(GTN)为经典抗心绞痛药,至今,它仍为心绞痛急性发作时有效的首选药物,同时也是评定其他抗心绞痛药物临床疗效的标准对照物。     

抗高血压药物研发进展

高血压是多种心血管事件的主要诱发因素之一,针对高血压的治疗最直接且最有效的方式为通过各种手段综合降低血压。针对高血压药物的研发与进展,世界各国对于高血压药物的研发主要集中于直接抗高血压药物的研究。单独应用抗高血压药物虽然可以发挥有效的降压作用,但是抗高血压药物的耐药性及顽固性高血压的治疗仍是抗高血压治疗的重点研发领域。目前针对抗高血压药物治疗瓶颈的解决方式主要分为寻找新靶点药物和固定剂量联合用药,但仍有巨大的临床缺口需要更加深入的基础研究,为抗高血压药物的研发提供新的靶点。     

通心络治疗常规药物治疗无效的顽固性心绞痛临床观察

目的研究通心络对常规药物治疗无效的顽固性心绞痛的疗效。方法将60例常规标准药物治疗无效的门诊冠心病患者随机分为两组,治疗组及对照组各30例,治疗组在常规药物治疗基础上给予口服通心络胶囊,对照组给予常规药物治疗,4周后比较两组临床症状的变化、心电图变化。结果治疗4周后症状总有效率治疗组和对照组分别是60.O%和26.7%,有统计学差异(P<0.01);心电图疗效总有效率治疗组和对照组分别是43.3%和20%,有统计学差异(P<0.05)。结论通心络胶囊可改善常规药物治疗无效的顽固性心绞痛患者的临床症状及心电图改变。     

复方丹参滴丸治疗老年不稳定型心绞痛的临床观察

目的观察复方丹参滴丸对老年不稳定型心绞痛的临床疗效。方法选取100例老年不稳定型心绞痛患者，随机分为治疗组（50例）和对照组（50例）。对照组应用常规抗心绞痛药物，治疗组在常规抗心绞痛药物的基础上加职复方丹参滴丸，4周为1个疗程。结果治疗组在心绞痛缓解率、降低心绞痛发作率、持续时间、改善心电图等方面均优于对照组（P〈0．05）。结论复方丹参滴丸是一种有效且不良反应小的治疗不稳定型心绞痛药物。     

体外反博治疗冠心病心绞痛50例临床疗效观察

目的评价体外反搏治疗冠心病心绞痛的疗效。方法采用随机单盲对照法,将100例冠心病心绞痛患者分为对照组和治疗组。对照组使用常规的抗心绞痛药物治疗,治疗组除了常规抗心绞痛药物治疗,给予体外反搏治疗。结果两组心绞痛患者治疗的有效率分别为:对照组70%,治疗组92%,治疗组明显优于对照组(P<0.05)。结论体外反搏治疗冠心病心绞痛是安全有效的。     

尼可地尔联合替格瑞洛治疗PCI术后难治性心绞痛的效果

目的探讨尼可地尔联合替格瑞洛治疗经皮冠状动脉介入治疗(PCI)术后难治性心绞痛的效果。方法 300例PCI术后出现难治性心绞痛的患者,随机分为研究组和对比组,每组150例。对比组患者实施标准抗心绞痛治疗,研究组患者在对比组的基础上进行尼可地尔联合替格瑞洛治疗。比较两组患者的治疗效果。结果治疗后,研究组患者的总有效率为86%,高于对比组的56%,差异具有统计学意义(P<0.05)。结论尼可地尔联合替格瑞洛治疗PCI术后难治性心绞痛效果较好,对患者心肌供血的改善情况具有显著的效果。     

卡托普利对冠状动脉扩张症的治疗

目的评价卡托普利对冠状动脉扩张症的疗效。方法将冠状动脉造影证实为冠状动脉扩张的稳定性心绞痛患者,患者总数40例,随机分为硝酸异山梨酯组和卡托普利组,疗程1年,观察心绞痛发作、平板运动试验、冠状动脉造影等项的影响。结果治疗后卡托普利组总有效率87.5%,硝酸异山梨酯组总有效率17.7%,两组对比有显著差异,P〈0.05。结论卡托普利治疗冠状动脉扩张中明显改善平板运动试验的结果,减少心绞痛的发病,冠脉血流明显改善,所以卡托普利是治疗冠状动脉扩张的有效药物。     

单硝酸异山梨酯片联合定痛救心胶囊治疗冠脉介入术后再发稳定型心绞痛的临床疗效

目的观察单硝酸异山梨酯片联合定痛救心胶囊对冠脉介入术(PCI)后再发稳定型心绞痛的临床疗效和安全性。方法将48例PCI后再发稳定型心绞痛患者随机分为治疗组(24例)和对照组(24例)。对照组口服单硝酸异山梨酯片20mg/次,3次/d;治疗组口服定痛救心胶囊6粒/次,3次/d,单硝酸异山梨酯片的用法和用量同对照组,两组患者均持续治疗8周。治疗结束后,观察两组患者临床疗效、心电图变化、中医证候疗效。结果治疗后治疗组临床疗效、心电图变化、中医证候疗效与对照组比较差异均有统计学意义(P<0.05)。结论单硝酸异山梨酯片联合定痛救心胶囊能有效地改善PCI术后再发稳定型心绞痛患者的疗效,且无不良反应,值得临床推广。     

PTCA及冠脉内支架术治疗不稳定心绞痛

目的 探讨PTCA及冠脉内支架术治疗不稳定心绞痛的临床疗效、应用价值。方法 对7例经内科常规芗治疗不能缓解的不稳定心绞痛（UAP）行冠脉造影术,5例为双枝或多枝复杂病变,2例为单枝严重狭窄。对“罪犯”血管施行经皮冠脉腔内成形术（PTCA）,有残留狭窄而植入冠脉内支架。结果 7例全部成功,术后重复造影“罪犯”血管开通无残留狭窄。随3-4个月无心绞痛发作,恢复正常生活与工作。结论 PTCA及冠脉内支架术是治疗不稳定心绞痛的安全、有效的方法。     

Management of Angina Pectoris

Progress in prevention as well as drug and interventional therapy has improved the prognosis of patients with cardiovascular disorders. Many patients at risk have advanced coronary artery disease (CAD), have had multiple coronary interventions, and present with significant co-morbidity. Despite adequate risk factor modulation and often several revascularization procedures, some of these patients still have refractory angina pectoris. Apart from advanced CAD and insufficient collateralization, the cause is often endothelial dysfunction. For this situation, one treatment option is neuromodulation. Controlled studies suggest that, in patients with chronic refractory angina pectoris, spinal cord stimulation (SCS) provides a relief from symptoms equivalent to that provided by surgical therapy, but with fewer complications and lower rehospitalization rates. SCS may result in significant long-term pain relief with improved quality of life. In patients with refractory angina undergoing SCS, some studies have shown not only a symptomatic improvement, but also a decrease in myocardial ischemia and an increase in coronary blood flow. Discussion is ongoing as to whether this is a direct effect on parasympathetic vascodilation or merely a secondary phenomenon resulting from increased physical activity following an improvement in clinical symptoms. Results from nuclear medical studies have sparked discussion about improved endothelial function and increased collateralization. SCS is a safe treatment option for patients with refractory angina pectoris, and its long-term effects are evident. It is a procedure without significant complications that is easy to tolerate. SCS does not interact with pacemakers, provided that strict bipolar right-ventricular sensing is used. Use in patients with implanted cardioverter defibrillators is under discussion. Individual testing is mandatory in order to assess optimal safety in each patient.     

Denopamine,a selective beta1-receptor agonist and a new coronary vasodilator

Up until now, it has been suggested that nitrate and/or calcium channel blockers were effective against variant angina pectoris. On the other hand, it is known that about 20% of variant angina pectoris was refractory to both nitrate and calcium channel blockers. In Japan, it has been reported that denopamine, which is an oral beta1-adrenoceptor selective agonist developed by the Japanese pharmaceutical industry (Tanabe Seiyaku), is effective in those refractory cases. To date, in Japan nine cases have been recognized of patients with vasospastic angina pectoris whose symptoms were relieved by taking denopamine, including one case in which the author has had personal experience. Eight of these nine cases were refractory, and were not relieved by combined therapy using both nitrate and a calcium channel blocker. It was also documented that denopamine was effective in cases where attacks were not relieved by prazosin or magnesium, which have been documented as effective in other refractory cases. In a study of canine coronary arteries, localization of beta-adrenoceptor subtypes was documented, with the beta1-adrenoceptor predominantly found in the conduit coronary artery. In recent years it has been emphasized that the principal role of sympathetic nerves was not associated with the constrictive action of alpha-adrenoceptors, but with the coronary dilative action of beta-adrenoceptors. It would therefore be worthwhile to determine whether denopamine is able to relieve vasospastic angina pectoris in many more cases.     

Denopamine,a Selective 1-Receptor Agonist and a New Coronary Vasodilator

Summary

Up until now, it has been suggested that nitrate and/or calcium channel blockers were effective against variant angina pectoris. On the other hand, it is known that about 20% of variant angina pectoris was refractory to both nitrate and calcium channel blockers. In Japan, it has been reported that denopamine, which is an oral 1-adrenoceptor selective agonist developed by the Japanese pharmaceutical industry (Tanabe Seiyaku), is effective in those refractory cases. To date, in Japan nine cases have been recognized of patients with vasospastic angina pectoris whose symptoms were relieved by taking denopamine, including one case in which the author has had personal experience. Eight of these nine cases were refractory, and were not relieved by combined therapy using both nitrate

and a calium channel blocker. It was also documented that denopamine was effective in cases where attacks were not relieved by prazosin or magnesium, which have been documented as effective in other refractory cases. In a study of canine coronary arteries, localization of β-adrenoceptor subtypes was documented, with the β1-adrenoceptor predominantly found in the conduit coronary artery. In recent years it has been emphasized that the principal role of sympathetic nerves was not associated with the constrictive action of α-adrenoceptors, but with the coronary dilative action of β-adrenoceptors. It would therefore be worthwhile to determine whether denopamine is able to relieve vasospastic angina pectoris in many more cases.     

氯吡格雷在治疗冠心病不稳定型心绞痛的临床分析

目的研究氯吡格雷治疗冠心病不稳定型心绞痛的临床疗效。方法 120例疗病毒性心肌炎患者分为Ⅰ、Ⅱ,Ⅰ组60人,采用氯吡格雷和阿司匹林联合治疗;Ⅱ组为60人,作为对照,单用阿司匹林治疗。结果经治疗后,Ⅰ组、Ⅱ组两组治疗方法都有着一定的功效,与治疗前相比,都有着一定的改善,两组相比较来看,Ⅰ组的治疗疗效明显优于对照组Ⅱ组(P<0.05)。结论氯吡格雷治疗冠心病不稳定型心绞痛有着较好的医疗效果,值得在临床上推广研究。     

氢氯吡格雷联合冠心舒通胶囊对急性冠脉综合征PCI术后心绞痛患者高敏C反应蛋白及LDL-C的影响

目的观察氢氯吡格雷联合冠心舒通胶囊对急性冠脉综合征患者经皮冠状动脉介入治疗（PCI）术后心绞痛的疗效,及对血清高敏C反应蛋白（hs-CRP）和低密度脂蛋白胆固醇（LDL-C）的影响。方法选择70例ACS行PCI术后患者心绞痛随机分为2组：对照组给予阿司匹林、硝酸酯类、β-受体阻滞剂、钙离子拮抗剂、他汀类药物、低分子肝素等,联合组在此基础上加用硫酸氢氯吡格雷和冠心舒通胶囊。2组治疗均为4周,分别在用药前及用药后14 d、30 d检测hs-CRP和LDL-C;在用药前后检测血尿常规、凝血酶原时间（PT）、APTT、血小板计数（PLT）、肝肾功能、血糖、血脂及心肌酶等测定。观察心血管事件的发生情况、药物不良反应、患者临床症状改善情况及hs-CRP、LDL-C水平。结果治疗后联合组和对照组的总有效率分别为94.29%和77.14%,联合组明显优于对照组（P〈0.01）。2组患者hs-CRP水平较治疗前明显下降,联合组更为明显（P〈0.05）。2组治疗后低密度脂蛋白胆固醇（LDL-C）水平较治疗前有下降（P〈0.05）。其中LDL-C 2组治疗后比较,联合组较对照组下降更明显（P〈0.05）。联合组在用药过程中未见明显不良反应。结论采用联合组的方法能显著改善冠心病PCI术后心绞痛的临床症状,并显著抑制炎性因子水平,降低hs-CRP、LDL-C,稳定斑块,降低心血管事件,且不增加出血事件的发生率,是一种辅助治疗急性冠脉综合征PCI术后心绞痛的安全有效的方法。     

麝香保心丸在治疗心绞痛的应用

目的观察麝香保心丸治疗冠心病心绞痛的疗效。方法将冠心病心绞痛患者80例,随机分为麝香保心丸组(40例)和消心痛组(40例),治疗组口服麝香保心丸,6丸/d;对照组口服消心痛片,30 mg/d,两组疗程均为6个月,疗程结束后观察其对冠心病心绞痛的疗效。结果治疗组、对照组冠心病心绞痛的发作频率减少分别为95.8%,81.6%(P<0.05),症状疗效分别为92.5%,80%(P<0.05)、心电图疗效分别为82.5%,70%(P<0.05)、随访6个月期间因心绞痛再住院或急诊的发生率10%,25%(P<0.05),各项指标治疗组均优于对照组。且不良反应麝香保心丸组明显轻于消心痛组。结论麝香保心丸治疗冠心病心绞痛具有较好疗效,而且安全,耐受性好,是长期治疗与预防冠心病心绞痛值得推广的纯中药制剂。