单硝酸异山梨酯注射液治疗充血性心力衰竭80例

目的 观察单硝酸异山梨酯注射液治疗充血性心力衰竭(CHF)的临床疗效.方法 对照组(82例)用常规治疗方法,即强心、利尿,扩血管等治疗.治疗组(80例)在常规治疗方法的基础上加用单硝酸异山梨酯注射液100 mL静脉输注,每日1次,7 d为1个疗程.结果 经治疗(1～2)个疗程后,治疗组总有效率97.5%,对照组为76.8%.结论 单硝酸异山梨酯治疗CHF安全有效.     

单硝酸异山梨酯治疗冠心病心绞痛的疗效观察

目的观察单硝酸异山梨酯在治疗冠心病心绞痛的疗效。方法将我院收治的60例冠心病心绞痛患者随机分为对照组和观察组,对照组采用硝酸甘油注射液治疗,观察组采用单硝酸异山梨酯治疗,比较两组治疗效果及不良反应发生情况。结果对照组总有效率为73.3%。观察组总有效率为93.3%。两组总有效率比较差异有统计学意义。两组治疗过程中均未见明显不良反应。结论单硝酸异山梨酯疗效好,不良反应少,安全性好,值得临床推广应用。     

对80例老年冠心病患者使用单硝酸异山梨酯的临床疗效观察

目的为了深入观察单硝酸异山梨酯在治疗老年冠心病心绞痛患者时的效果。方法选取2011年8月到2012年2月在我院接受治疗的冠心病心绞痛病患80例,按照治疗药物不同将这些病患分成两组,治疗组与对照组,每组共有病患40人,为治疗组中的病患静脉注射单硝酸异山梨酯注射液,为对照组中的病患静脉注射硝酸甘油注射液,对比两组病患的治疗效果。结果连续治疗10天,治疗组中病患的总有效率为92.5%明显比对照组72.5%的总有效率高,P0.05,具有统计学差异意义。结论在治疗老年冠心病心绞痛病患时,单硝酸异山梨酯具有治疗效果好、副反应少等优点,值得在临床治疗中推广使用。     

疏血通联合单硝酸异山梨酯注射液治疗稳定型心绞痛的对比研究

目的 对疏血通注射液治疗稳定型心绞痛的疗效及安全性作出评价。方法 应用随机双盲对照观察疏血通注射液和/或单硝酸异山梨酯注射液治疗稳定型心绞痛的疗效及其对血清总胆固醇(TC)、低密度脂蛋白(LDL)及血小板粘附率的影响。结果 疏血通注射液能有效缓解症状及改善心电图疗效,降低血清TC、LDL及血小板粘附率(P<0.05),二种药物联合应用疗效更好(P<0.05)。结论 疏血通注射液治疗稳定型心绞痛安全有效,与单硝酸异山梨酯注射液联合应用可获得更好疗效。     

脉络宁联合单硝酸异山梨酯注射液治疗稳定型心绞痛的对比研究

目的评价脉络宁注射液治疗稳定型心绞痛的疗效及安全性。方法应用随机双盲对照观察脉络宁注射液和／或单硝酸异山梨酯注射液治疗稳定型心绞痛的疗效及其对血清总胆固醇（TC）、低密度脂蛋白（LDL—C）及血小板黏附率的影响。结果脉络宁注射液能有效缓解症状及改善心电图疗效，降低血清TC、LDL—C及血小板黏附率（P〈0．05），两种药物联合应用疗效更好。结论脉络宁注射液治疗稳定型心绞痛安全有效，与单硝酸异山梨酯注射液联合应用可获得更好疗效。     

国产注射用5-单硝酸异山梨酯(鲁南欣康)的应用

5-单硝酸异山梨酯(isosorbidemononittrate,IS-5-MN),化学品名为1,4:3,6-二脱水D山梨糖醇单硝酸酯。它是硝酸异山梨酯的主要代谢产物,可通过扩张外周血管,特别是增加静脉血容量,减少回心血量,降低心脏前、后负荷,而减少心肌耗氧量;同时还可通过促进心肌血流重新分布而改善缺血区血流供应,可能通过这两方面发挥抗心肌缺血作用。山东鲁南制药厂经过几年的研制,生产出注射用的5-单硝酸异山梨酯(鲁南欣康注射液),其作用及效果优越,与进口的Isoket效果相近,值得进一步推广。1　作用机理1.1　扩血管作用IS-5-MN的治疗机理最终是通过生成一氧化…     

单硝酸异山梨酯静滴治疗老年冠心病探讨

目的探讨单硝酸异山梨酯静滴治疗老年冠心病患者的实际效果。方法选取2013年06月~2014年06月我院收治的老年冠心病患者80例,按随机数字表法将其分成实验组40例,对照组40例,实验组病例应用单硝酸异山梨酯治疗,对照组病例应用硝酸异山梨酯治疗,比较临床疗效。结果治疗后,实验组SV为（62.21±14.02）ml/次,LVEF为（0.31±0.13）,临床症状控制有效率为90.0%,与对照组相比,差异有统计学意义（P〈0.05）。结论单硝酸异山梨酯静滴治疗老年冠心病,效果佳,安全性高,值得临床进一步应用。     

单硝酸异山梨酯联合多巴酚丁胺治疗肺心病急性加重期疗效分析

目的：观察单硝酸异山梨酯联合多巴酚丁胺治疗慢性肺源性心脏病（肺心病）急性加重期心力衰竭患者的疗效。方法将138例慢性肺心病心力衰竭患者根据用药情况分为对照组（69例）和治疗组（69例）。治疗组在常规综合治疗的基础上加用单硝酸异山梨酯注射液和多巴酚丁胺注射液。观察两组疗效及动脉血气分析指标、并发症、病死率。结果治疗组疗效明显,并发症、病死率均低于对照组（P〈0.01）。两组疗效比较差异有统计学意义（P〈0.05）。结论单硝酸异山梨酯联合多巴酚丁胺治疗慢性肺心病急性加重期心力衰竭效果显著。     

复方丹参滴丸治疗冠心病的临床疗效观察

目的临床观察复方丹参滴丸治疗冠心病疗效情况。方法将我院特殊疾病门诊患者中82例冠心病患者随机分组,观察组41例使用复方丹参滴丸加单硝酸异山梨酯片治疗;对照组41例使用单硝酸异山梨酯片治疗。服用8周后观察疗效。结果使用复方丹参滴丸加单硝酸异山梨酯片治疗冠心病明显优于单用单硝酸异山梨酯片。结论复方丹参滴丸加单硝酸异山梨酯片治疗冠心病有良好疗效,能够有效降低心绞痛发作频率及血脂,使心电图缺血性改变得到改善。两组比较,前者明显优于后者,且并未出现明显的不良反应。     

5-单硝酸异山梨酯注射液治疗冠心病心绞痛40例疗效观察

5-单硝酸异山梨酯(5-ISMN)是硝酸异山梨酯的代谢产物,它拥有与母体相似的药理特性,由于它的5位严硝酸基团立体构型阻碍肝脏硝酸酯酶的作用,故解离甚缓慢,生物利用度高,血药浓度稳定,半衰期长.为了评价5-单硝酸异山梨酯注射液在冠心病心绞痛治疗中的临床价值,现将研究结果报告如下.     

Medical treatment of patients with severe exertional and rest angina: double blind comparison of beta blocker, calcium antagonist, and nitrate.

The role of medical treatment of patients who had resting nocturnal angina as well as exertional angina was investigate. The effects of atenolol 100 mg a day, nifedipine 20 mg three times a day, and isosorbide mononitrate 40 mg twice a day were investigated in a double blind, triple dummy randomised study. Nine patients with coronary artery disease, early positive exercise tests, and transient daytime and nocturnal ambulatory ST segment changes were initially assessed off all antianginal medication. They were then treated with each drug for three five day periods. Angina diaries were reviewed and maximal treadmill exercise tests and 48 hour ambulatory ST segment monitoring were performed at the end of each treatment period. Resting and exercise heart rate and blood pressure were significantly lower on atenolol than on either isosorbide mononitrate or nifedipine. The duration of exercise to 1 mm ST segment depression was significantly greater on atenolol than on isosorbide mononitrate. Only one patient had an improvement in exercise tolerance on nifedipine that was greater than the improvement on atenolol; this patient had single vessel disease. The total number and duration of episodes of ST segment change during ambulatory monitoring were significantly lower with atenolol than on either isosorbide mononitrate or nifedipine. Nocturnal ST segment changes were abolished in six patients on atenolol, in six patients on nifedipine, and in five patients on isosorbide mononitrate. When nocturnal ST segment changes occurred, their frequency was reduced with all three drugs. Pain was abolished in four patients on atenolol and pain relief was significantly better on atenolol than on isosorbide mononitrate. There was no significant difference in pain relief between isosorbide mononitrate and nifedipine. Thus beta receptor blockade with atenolol was the most effective means of reducing myocardial ischaemia both during exercise and at rest at night without causing deterioration in any patient. Nocturnal myocardial ischaemia in patients with severe coronary artery disease can be effectively treated with beta receptor antagonists and vasodilators.     

Medical treatment of patients with severe exertional and rest angina: double blind comparison of beta blocker, calcium antagonist, and nitrate

The role of medical treatment of patients who had resting nocturnal angina as well as exertional angina was investigate. The effects of atenolol 100 mg a day, nifedipine 20 mg three times a day, and isosorbide mononitrate 40 mg twice a day were investigated in a double blind, triple dummy randomised study. Nine patients with coronary artery disease, early positive exercise tests, and transient daytime and nocturnal ambulatory ST segment changes were initially assessed off all antianginal medication. They were then treated with each drug for three five day periods. Angina diaries were reviewed and maximal treadmill exercise tests and 48 hour ambulatory ST segment monitoring were performed at the end of each treatment period. Resting and exercise heart rate and blood pressure were significantly lower on atenolol than on either isosorbide mononitrate or nifedipine. The duration of exercise to 1 mm ST segment depression was significantly greater on atenolol than on isosorbide mononitrate. Only one patient had an improvement in exercise tolerance on nifedipine that was greater than the improvement on atenolol; this patient had single vessel disease. The total number and duration of episodes of ST segment change during ambulatory monitoring were significantly lower with atenolol than on either isosorbide mononitrate or nifedipine. Nocturnal ST segment changes were abolished in six patients on atenolol, in six patients on nifedipine, and in five patients on isosorbide mononitrate. When nocturnal ST segment changes occurred, their frequency was reduced with all three drugs. Pain was abolished in four patients on atenolol and pain relief was significantly better on atenolol than on isosorbide mononitrate. There was no significant difference in pain relief between isosorbide mononitrate and nifedipine. Thus beta receptor blockade with atenolol was the most effective means of reducing myocardial ischaemia both during exercise and at rest at night without causing deterioration in any patient. Nocturnal myocardial ischaemia in patients with severe coronary artery disease can be effectively treated with beta receptor antagonists and vasodilators.     

坎地沙坦联合单硝酸异山梨酯治疗肺心病心力衰竭疗效观察

目的观察坎地沙坦、单硝酸异山梨酯（ISMN）联合治疗重症肺心病心力衰竭的疗效。方法 80例肺心病心力衰竭患者随机分为甲乙两组,每组40例。甲组（治疗组）在乙组常规治疗基础上加坎地沙坦、单硝酸异山梨酯,5 d为1个疗程。结果治疗组显效率71.5%,总有效率90.9%;对照组显效率42.5%,总有效率66.2%,两组显效率、总有效率差异均有统计学意义（均P〈0.01）。结论坎地沙坦、单硝酸异山梨醑（ISMN）合用,治疗老年慢性肺源性心脏病心力衰竭疗效显著,不良反应少,使用安全。     

国产5-单硝酸异山梨醇酯缓释片治疗心绞痛的临床疗效

目的 :观察国产 5 单硝酸异山梨醇酯缓释片治疗冠心病心绞痛疗效安全性。方法 :所选冠心病心绞痛患者共 117例 ,分两组进行治疗。治疗组 :80例 ,口服国产 5 单硝酸异山梨醇酯缓释片 6 0mg ,每日 1次 ,每次1片。对照组 :37例 ,口服长效异乐定 5 0mg ,每日 1次 ,每次 1片。两组均服药 30d为 1个疗程。结果 :治疗组治疗心绞痛的总有效率为 91.2 5 % ,对照组为 91.89%。治疗组治疗后 ,硝酸甘油消耗量明显减少甚至完全停用 ,缺血性ST T变化明显改善 ,心电图疗效达 6 1.6 % ,与对照组相比 ,差异无显著性意义。两组均无明显不良反应。结论 :5 单硝酸异山梨醇酯缓释片疗效确切、安全 ,无明显毒副反应 ,有利于冠心病心绞痛的长期治疗     

Nitrates as adjunct hypertensive treatment

Isolated systolic hypertension (ISH) is an important cause of strokes and heart failure among the elderly, but it is difficult to control in some elderly patients, even with combination antihypertensive therapy. The presence of a prominent reflection wave in the arterial pulse-wave profile of such patients signifies that adjuvant nitrate therapy may prove effective in lowering pulse pressure. This reflection arises in the muscular arteries and is caused by arterial stiffness associated with hypertension and other cardiovascular risk factors, probably including endothelial dysfunction. By acting directly on the arterial wall, nitrates produce endothelium-independent vasorelaxation. The reflection wave and the contribution this makes to pulse pressure are thereby ablated. Controlled trials of the use of isosorbide mononitrate and isosorbide dinitrate in ISH have shown that these agents decrease systolic blood pressure as well as pulse pressure, and with the mononitrate, efficacy appears to be unimpaired by nitrate tolerance.     

Efficacy of isosorbide-5-mononitrate on painful and silent myocardial ischemia after myocardial infarction

The anti-ischemic efficacy of isosorbide-5-mononitrate, 20 mg 3 times daily, on silent myocardial ischemia after myocardial infarction was studied in 28 Chinese patients with use of 48 hours of ambulatory electrocardiographic monitoring in a randomized, crossover, single-blind, placebo-controlled study. Isosorbide mononitrate reduced both painful and painless episodes of ischemia compared with placebo. The number of total ischemic episodes was reduced 88%, duration of ischemia 94%, time-ischemia integral 95%, and total maximal ST-segment depression 86% (p less than 0.01). The drug did not alter the heart rate and blood pressure, and had no evident adverse effect. Thus, isosorbide mononitrate is effective and well tolerated in postinfarction patients with silent ischemia.     

内皮细胞在缺血性心脏病及心力衰竭中的作用

内皮细胞是上皮细胞的一种,广泛分布于心、血管和淋巴管腔面,在人体生理稳态中参与止血、血管调节、血管生成等重要过程.近年来有研究发现,内皮细胞除上述作用外,还促进了缺血性心脏病等多种疾病的病理进展,并且表现出独特的多向分化能力,其中内皮间质转分化能力与心肌纤维化及心力衰竭关系密切.本文主要探讨血管内皮细胞生理特点及在缺血...     

Coronary artery disease observed in general hospitals: ETTIC study. Comparison between trimetazidine and mononitrate isosorbide for patients receiving betablockers

The extended use of interventional surgery of revascularisation has modified the prognosis and the evolution of ischaemic heart diseases. However, both coronary artery bypass graft and percutaneous transluminal coronary angioplasty failed to make the symptomatic or subclinical ischaemic manifestations of chronic coronary insufficiency disappear. The interest of using betablockers as a first-line therapy was widely demonstrated. However, their combination with another efficient molecule is often necessary. The aim of this trial has been to appreciate the efficiency of the association of a betablocker with either trimetazidine or with isosorbide monoitrate. Hundred and eighty five patients retaining a positive effort test despite 100 mg of atenolol, received in addition, either 60 mg of trimetazidine (93 cases) of 60 mg of isosorbide mononitrate (92 cases) for a two-month period and are then re-evaluated at the end of this period. The ischaemic threshold is delayed in a significant way in both groups (p < 0.0001; trimetazidine +7%, isosorbide mononitrate +10.7%). Twenty-three percent of the exercise tests under trimetzidine and 19% under isosorbide mononitrate become negative after two months of the therapeutic combination. The clinical improvement is even clearer with the disappearance of the angina crisis during the week before the second exercise test in 63% of the cases under trimetazidine and 54% of the cases under isosorbide mononitrate, among the patients who had kept it under atenolol at the inclusion. In conclusion, the combination of a second efficient molecule, trimetazidine or isosorbide mononitrate, brings a functional and objective improvement to patients with insufficient chronic coronary disease not totally controlled using a betablocker, even with high dosage. One should notice two important advantages in favour of the trimetazidine: one is practical due to a better tolerance (lack of cephalalgia), the other is conceptual (use of the complementary metabolic approach of cellular oxygenation rather than the haemodynamic approach of nitrate compounds which are already in concurrency with all other anti-ischaemic molecules).     

Selection of therapy with nitrates in patients with stable effort angina: results of comparative study of common isosorbide dinitrate and long acting preparation of isosorbide-5-mononitrate

AIM: To assess efficacy and tolerability of a novel drug form of isosorbide-5-mononitrate in patients with ischemic heart disease and stable effort angina as compared with common isosorbide dinitrate pills. MATERIAL AND METHODS: Patients with stable class II-III effort angina (n=30) were included into a randomized crossover study in which they received isosorbide dinitrate (nitrosorbide, 10-20 mg t.i.d.) and long acting isosorbide-5-mononitrate (ephox-long, 50-100 mg o.d.) for 3 weeks each. Efficacy of treatment was assessed by clinical data and treadmill exercise tests. Questionnaires were used for registration of frequency and intensity of attacks of headache. RESULTS: The use of both isosorbide dinitrate and 5-mononitrate was associated with significant improvements of exercise tolerance however effect of mononitrate lasted longer. Nitroglycerine requirement diminished during first week of use of both drugs and remained on this level by the end of 3-rd week of treatment with mononitrate but substantially rose by the end of treatment with dinitrate. Number of attacks of headache increased during first week of treatment with both drugs, became even higher by the end of use of dinitrate and decreased by the end of use of mononitrate. CONCLUSION: Long acting form of isosorbide-5-mononitrate ephox-long taken once daily provides sufficient antianginal effect throughout a day and is better tolerated than nitrosorbide preparation of isosorbide dinitrate with moderately prolonged activity.     

Isosorbide mononitrate 30% immediate-release 70% sustained-release formulation: a review. DUMQOL (DUtch Mononitrate Quality of Life) Study Group

Since the first publication of isosorbide mononitrate 30% immediate-release 70% sustained-release (IR-SR) formulation in 1985, a considerable body of literature concerning its clinical efficacy and safety has become available. Theoretically, the formulation has the advantage over conventional isosorbide mononitrate or dinitrate (ISMN/ISDN) that it has a simpler and more predictable pharmacokinetic profile. The objectives of this paper are to review published data so far and to see whether the theoretical advantages translate into better clinical effectiveness. 1. After oral administration, isosorbide mononitrate IR-SR has a rapid onset of action (30 minutes), and effects are evident for up to 17 hours. 2. The antianginal effects of once-daily isosorbide mononitrate IR-SR increased with increasing dosages, were generally larger than those of either placebo or equipotent doses of conventional ISMN/ISDN, and were somewhat larger than those of the beta blocker bupranolol. The effects were generally similar to those of sustained release nifedipine. 3. Patients showed significantly greater improvement in some quality-of-life indices with once-daily isosorbide mononitrate IR-SR than with twice or three times daily regimens of conventional ISMN/ISDN. This was particularly so with mobility, psychological distress, and life satisfaction indices. 4. Tolerance did not develop after 13 months of once daily isosorbide dinitrate IR-SR. No rebound increase in incidence of ischemic episodes was observed after discontinuation of treatment. 5. Long-term efficacy data both of isosorbide mononitrate IR-SR and of conventional ISMN/ISDN are limited so far. Large studies in patients with angina pectoris and patients with heart failure addressing long-term effects are ongoing, and some of the data will be completed within the next months. Isosorbide mononitrate IR-SR has a rapid onset of action and has been shown to be clinically efficient and, in addition, to be more so than conventional ISMN / ISDN. Nitrate tolerance with continued use of the formulation has not yet been reported. Long-term effects on morbidity and mortality are currently being assessed.