静脉滴注地尔硫治疗不稳定心绞痛伴心功能不全患者的临床观察

目的　探讨静脉滴注地尔硫治疗伴有心功能不全的不稳定心绞痛 (UAP)患者的疗效和安全性。方法　 68例伴心功能不全 NYHA分级 ～ 级的 UAP患者 ,其中 3 2例应用地尔硫静脉滴注持续 48h,3 6例同法应用硝酸甘油 ,对照观察其心绞痛改善程度、心电图变化及对心功能不全的影响。结果　临床总有效率地尔硫组高于硝酸甘油组 ,差异有显著性意义 (P<0 .0 5 ) ,而对心功能的影响两组间无明显差别。结论　在 U AP急性发作期间 ,对那些伴有轻、中度心功能不全的患者 ,短期静脉滴注地尔硫不致引起心功能的恶化 ,临床应用较为安全有效。     

地尔硫(艹卓)联合美托洛尔治疗不稳定型心绞痛临床观察

目的:观察地尔硫(艹卓)联合美托洛尔治疗不稳定型心绞痛(UA)的疗效.方法:32例UA患者(初发劳力性心绞痛18例,恶化劳力性心绞痛14例,均合并静息性心绞痛)在基础治疗的同时,联合应用地尔硫(艹卓)口服,30～45mg/次,每日3次,美托洛尔口服,12.5～50mg,每日2次,疗程2周.观察并记录治疗前后心绞痛发作频率、程度、持续时间,硝酸甘油用量,心率,血压及12导联心电图;以ST下移导联数(NST)和ST下移总和(∑ST)表示心肌缺血范围及程度.结果:治疗前后心绞痛发作频率(次)为3.0±1.2∶0.9±0.6,持续时间(分钟)为10.6±3.2∶2.3±1.8,硝酸甘油消耗量(片/日)为2.8±1.3∶0.8±0.5,收缩压(mmHg)为140±12.6∶120±10.4,心率(次/分)为88±9.12∶70±8.6,NST为3.58±1.56∶2.12±1.10,∑ST为2.72±1.48∶1.10±0.92,差异显著(P<0.01).临床显效16例(50%),有效12例(37.50%),总有效率87.50%.结论:地尔硫(艹卓)联合美托洛尔为UA的有效治疗方法.     

静脉滴注地尔硫Chuo治疗不心绞痛伴心功能不全患者的临床观察

目的：探讨静脉滴注地尔硫Chuo治疗伴有心功能不全的不稳定心绞痛（UPA）患者的疗效和安全性。方法：68例伴心功能不全NYHA分级Ⅱ-Ⅲ级的UAP患者，其中32例应用地尔硫Chuo静脉滴注持续48h,36例同法应用硝酸甘油，对照观察其心绞痛改善.苡电图变化及对心功能不全的影响。结果：临床总有效率地尔硫Chuo组高于硝酸甘油组，差异有显著性意义（P＜0．05），而对心功能的影响两组间无明显差别。结论：在UAP急性发作期间，对那些伴有轻、中度心功能，不全的患者、短期静脉滴注地尔硫Chuo不致引起心功能的恶化，临床应用较为安全有效。     

地尔硫(艹卓)治疗不稳定型心绞痛疗效观察

目的观察口服地尔硫[艹卓]（合心爽）治疗不稳定型心绞痛的临床疗效。方法45例不稳定型心绞痛患者予合心爽30mg．每日3次口服,观察心绞痛发作情况,心电图及血压心率变化。结果45例患者用药前后,平均心绞痛发作次数减少,每次持续时间缩短;其中38例用药后的48h内未再发作心绞痛,患者异常ST恢复。5例心电图缺血性表现明显改善,2例无改善;口服地尔硫[艹卓]血压下降,心率减慢,出现1例窦性心动过缓,1例皮疹,经停服药物后给予对症处理均好转。结论口服合心爽维持治疗不稳定型心绞痛是安全的、有效的。     

静滴地尔硫(艹卓)治疗不稳定型心绞痛的疗效观察

目的:探讨静滴地尔硫(艹卓)(diltiazem)对不稳定型心绞痛(unstable angi-na pectoris,UAP)的疗效.方法:对32例经常规抗心绞痛治疗(变异型心绞痛14例和梗死后心绞痛18例)不能控制的夜间心绞痛患者,给予静滴地尔硫 (艹卓)30～40毫克/晚,维持8～10h,疗程7d,评价其疗效及心率和血压的变化.结果:32例的临床和心电图总有效率为90%,治疗前后心率和血压无临床意义变化.结论:静滴地尔硫(艹卓)治疗UAP疗效确切、安全,使用方便,值得推广.     

口服地尔硫(艹卓)治疗不稳定型心绞痛临床疗效观察

目的观察口服地尔硫(艹卓)对不稳定型心绞痛(UAP)患者的疗效及安全性.方法选择62例常规疗法疗效不佳的UAP患者,口服地尔硫(艹卓)(合心爽)90～240mg/d,观察心绞痛症状、心电图变化、心肌耗氧量变化.结果开始用药后的72h内与用药前相比:(1)心绞痛次数减少,疼痛最长持续时间缩短,疼痛程度减轻;(2)异常ST段及T波恢复及改善;(3)血压、心率值降低,心肌耗氧量减少;(4)3例出现窦性心动过缓,1例Ⅰ度房室传导阻滞,2例一过性低血压,停药后恢复.26例Ⅱ度以下心力衰竭未见加重.结论口服地尔硫(艹卓)治疗顽固的UAP有效且安全.     

地尔硫(艹卓)治疗急性冠状动脉综合征的剂量及疗效观察

目的:观察地尔硫(艹卓)治疗急性冠状动脉综合征的剂量及临床疗效.方法:25例急性冠状动脉综合征患者静脉滴注地尔硫(艹卓)1～5 μg*kg-1*min-1,持续用药48 h.结果:ST段抬高型心绞痛及非ST段抬高型心绞痛用药前后心绞痛发作次数明显减少(P<0.05);地尔硫(艹卓)治疗ST段抬高型心绞痛较非ST段抬高型心绞痛更为有效(P<0.05).地尔硫(艹卓)可不同程度地降低心率、血压及心肌氧耗量,其中用药后2 h及12 h心肌氧耗量明显下降(P<0.05).结论:静脉滴注地尔硫(艹卓)1～3 μg*kg-1*min-1可有效改善各种类型心绞痛的发作,且其不良反应小、安全性高.     

静脉应用地尔硫(艹卓)治疗不稳定型冠状动脉疾病的临床观察

目的观察静脉应用地尔硫(艹卓)治疗不稳定型冠状动脉疾病,评价其疗效及其对心脏功能的影响.方法58例冠心病病人,包括不稳定型顽固性心绞痛45例及急性非Q波心肌梗死13例,静脉注射地尔硫(艹卓)0.3mg/kg(5mg/mm),继而静脉点滴10ug·kg-1·min-1(90min内),随后口服地尔硫(艹卓)30mg,每日4次,共计10d为一个疗程,分别在用药前、用药过程中及用药后1、3、5、10、15、20、30、60、90min及第10d监测心率、血压,用药前及用药后90min、10d各做同一切面超声心动图,监测心脏功能指数(每搏心输出量SV、每搏心指数SI、每分心输出量CO、每分心指数CI、射血分数EF、心率HR).结果用药后5min心率开始下降,15min时达高峰,下降幅度为(15±5)bpm(P＜0.05),收缩压(SBP)10min下降(12±4)mmHg(P＜0.05)、舒张压(DBP)下降不明显(6±2)mmHg(P≥0.05);超声心动图显示心脏功能指数变化:SV、CI、EF无明显改变(P≥0.05),而SI、CO、HR明显改善(P＜0.05).结论静脉应用地尔硫(艹卓)治疗不稳定型冠状动脉疾病疗效确切,安全可靠.     

静脉注射地尔硫卓治疗不稳定心绞痛临床疗效观察

<正> 不稳定心绞痛属急性冠脉综合征之一,病情大多进展迅速,部分为急性心肌梗死或心性猝死的先兆症状.快速有效地扩张狭窄及痉挛的冠状动脉,是终止和减少急性心肌梗死和心性猝死的有效措施.本文通过静脉注射地尔硫卓,目的是评价其临床有效性和安全性.1 对象与方法18例不稳定心绞痛患者,男性8例,女性10例,年龄58±14,心绞痛按Braun wald分型:初发劳累型3例,恶化型6例,自发型3例,混合型4例,心梗后心绞痛2例.入选者,12例为静注硝酸甘油30ug/min,持续30分钟心绞痛不缓解者,6例为静注硝酸甘油后出现头痛,头胀不能耐受者.发作后心电图:ST段异常者6例,T波异常3例,ST段和T波均有异     

地尔硫（艹/卓）联合依那普利治疗肥厚型心肌病临床观察

目的:探讨地尔硫（艹/卓）联合依那普利治疗肥厚型心肌病(HCM)的疗效.方法:19例HCM病人口服地尔硫及依那普利,从小剂量开始,逐渐加量致地尔硫60mg,3次/日,依那普利10mg,2次/日,观察治疗前、后临床症状、心电图、心率、心脏彩超检查的变化.结果:治疗后临床症状减轻,心电图倒置T波深度减少或变为直立,心率下降,总有效率分别为89.47%、73.68%、100%.心脏彩超改变总有效率为36.84%.结论:在无临床禁忌的情况下,地尔硫联合依那普利治疗肥厚型心肌病有一定疗效.     

静脉滴注地尔硫治疗不稳定型心绞痛疗效观察

目的观察静脉用地尔硫对不稳定型心绞痛(UAP)患者的短期疗效、安全性及不良反应。方法选择UAP患者31例,地尔硫从100μg/min起始,最大用量200~300μg/min,持续静脉滴注48 h,观察心绞痛症状,心电图及血压(BP)、心率(HR)变化。结果31例UAP患者开始用药后48 h内与用药前48 h比较,平均心绞痛发作次数减少,平均心绞痛最长持续时间缩短,其中20例患者在用药开始后48 h内未再发作心绞痛,治疗24 h和48h心电图缺血性表现改善明显,BP下降,HR减慢,心肌耗氧量降低;出现3例窦性心动过缓,2例低BP,均在减量后恢复。结论短期静脉用地尔硫可以安全有效缓解UAP患者症状,改善心肌缺血。     

Hemodynamic observations in patients with unstable angina pectoris

Brachial and pulmonary arterial pressures were monitored for 48 hours in 26 patients with unstable angina pectoris and documented occlusive coronary artery disease. The circulatory response during 56 episodes of spontaneous anginal pain permitted the division of responses into three distinctive hemodynamic subsets. Patients in group I had an increased heart rate only with the spontaneous attack of angina; patients in group II had associated increases in brachial arterial pressure and slight increases in heart rate during the episodes of pain; patients in group III demonstrated increases in both brachial and pulmonary arterial diastolic pressures with minimal changes in heart rate. Resting hemodynamic data during pain-free periods were normal in 25 of 26 patients. Patients in all groups who had more than one episode of pain had similar hemodynamic responses to the first and later episodes. Although myocardial hypoxemia appears to be responsible for the spontaneous attack of angina, the hemodynamic responses to the attack varied but were highly specific for any one patient.Our observations suggest that there may be various pathogenic mechanisms for “spontaneous” or resting angina in patients with occlusive coronary artery disease but that the mechanism and associated hemodynamic changes may be specific for individual patients.     

口服地尔硫治疗不稳定型心绞痛临床疗效观察

目的　观察口服地尔硫对不稳定型心绞痛 ( UAP)患者的疗效及安全性。方法　选择 62例常规疗法疗效不佳的 UAP患者 ,口服地尔硫 (合心爽 ) 90～ 2 40 mg/d,观察心绞痛症状、心电图变化、心肌耗氧量变化。结果　开始用药后的 72 h内与用药前相比 :( 1)心绞痛次数减少 ,疼痛最长持续时间缩短 ,疼痛程度减轻 ;( 2 )异常 ST段及 T波恢复及改善 ;( 3 )血压、心率值降低 ,心肌耗氧量减少 ;( 4 ) 3例出现窦性心动过缓 ,1例 度房室传导阻滞 ,2例一过性低血压 ,停药后恢复。2 6例 度以下心力衰竭未见加重。结论　口服地尔硫治疗顽固的 UAP有效且安全     

Long-term follow-up after early intervention with intravenous diltiazem or intravenous nitroglycerin for unstable angina pectoris

Aims In a double-blind randomized trial in unstable angina itwas shown that intravenous diltiazem reduced ischaemic eventsin the first 48h after inclusion better than intra-venous nitroglycerin.The present study was performed to establish the long-term prognosisof the randomized patients, with respect to their initial treatmentassignment. Methods and results One year follow-up data on ischaemic end-pointsand anti-ischaemic medication were recorded. Results were availablefor all of the 121 randomized patients. One hundred and sixty-sevenprimary end-point events were recorded, of which 54 occurredin the first 48h and 113 during the follow-up. Survival analysisshowed that event-free survival was significantly better inthe diltiazem group (45·0%) than in the nitroglyceringroup (34·4%),P=0·04. The incidence rate after48h and one year for cardiac death are, respectively, 0% and4·1%. The trend in anti-ischaemic medication was higherin the nitroglycerin group. For beta-blockers, this trend becamesignificant after 12 months (P=0·03). Conclusion These results show that the initial benefit obtainedby early treatment with intravenous diltiazem was preservedduring the first year after the initial hospitalization, andthat, despite the high risk of cardiac events in our population,the overall mortality 12 months after inclusion was low.     

静脉滴注地尔硫(艹卓)治疗不稳定心绞痛临床疗效和安全性观察

一、目的 观察静脉点滴地尔硫(艹卓)对于不稳定性心绞痛的临床有效性和安全性.为开放性病例收集研究.     

缬沙坦治疗不稳定型心绞痛的疗效和安全性

目的:观察缬沙坦治疗不稳定型心绞痛（Unstable angina pectoris,UAP）的疗效及安全性。方法: 选择UAP患者120例，随机分为常规组（60例）和缬沙坦组（60例）。常规组:常规治疗，包括硝酸酯类药物、阿司匹林、β-受体阻滞剂及他汀类药物，连续服药6个月，缬沙坦组在常规治疗的基础上加缬沙坦80～160 mg，每天1次。观察治疗前后患者心绞痛临床症状的改善情况、心绞痛发作次数的改变、心电图ST段变化、血压变化及左心室肥厚的改变等情况。结果: 治疗后，常规组和缬沙坦组心绞痛临床症状明显缓解，发作次数减少，ST-T段压低减轻，左心室肥厚明显逆转（均P<0.05），缬沙坦组改善更显著（P<0.05），两组患者的血压均明显下降（P<0.05），但两组比较差异无统计学意义。结论: 在UAP常规治疗的基础上，加用缬沙坦，对UAP治疗的疗效、安全性及耐受性均好。     

静脉注射地尔硫治疗不稳定性心绞痛临床疗效观察

目的观察静脉地尔硫对不稳定性心绞痛（ＵＡＰ）患者的疗效与安全性。方法选择１５例严重且硝酸甘油疗效不好的ＵＡＰ患者，静注地尔硫１０～２０ｍｇ（０．２５ｍｇ／Ｋｇ体重）后，继以５～１０ｍｇ／ｈ维持４８小时。观察心绞痛症状，心电图及血流动力学变化，其中８例行漂浮导管检查。结果（１）１５例中１１例（７３．３％）ＵＡＰ患者静注地尔硫后约８．５±８．１分钟时，心绞痛症状缓解。与用药前４８小时内相比，开始用药４８小时后的心绞痛次数减少，每次最长持续时间明显缩短。（２）静脉地尔硫使１０／１５例的异常ＳＴ段恢复，３／１５明显改善。（３）静脉使用地尔硫后血压、心率降低，１０１５分钟起效，维持持续静滴的４８小时，尤其血压×心率值降低更为明显。（４）８例漂浮导管监测显示，静脉使用地尔硫中心静脉压（ＣＶＰ）短暂升高。（５）出现４例窦性心动过缓，１例一过性低血压，经处理后恢复。结论静脉地尔硫治疗对某些较顽固的ＵＡＰ有效，且相对安全。     

Combination treatment with trimetazidine and diltiazem in stable angina pectoris

Objective—To assess antianginal efficacy and possible adverse haemodynamic effects of combination treatment with trimetazidine and diltiazem in patients with stable angina.
Design—Double blind, randomised, placebo controlled trial of four weeks duration.
Setting—Outpatient department of two Indian hospitals.
Subjects—64 male patients with stable angina, uncontrolled on diltiazem alone.
Interventions—Diltiazem 180 mg and trimetazidine 60 mg, or diltiazem 180 mg and placebo daily.
Main outcome measure—Change in exercise time to 1 mm ST segment depression.
Results—33 patients (55%) had no exercise induced angina at 3 mm ST segment depression at inclusion in the study (silent ischaemia). Intention to treat analysis showed that of 32 patients in each treatment group, the number (%) of patients responding to trimetazidine compared to placebo was: for anginal attacks, 28 (87.5) v 15 (46.9), p < 0.001; for exercise time to 1 mm ST segment depression, 21 (65.6) v 9 (28.1), p < 0.003; for exercise time to angina, 12 (37.5) v 5 (15.6), p < 0.05; and for maximum work at peak exercise, 17 (53.1) v 8 (25), p < 0.02. Compared to placebo, there was net improvement with trimetazidine in mean anginal attacks of 4.8/week (95% confidence interval (CI) 7.5 to 2.1; p < 0.002); in mean exercise times at 1 mm ST segment depression of 94.2 seconds (95% CI 182.8 to 5.6; p < 0.05), and at onset of angina of 113.1 seconds (95% CI 181.6 to 44.6; p < 0.02); and in mean maximum work at peak exercise of 1.4 metabolic equivalents (95% CI 2.4 to 0.3; p < 0.05).
Conclusions—Patients with stable angina uncontrolled with diltiazem had a clinically important improvement after combination treatment with trimetazidine, without adverse haemodynamic events or increased side effects.

Keywords: trimetazidine;  diltiazem;  blood pressure;  stable angina;  treatment     

A comparative study of intravenous diltiazem and nitroglycerin in the treatment of unstable angina]

To compare the efficacy of intravenous diltiazem vs nitroglycerin in patients with unstable angina, we conducted a prospective, single blinded study enrolling 45 patients, 24 of them received diltiazem and 21 nitroglycerin. We considered drug failure if the patient experienced two or more anginal episodes or if one of them was longer than 30 minutes. There was a good response in 19 of 24 patients (79%) of the diltiazem group and 17 of 21 (81%) in the nitroglycerin group. Only one of the 5 non-response patients in the diltiazem group that was crossed to nitroglycerin was controlled, in opposition to the 4 patients crossed to diltiazem that were controlled all of them (p less than 0.05). Both drugs significantly (p less than 0.01) reduced systolic and diastolic blood pressure, but there was not difference between the two groups. Heart rate and double product decreased only in the diltiazem group (p less than 0.05). We did not find notorious side effects. We concluded that diltiazem is an alternative to nitroglycerin in patients with unstable angina.