曲美他嗪对稳定性劳力型心绞痛的疗效观察

目的 :观察曲美他嗪 (Trimetazidine)联合传统疗法对冠心病 (CHD)稳定性劳力型心绞痛患者抗心绞痛的疗效和安全性。方法 :将 12 0例确诊的稳定性劳力型心绞痛患者 ,随机分为 A组和 B组各 6 0例 ,两组均予传统疗法治疗 ,B组加服曲美他嗪 2 0 mg,3次 / d,疗程均为 12周。观察全组病例治疗前后每周心绞痛发作次数、基础心率、运动诱发心绞痛所需时间、运动至 ST段压低 1mm所需时间及运动持续时间。结果 :B组治疗前后自身比较每周心绞痛发作次数、运动诱发心绞痛所需时间、运动至 ST段压低 1mm所需时间及运动持续时间均有显著统计学差异 (P<0 .0 1) ,治疗后组间比较运动诱发心绞痛所需时间 B组明显优于 A组 (P<0 .0 1) ;每周心绞痛发作次数、运动至 ST段压低 1mm所需时间及运动持续时间 B组明显优于 A组 (P<0 .0 5 )。结论 :曲美他嗪联合传统疗法对稳定性劳力型心绞痛患者抗心绞痛的疗效优于单纯用传统药物治疗     

虾青素对储存去白悬浮红细胞内抗氧化酶活性的影响

目的:观察抗氧化剂虾青素(ASTA)对储存去白悬浮红细胞内超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)等抗氧化酶系活性的影响。方法:去白悬浮红细胞随机分为A、B、C、D 4组,B、C、D组悬浮红细胞保存液内加入ASTA,其终浓度分别为5、10和20μmol/L,A组只加入ASTA的溶解液DMSO。去白悬浮红细胞储存至d 7、14、28和42时,荧光酶标仪测定红细胞内活性氧族(ROS)含量,硫代巴比妥酸比色法测定细胞内丙二醛(MDA)含量,黄嘌呤氧化酶法测定SOD活性,可见光法测定CAT活性,比色法测定GSHPx活性。结果:储存至d 7、14、28和42时,B、C、D组悬浮红细胞内ROS和MDA含量均明显低于A组(P 0.05),SOD活性、GSH-Px活性均明显高于A组(P 0.05);储存至d 28和42时,CAT活性均明显高于A组(P 0.05)。A、B、C、D 4组去白悬浮红细胞内ROS含量、MDA含量与储存时间均呈正相关关系(P 0.01),SOD活性、CAT活性、GSH-Px活性与储存时间均呈负相关关系(P 0.01)。结论:ASTA通过提高去白悬浮红细胞内抗氧化酶系活性来降低细胞内氧化应激水平和过氧化损伤程度。     

平板运动试验心电图阳性各时段QTd和QTcd观察

目的 观察平板运动心脏负荷试验诱发患者心电图ST段缺血型改变时QT离散度(QTd)和校正QT离散度(QTcd).方法 选掸临床疑诊为冠心患者进行平板运动负荷心电图试验,诱发心电图ST段呈缺血型下移者35例(缺血组),测量运动前、运动后缺血型ST段下移达最大值时及运动后ST段恢复正常时QTd及QTcd,与平板运动负荷心电图ST段无缺血型改变者35例(正常组)进行对比研究.结果 缺血组在运动后ST段下移达最大值时QTd、QTcd分别为(57.60±11.74)及(76.62±9.35)ms,与运动前及运动后ST段恢复正常时的QTd、QTcd之间存在显著差异(P<0.01),与正常组运动后即刻QTd、QTcd对比同样存在显著差异(P<0.01),而正常组在运动前、运动后即刻及运动后6 min时QTd、QTcd无显著性差异(P>0.05).结论平板运动负荷试验诱发冠心病患者心电图ST段呈缺血型改变时QTd、QTcd明显增大.冠心病患者心肌缺血时存在心肌复极的不均一性和电的不稳定性,是导致严重室性心律失常和心脏猝死的独立危险因素.     

平板运动试验心电图阳性各时段QTd和QTcd观察

目的 观察平板运动心脏负荷试验诱发患者心电图ST段缺血型改变时QT离散度(QTd)和校正QT离散度(QTcd).方法 选掸临床疑诊为冠心患者进行平板运动负荷心电图试验,诱发心电图ST段呈缺血型下移者35例(缺血组),测量运动前、运动后缺血型ST段下移达最大值时及运动后ST段恢复正常时QTd及QTcd,与平板运动负荷心电图ST段无缺血型改变者35例(正常组)进行对比研究.结果 缺血组在运动后ST段下移达最大值时QTd、QTcd分别为(57.60±11.74)及(76.62±9.35)ms,与运动前及运动后ST段恢复正常时的QTd、QTcd之间存在显著差异(P<0.01),与正常组运动后即刻QTd、QTcd对比同样存在显著差异(P<0.01),而正常组在运动前、运动后即刻及运动后6 min时QTd、QTcd无显著性差异(P>0.05).结论平板运动负荷试验诱发冠心病患者心电图ST段呈缺血型改变时QTd、QTcd明显增大.冠心病患者心肌缺血时存在心肌复极的不均一性和电的不稳定性,是导致严重室性心律失常和心脏猝死的独立危险因素.     

壳聚糖对运动过氧化损伤的康复作用研究

目的 探讨补充壳聚糖对不同负荷运动大鼠骨骼肌自由基代谢的影响。方法 以 SD大鼠为实验对象，随机分成壳聚糖服用组和对照组。每大组群又分成安静组、一次性有氧运动组、一次性大强度运动组和连续运动组。处死后，测定比目鱼肌和腓肠肌的 SOD(超氧化物岐化酶 )MAD丙二醛。结果 1.比目鱼肌和腓肠在一次性有氧运动后即刻和一次性大强度运动后即刻， MDA值均较安静对照组有显著性升高 (P < 0.01)。 2.腓肠肌的脂质过氧化反应程度明显高于比目鱼肌；腓肠肌的 MDA与安静对照组相比高出 85.7％ (P< 0.01)。 3.连续运动＋服壳聚糖组的 MDA显著下降。结论 1.脂质过氧化加强，与运动强度有关。 SOD活性相对下降可能是运动后骨骼肌细胞脂质过氧化加强的原因之一。 2.不同骨骼肌脂质过氧化水平是不同的。 3.随着运动负荷加大，壳聚糖消除体内自由基的作用越明显。     

增强型体外反搏联合美托洛尔对老年不稳定型心绞痛患者SOD、VEGF水平及心电图ST段改变的影响

目的探讨增强型体外反搏联合美托洛尔对老年不稳定型心绞痛患者超氧化物歧化酶(SOD)、血管内皮生长因子(VEGF)水平及心电图ST段改变的影响。方法选取2018年2月至2020年2月于某院接受治疗的86例老年不稳定型心绞痛患者作为研究对象,按随机数字表分为观察组(增强型体外反搏联合美托洛尔治疗,43例)和对照组(美托洛尔治疗,43例),均治疗30 d。比较两组心电图ST段疗效及SOD、VEGF、一氧化氮(NO)水平。结果治疗30 d后,观察组心电图ST段疗效总有效率93.03%高于对照组的67.44%,NO、SOD水平均高于对照组,VEGF水平低于对照组,差异有统计学意义(P0.05)。结论增强型体外反搏联合美托洛尔能调节老年不稳定型心绞痛患者血液中SOD、VEGF水平,有助于心电图ST段回归正常水平,促进患者康复。     

缺血后处理对急性心肌梗死患者血清氧自由基的影响及意义

目的探讨缺血后处理对急性心肌梗死患者血清超氧化物歧化酶(SOD)、丙二醛(MDA)影响及临床意义。方法根据急诊经皮介入治疗术(PCI)是否设置心肌梗死后处理方式,将101 例急性ST段抬高型心肌梗死患者分为缺血后处理组(46 例)和常规PCI组(55 例),比较两组术后4 h、8 h、12 h、16 h、20 h、24 h、36 h 和48 h 血清SOD及MDA动态变化,比较两组PCI后心肌梗死溶栓(TIMI)血流、TIMI 心肌灌注分级(TMPG)、血清肌酸激酶同工酶MB(CK-MB)酶峰,术后10 d 核素心肌显像计分以及30 d 内心脏事件的发生率。结果与常规PCI 组比较,术后缺血后处理组血清SOD值明显升高(P<0.01),MDA值明显降低(P<0.001);SOD谷值明显增高(P<0.01),MDA峰值显著降低(P<0.001);TIMI 血流3 级和TMPG 3 级患者均增多(P<0.05);血清CK-MB峰值明显降低(P<0.01);心肌显像计分降低(P<0.05)。术后30 d 内缺血后处理组心脏事件发生率低于常规PCI 组(P<0.05)。结论急性ST段抬高型心肌梗死救治中,缺血后处理能升高PCI 术后血清SOD浓度,减少MDA产生,改善心肌灌注,减小梗死面积,改善患者预后。     

原花青素对脊髓损伤大鼠运动功能的影响

目的观察原花青素对脊髓损伤大鼠运动功能恢复的影响。方法健康成年SD大鼠36 只,采用Allen 法(250 g·mm)在T9复制急性脊髓损伤模型,分为A、B、C 3 组,每组12 只。造模型成功后30 min,A组腹腔注射原花青素40 mg/kg,B 组腹腔注射甲基强的松龙30 mg/kg,C 组腹腔注射等体积生理盐水。于术后1 d、3 d、7 d 对各组进行后肢功能BBB 评分、斜板试验,血清丙二醛(MDA)和超氧化物歧化酶(SOD)测定。结果BBB 评分和斜板试验结果均显示,术后3 d 和7 d,A、B 两组较C 组后肢运动功能恢复更好(P<0.05)。与C 组相比,A、B 两组术后1 d 和3 d SOD 活性升高,MDA 含量降低(均P<0.05);7 d 时,A 组较C 组SOD活性增高,MDA降低(P<0.05)。结论原花青素可有效抑制脂质过氧化反应,对脊髓损伤大鼠运动功能的恢复具有促进作用。     

运动试验中STc延长对诊断冠心病的临床意义

冠心病是常见病,为减少漏误诊,本文通过对近两年来临床资料完整的45例心绞痛患者及26例健康者做运动平板试验前后心电图ST段比较,旨在探讨ST段延长对诊断冠心病的临床价值。资料与方法1.一般资料:心绞痛(按WHO的冠心病临床诊断标准)患者45例(A组),均来自本院门诊或住院病人,其中男30例,女15例,年龄36～66岁,平均(51.2±4.6)岁。健康体检志愿者26例(B组),其中男19例,女7例,年龄37～65岁,平均(50.1±3.5)岁。本文对象均排除冠心病外的其他器质性心脏病及电解质等原因引起的ST段变化。A组患者均停用影响心电图变化的药物,5天后进行运动试…     

耳穴压丸对冠心病患者脂质过氧化的影响

目的：观察耳穴压丸对冠心病患者脂质过氧化的影响。方法：选取冠心病患者46例，分为对照组20例和耳穴组26例，均给予常规冠心病药物治疗，耳穴组同时加用耳穴压丸法治疗，将粘于胶布的王不留行籽贴压耳穴心、小肠、交感、内分泌及皮质下，患者每日自行按压4次，每5d换贴1次，历时60d。治疗前后分别检测2组患者的血清丙二醛（MDA）含量和超氧化物歧化酶（SOD）活性。结果：对照组治疗后血清MDA含量及SOD活性与治疗前比较差异无统计学意义；耳穴组治疗后与治疗前及对照组比较，血清MDA含量明显降低，SOD活性明显升高（均P〈0．05）。结论：耳穴压丸能提高冠心病患者抗氧化酶的活性，抑制脂质过氧化反应，对冠心病的治疗和康复具有明显的作用。     

A randomized, double-blind comparison of lercanidipine 10 and 20 mg in patients with stable effort angina: clinical evaluation of cardiac function by ambulatory ventricular scintigraphic monitoring

We evaluated the antiischemic action and the effects on left ventricular response to exercise of lercanidipine, a long-acting dihydropyridine calcium antagonist, in 23 patients with stable effort angina in a randomized, double-blind, parallel trial. Left ventricular function was assessed during upright bicycle exercise using an ambulatory radionuclide detector for continuous noninvasive monitoring of cardiac function. Exercise was performed under control conditions before (run-in placebo period) and after 2-week treatment with lercanidipine 10 or 20 mg once daily. During the placebo run-in period and at the study end, patients underwent clinical examination, ECG, exercise tests, ambulatory ventricular scintigraphic monitoring (VEST). Results showed that both drug doses increased time to onset of ST segment depression >/=1 mm and peak ST segment depression, with improvement of total exercise duration. Heart rate, blood pressure, and the rate-pressure product did not significantly change with respect to pretreatment value. The left ventricular ejection fraction, indicating contractility state of myocardium, was unchanged at rest and during exercise after both lercanidipine doses. In conclusion, lercanidipine is safe and effective in reducing ischemia in patients with stable effort angina without any deterioration of cardiac function.     

Improved left ventricular function after short-term treatment with fructose-1,6-diphosphate: echocardiographic study in chronic ischemic heart disease and idiopathic dilated cardiomyopathy

The effect of fructose-1,6-diphosphate (FDP) on left ventricular function was assessed in seven patients with chronic ischemic heart disease and eight patients with idiopathic dilated cardiomyopathy. In a crossover study design each patient received 10 gm of FDP or saline placebo intravenously for three days. An M-mode echocardiographic assessment of left ventricular (LV) function was made before and after each treatment period. After FDP treatment, LV end-diastolic and systolic dimensions showed a 6% reduction (P less than 0.01), while peak lengthening rate of LV dimension in diastole and peak shortening rate of LV dimension in systole increased 17% and 10%, respectively (P less than 0.05). There was evidence that FDP was more effective in the patients with ischemic heart disease than in the patients with cardiomyopathy.     

Effect of superhigh frequency electromagnetic fields and physical exercise on physical performance and extrasystole in myocardial ischemia patients with stable angina pectoris

AIM: To study impact of UHF electromagnetic fields in combination with bicycle exercise on muscular performance (MP) and extrasystole (ES) in IHD patients with stable angina of functional class 1 and 2 (SA). MATERIAL AND METHODS: The trial included 112 IHD patients with SA and ES. 36 of them were exposed to coursed electromagnetic fields (40 W, on heart area). The other 42 patients received the same treatment and exercised on bicycle ergometer. 34 patients received placebo procedures and did therapeutic exercises. The effect was assessed with spiroveloergometry and ECG Holter ambulatory monitoring. RESULTS: It was found that 40 W UHF electromagnetic fields in combination with exercise on veloergometer exert a training effect in IHD patients with extrasystole manifesting with higher physical performance and coronary heart reserve. The antiarrhythmic effect consisted in a significant daily fall in mean ventricular ES number by 48.2%, supraventricular EX by 54.8%. CONCLUSION: Combined application of 40 W UHF electromagnetic fields on heart area with bicycle exercise is effective in IHD patients with ES.     

Preliminary data on combined assessment of tolerance to exercise,left ventricular contractile function in ischemic heart disease patients taking bradycardic agents

AIM: To study effects of bradicardia induced by atenolol, diltiazem and ivabradin on exercise tolerance, myocardial perfusion and left ventricular contractile function in patients with stable angina pectoris. MATERIAL AND METHODS: The trial included 7 male patients aged 57 +/- 2.6 years with coronary heart disease, stable angina of functional class II free of cardiac failure and severe arterial hypertension, with a positive and reproducible VEM test after therapy discontinuation. For 10 consecutive days with 5-day intervals, all the patients received atenolol, diltiazem, ivabradin in doses lowering heart rate at rest by 20% from the initial level. Before the treatment all the patients were studied with VEM test, perfusion synchronized single-photon emission computerized tomoscintigraphy of the myocardium (PSSPECT) at rest and exercise. On day 10 of each drug intake PSSPECT and VEM test were performed if the expected heart rate was achieved. RESULTS: Each of the studied drugs resulted in a 22-24% reduction in the heart rate at rest accompanied by a significant rise in exercise tolerance, improvement of performance and myocardial perfusion. There were no significant changes in left ventricular contractility. CONCLUSION: A 20% reduction in resting heart rate due to monotherapy with drugs having a bradicardic effect leads to positive changes in exercise tolerance and myocardial perfusion.     

Effect of L-arginine on platelet aggregation, endothelial function adn exercise tolerance in patients with stable angina pectoris

AIM: Examination of the action of donor NO (L-arginine) on platelet aggregation, endothelial function and exercise tolerance in patients with stable angina of effort (SAE). MATERIAL AND METHODS: 42 patients with SAE (functional class I-II) and 10 healthy volunteers (control group) were assigned to two groups. 22 patients of group 1 were randomized to cross-over. They received cardiket (60 mg/day for 10 days or cardiket (60 mg/day) in combination with L-arginine (15 g/day for 10 days). 20 SAE patients of group 2 and control group received L-arginine (15 g/day for 10 days). In each group blood lipids were examined, and bicycle exercise test (BET) was performed. In addition, platelet aggregation and endothelial function were studied in group 2 and control group before and after the course of L-arginine. RESULTS: Compared to control group, endothelial function significantly improved in group 2 (from 5.0 +/- 2.9 to 7.8 +/- 4.1% vs 7.1 +/- 1.9 to 6.6 +/- 4.8%) (M +/- SD). BET duration increased in all the patients. After ADP addition in concentrations 1.5, 2.0, and 5.0 micromol/l platelet aggregation declined in 17 patients except 3 in whom the aggregation remained unchanged. CONCLUSION: Positive effect of L-arginine on endothelial function, exercise tolerance and platelet aggregation was observed in patients with stable angina of effort (functional class I-II). Therefore, arginine can be recommended as an adjuvant in the treatment of patients with ischemic heart disease.     

Trials with an adenosine analogue as antianginal medication.

The potential antianginal effects of orally administered ethyl-adenosine-5-carboxylate hydrochloride (EACH) were assessed in 9 patients with stable angina pectoris who underwent two standardized exercise tests for 3 consecutive days. The first daily exercise performed after placebo revealed no daily variation. The second test was preceded by placebo, 26 mg EACH or 33 mg EACH administered in a double-blind fashion with the use of crossover design. After the completion of the study in the first 6 patients, the 33-mg dose of EACH had to be discontinued because 3 patients had severe angina and another one had nausea and diffuse numbness after this dose. In the remaining 3 patients a 6-mg dose of EACH was used instead of 33 mg, after which the study was terminated because no difference could be determined. EACH, 26-mg and 6-mg, had no significant effect on resting and exercise heart rate, on blood pressure, on onset or duration of angina and positive-exercise electrocardiogram, or on exercise duration. Our study revealed that EACH had no potential antianginal effect and that at a dosage of 33 mg it may induce angina.     

Efficacy and Safety of Evening Administration of Controlled-Delivery Diltiazem Capsules in Chronic Stable Angina Patients

The safety and efficacy of controlled-delivery (CD) once-a-day formulation of diltiazem administered in the evening, at a dose of 240 mg, was assessed in 37 patients with stable angina pectoris. A double-blind, placebo-controlled, randomized, crossover protocol was used. Following a 4-day washout period, patients entered a 5--7-day single-blind placebo run-in period during which qualification and reproducibility exercise treadmill tests (ETTs) were performed 24 h postdose. Eligible patients were randomized in a double-blind fashion, to either CD diltiazem or to placebo for a 7--10-day treatment period. They then entered a 5--7-day single-blind washout period, after which they received the alternate treatment for another 7 to 10 days. ETTs were performed at the end of each treatment period. Compared to placebo, evening administration of CD diltiazem produced a marked improvement of the time to ETT termination, time to onset of angina, and time to 1 mm ST depression. In addition, the number of angina attacks recorded in patient diaries was reduced compared to placebo. Incidence of adverse events was comparable with CD diltiazem and placebo. We conclude that evening administration of controlled-delivery diltiazem is highly effective and safe in the treatment of stable angina pectoris.     

Efficacy of Nicardipine for Long-Term Therapy of Chronic Stable Angina

BACKGROUND: Although angina is a chronic disease, most clinical trials evaluating antianginal therapy are of a few weeks or months in duration. METHODS AND RESULTS: To evaluate the effects of nicardipine, a second-generation dihydro-pyridine calcium channel blocker, as long-term therapy, patients with chronic stable angina were treated for 1 year with open-label nicardipine. Anginal symptoms were controlled with 20 mg tid in 24%, 30 mg tid in 34%, and 40 mg tid in 42%. Of 72 patients completing the 1-year trial, only 14 (19%) had required the addition of long-acting nitrates for control of symptoms. The remaining 57 patients, who had anginal symptoms controlled with nicardipine alone, were continued into the 3-week, double-blind period and were randomized to continue their usual dose of nicardipine or placebo. Throughout the 1-year, open-label treatment period, the number of anginal episodes and exercise parameters of angina were significantly reduced with nicardipine. CONCLUSIONS: During the double-blind period, the patients who continued on nicardipine had significantly greater exercise time and time to onset of angina than patients who were randomized to placebo. The exercise parameters in the patients randomized to placebo were improved over baseline after 1 year of therapy; however, the improvement with nicardipine was significantly greater.     

Comparison of carvedilol and atenolol efficacy in patients with stable effort angina

AIM: To compare effectiveness of carvedilol--beta-adrenoblocker with vasodilating action--with atenolol which is beta-adrenoblocker having no vasodilating activity in coronary heart disease (CHD) patients with stable effort angina. MATERIAL AND METHODS: The trial entered 28 CHD patients with a history of myocardial infarction (MI). All the patients had no contraindications to beta-adrenoblockers, had positive exercise tolerance test. After the control period of 7-10 days the patients received either carvedilol (14 patients) or atenolol (14 patients) in a mean daily dose 20.5 mg (6.25 to 50 mg) and 25.9 mg (12.5 to 100 mg), respectively, twice a day. The course of the treatment took 4 weeks. The effect was evaluated at treadmill exercise test. RESULTS: Both drugs diminished heart rate, carvedilol was less effective in this respect. Both drugs significantly prolonged time of exercise to the anginal attack and ST depression by 1.0 mm. Side effects arose in 6 and 4 patients, respectively. CONCLUSION: Carvedilol and atenolol are equally effective in the treatment of stable effort angina.     

硝酸甘油联合血栓通治疗急性冠脉综合症对照研究

目的 评价硝酸甘油注射液联合血栓通注射液治疗急性冠脉综合症的临床疗效.方法 将120例急性冠脉综合症患者随机分为两组,每组60例,两组均给予硝酸甘油静脉滴注及常规治疗,治疗组联合血栓通注射液静脉滴注,观察14 d.观察两组心绞痛症状改善效果、发作次数、持续时间、心电图变化以及硝酸甘油用量,治疗前后血脂变化等.结果 治疗...