地尔硫[艹卓]注射液治疗老年人非心脏手术后高血压的临床应用

目的观察地尔硫[艹卓]注射液治疗老年人非心脏手术后高血压的疗效及安全性。方法采用随机、对照方法将58例老年非心脏手术后高血压患者分为地尔硫[艹卓]组（n=30）与硝酸甘油组（n=28），分别用地尔硫[艹卓]注射液与硝酸甘油注射液治疗，剂量分别为5～15μg／（min·kg）和5～15μg／min。观察用药前及用药后30、60、120min各血压及心率变化。结果地尔硫[艹卓]组与硝酸甘油组血压均显著下降，总有效率分别为80％和82．1％，组间差异无统计学意义（P〉0．05），不良反应轻。结论地尔硫[艹卓]治疗老年人非心脏手术后高血压安全、有效，与硝酸甘油相似，而在降低心率作用方面更优于硝酸甘油。     

地尔硫卓注射液治疗高血压急症的疗效观察

目的观察地尔硫卓注射液治疗高血压急症的疗效和安全性。方法采用随机对照方法将72例高血压急症患者分为地尔硫卓组(38例)与硝普钠组(34例),分别用地尔硫卓注射液和硝普钠注射液治疗,剂量分别为5～15μg.kg-1.min-1和10～30μg/min。观察两组用药前与用药后60min血压和心率变化。结果地尔硫卓组与硝普钠组血压均显著下降,总有效率均为100%,两组间比较差异无统计学意义(P0.05)。结论地尔硫卓治疗高血压急症安全、有效,与硝普钠相似,而在降低心率作用方面更优于硝普钠。     

地尔硫卓注射液治疗老年人非心脏手术后高血压的临床应用

该文观察地尔硫卓注射液治疗老年人非心脏手术后高血压的疗效及安全性。方法:采用随机、对照方法将58例均有高血压病史的老年非心脏手术患者当天或术后第1天并发血压升高。入选标准收缩压≥160     

地尔硫卓对急性非ST段抬高型心肌梗死患者的疗效

目的比较硝酸甘油与地尔硫卓在治疗非ST段抬高型心肌梗死(NSTEMI)中的疗效与安全性。方法选取2016年1月-2016年12月于我院确诊为NSTEMI患者100例,随机分为硝酸甘油组(对照组,n=50)和地尔硫卓组(试验组,n=50),比较两组患者治疗前后的临床效果、心功能指标并评估其安全性。结果地尔硫卓组缓解缺血性胸痛及改善缺血性ST-T明显优于对照组(P0.05)。治疗后地尔硫卓组心率、脑钠肽(NT-pro BNP)、左室收缩末期内径(LVEDD)明显低于对照组(P0.05),左室射血分数(LVEF)明显高于对照组。治疗期间两组不良事件发生情况无统计学差异(P0.05)。结论对NSTEMI患者,地尔硫卓能显著缓解缺血性胸痛、改善心功能,疗效显著、安全可靠,可代替硝酸甘油作为早期抗缺血治疗的首选药物。     

盐酸地尔硫革与乌拉地尔治疗高血压急症的对比研究

目的：观察微泵静脉推注盐酸地尔硫革或乌拉地尔治疗高血压急症对血浆N-末端B型利钠肽原（NT—proBNP）及血压、心率的影响。方法：67例高血压急症患者随机分为盐酸地尔硫革组（n=34）和乌拉地尔组（n=33）。盐酸地尔硫革组用盐酸地尔硫革（合贝爽）100mg溶于0．9％氯化钠注射液100ml中静脉泵入,速度为5～15μg·kg^-1·min^-1。乌拉地尔组选用乌拉地尔（亚宁定）100mg溶于0．9％氯化钠注射液100ml中静脉泵入,速度为2-8μg·kg^-1·min^-1。两组患者于治疗前、用药后2h、用药后8h采血检测血浆NT—proBNP,同时监测两组患者血压、心率变化。结果：两组患者血压较治疗前均明显降低。治疗前患者血浆NT—proBNP显著升高,用药后2h、8h两组患者NT—proBNP、心率均降低,且盐酸地尔硫革组较乌拉地尔组下降更明显。结论：盐酸地尔硫革和较乌拉地尔对治疗高血压急症降压效果相似,但盐酸地尔硫革在降低血浆NT—proBNP及减慢心率方面效果更显著。     

地尔硫卓治疗非ST段抬高型急性冠状动脉综合征难治性心肌缺血的疗效分析

目的研究地尔硫卓静治疗非ST段抬高型急性冠状动脉综合征难治性心肌缺血(NSTEACS-RMI)的临床疗效。方法选择2012年1月~2015年12月于广州市番禺区第二人民医院内科接受治疗的老年NSTEACS-RMI患者124例,按照随机数字表法分为地尔硫卓组(n=64)与对照组(n=60),对照组患者给予阿司匹林、低分子肝素、氯吡格雷、血管紧张素转化酶抑制剂、倍他乐克及他汀类降酯药物等常规药物治疗,地尔硫卓组行常规治疗联合地尔硫卓治疗。治疗7 d后观察两组治疗前后血压、心率、胸痛频率及每次持续时间、心肌缺血程度及范围(以NST表示常规12导联ST段压低在0.2m V以上导联数;以∑ST表示12导联ST段压低之和),NST、∑ST以飞利浦TC30心电图机检测、以美国PI AECG系统检测心率变异性(HRV),记录传导阻滞、心动过缓、心力衰竭、心律失常等不良反应及评估临床疗效。结果治疗后,地尔硫卓组血压、心率、胸痛频率及每次持续时间、含服硝酸甘油次数、NST、∑ST均低于对照组,差异有统计学意义(P均0.05)。治疗后,地尔硫卓组各心率变异性指标均较对照组显著改善,差异有统计学意义(P均0.05)。地尔硫卓组总有效率(90.63%)高于对照组(61.67%),差异有统计学意义(P0.05)。地尔硫卓组不良反应发生率(6.25%)与对照组不良反应发生率(1.56%)比较,差异无统计学意义(P0.05)。结论地尔硫卓可显著改善NSTEACS-RMI患者心肌缺血状态,改善临床症状,不良反应发生率低,值得应用于临床。     

盐酸地尔硫(艹卓)与乌拉地尔治疗高血压急症的对比研究

目的:观察微泵静脉推注盐酸地尔硫革或乌拉地尔治疗高血压急症对血装N-末端B型利钠肤原(NT- proBNP)及血压、心率的影响.方法:67例高血压急症患者随机分为盐酸地尔硫革组(n=34)和乌拉地尔组(n=33).盐酸地尔硫革组用盐酸地尔硫革(合贝爽)100 mg溶于0.9%氯化钠注射液100 ml中静脉泵入,速度为5...     

地尔硫卓注射液治疗老年人非心脏手术后高血压的临床应用

该文观察地尔硫卓注射液治疗老年人非心脏手术后高血压的疗效及安全性。方法：采用随机、对照方法将58例均有高血压病史的老年非心脏手术患者当天或术后第1天并发血压升高。入选标准收缩压≥160mmHg和（或）舒张压≥95mmHg，时间超过1h或血压持续高于基础水平50mmHg，出现心脑缺血有关症状，如心悸、气急、头晕、头痛等，排除合并心、肝、肾功能不全患者。     

卡维地洛与地尔硫Zhuo对X综合征伴冠状动脉血流储备异常患者疗效的对比研究

目的比较卡维地洛与地尔硫(卓)对伴冠状动脉血流储备减低心脏X综合征患者的疗效.方法 30例心脏X综合征且冠状动脉血流储备减低患者随机接受卡维地洛(15例,卡维地洛组)或地尔硫治疗(15例,地尔硫组),随访治疗3个月后的临床情况并复查平板运动试验.结果用药后两组平板运动试验到达终点时间明显延长[卡维地洛组(7.2±1.2), min和(5.4±0.8) min;地尔硫(卓)组(5.3±1.8) min和(4.6±1.1) min,P均<0.05].卡维地洛组用药后临床胸痛(用药前后分别为15例和5例,P=0.001)、平板运动试验阳性(用药前后分别为15例和6例,P=0.001)显著减少;与地尔硫(卓)组比较,卡维地洛组平板运动试验中血压心率乘积减小(175±19和196±19,P<0.05),到达运动终点时间显著延长[(7.2±1.2)min和(5.3±1.8) min,P<0.05].结论卡维地洛能提高心脏X综合征患者的运动耐量,且较地尔硫(卓)更为有效.     

比索洛尔、地尔硫卓治疗老年单纯性收缩期高血压的疗效观察

目的比较比索洛尔、地尔硫卓治疗老年单纯性收缩期高血压的降压疗效和安全性。方法将128例老年单纯性收缩期高血压病人随机分为比索洛尔组43例、地尔硫卓组45例、硝苯地平控释片组40例,均治疗6周,与硝苯地平控释片进行比较,观察比索洛尔及地尔硫卓的降压达标率。结果 3组治疗后血压、心率均低于治疗前(P 0.05),比索洛尔组、地尔硫卓组治疗后血压、心率低于硝苯地平组(P 0.05)。治疗第2周时,地尔硫卓组血压达标率为9.2%,比索洛尔组达标率为9.9%,均低于硝苯地平组(22.2%),差异有统计学意义(P 0.05)。比索洛尔组和地尔硫卓组血压控制不达标的病人加用硝苯地平控释片联合治疗后,血压达标率上升。治疗2个月后,比索洛尔组、地尔硫卓组收缩压达标率为52.1%、55.6%,低于硝苯地平缓释片组(58.3%),但差异无统计学意义(P0.05)。结论以比索洛尔及地尔硫卓为基础的降压治疗均能使老年单纯性收缩期高血压病人收缩压及舒张压显著下降,比索洛尔及地尔硫卓缓释剂单一治疗临床疗效劣于硝苯地平控释片。     

地尔硫对主动脉夹层合并重度高血压的急诊内科处理23例分析

目的评价静脉使用地尔硫对主动脉夹层合并重度高血压的急诊处理效果。方法对23例主动脉夹层患者给予静脉使用地尔硫,观察用药前和用药后5、10、20、30、60、120 min、6h的心率和血压变化。结果患者在用药后,血压明显下降,心率明显减慢,原有症状缓解,总有效率为87%。未见明显不良反应。结论地尔硫不良反应少,能快速降低血压、减慢心率,可用于主动脉夹层急诊处理。     

Efficacy, electrocardiographic and renal effects of intravenous diltiazem for essential hypertension

The acute systemic blood pressure, electrocardiographic and renal function responses to an intravenous bolus infusion of diltiazem (0.2 to 0.5 mg/kg) were evaluated in 18 subjects with mild to moderate essential hypertension. Although a significant blood pressure response occurred within 5 minutes, blood pressure returned to pretreatment levels within 1 to 3 hours. After drug infusion, a variety of rhythm and conduction disturbances were noted; the most important were transient prolongation of the PR Interval (first-degree atrioventricular block), a single episode of second-degree atrioventricular block (Mobitz I) associated with T-wave inversion and a transient episode of junctional escape rhythm and atrioventricular dissociation. Intravenous diltiazem had no consistent effect on glomerular filtration rate or effective renal plasma flow. Natriuresis and kaliuresis were observed only at the highest infusion dose. It is concluded that an alternative dosing regimen will be required if intravenous diltiazem is to be used safely and effectively to control blood pressure in patients with hypertensive disease.     

Acute effects of diltiazem in pulmonary hypertension secondary to chronic obstructive bronchitis

The effect of acute i.v. administration of diltiazem on pulmonary haemodynamics was compared to that produced by oxygen in 10 hypoxemic patients with chronic obstructive lung disease and pulmonary hypertension (PAPm greater than 20 mmHg), without left ventricular dysfunction. Determinations were carried out at baseline, during 100% oxygen inhalation, at least 20 minutes after oxygen withdrawal and 15 minutes after i.v. diltiazem loading dose of 0.25 mg/kg followed by the infusion of 1 mcg/kg/min. Oxygen inhalation produced no significant modifications of haemodynamic variables, whilst a significant (p less than 0.05) decrease of PAPm, pulmonary arteriolar resistance (PAR) and peripheral resistance (TPR) was observed after diltiazem administration (respectively 14%, 23% and 11.6%). Heart rate, cardiac index and blood pressure did not change significantly even with diltiazem. These results could support the inclusion of diltiazem in the therapeutic regimen of pulmonary hypertension due to chronic obstructive lung disease, but further investigations are needed to clarify the predictive value of its acute administration in assessing long term efficacy.     

氨氯地平和硫氮酮缓释片联合治疗对单纯收缩期高血压患者动脉弹性功能及尿蛋白的影响

目的:探讨氨氯地平(络活喜)与硫氮草酮缓释片(合贝爽)联合治疗对单纯收缩期高血压(ISH)患者血压、动脉弹性功能、尿蛋白的影响.方法:选取74例单纯收缩期高血压患者,分别用氨氯地平(氨氯地平组,5 mg早晨一次,n=25)、硫氮草酮缓释片(硫氮草酮缓释片组,90 mg每日2次,n=23)、氨氯地平和硫氮草酮缓释片联合治疗组(氨氯地平5 mg早晨一次+硫氮酮缓释片90 mg每日2次,n=26例)治疗8周,观察治疗前后血压,大小动脉弹性功能指数(C1、C2),尿α1-微球蛋白、尿微量白蛋白的变化.结果:氨氯地平组、硫氮革酮缓释片组及联合治疗组治疗8周后均能显著地降低单纯收缩期高血压患者的血压水平,与治疗前比较差异有统计学意义(P＜0.05);联合治疗组较氨氯地平组及硫氮草酮缓释片组更显著降低患者的收缩压水平和脉压差,差异有统计学意义(P＜0.05).三组治疗8周后均可明显降低单纯收缩期高血压患者的尿α1-微球蛋白、尿微量白蛋白水平,改善患者大小动脉弹性功能指数,与治疗前比较差异有统计学意义(P＜0.05);联合治疗组较氨氯地平组及硫氮草酮缓释片组更显著,差异有统计学意义(P＜0.05).收缩压、舒张压和脉压差与大动脉弹性功能指数呈负相关(P＜0.05),而与小动脉弹性功能指数无相关性;治疗后尿蛋白的下降程度与动脉弹性功能指标呈正相关(P＜0.05),但尿蛋白的下降幅度与血压变化之间的相关性无统计学意义.结论:氨氯地平和硫氮草酮缓释片联合治疗在控制单纯收缩期高血压患者收缩压,降低尿α1-微球蛋白、尿微量白蛋白,改善动脉弹性功能方面均具有协同作用.     

Diltiazem in hypertensive patients with type II diabetes mellitus

Twenty-three patients with essential hypertension and diabetes mellitus type II were treated with the calcium antagonist diltiazem (120 to 180 mg twice daily). The mean dose was 307 mg/day. The study was a double-blind, placebo-controlled, crossover design. All measurements were performed 12 to 14 hours after drug intake. Blood pressure, heart rate and forearm blood flow were measured noninvasively. Platelet function was studied by measuring adenosine diphosphate-induced platelet aggregation and the platelet specific proteins, beta thromboglobulin and platelet factor 4. Thromboxane B2 formation in serum and the plasma concentration of diltiazem and its metabolites N-demethyldiltiazem, deacetyldiltiazem and N-demethyldeacetyldiltiazem were measured both during placebo and diltiazem treatment. Diabetic control was evaluated by following HbA1C, fasting blood glucose and urinary glucose. Diltiazem reduced both systolic and diastolic (supine and standing) blood pressure significantly. Forearm blood flow was significantly increased by 32%, p less than 0.05. Supine heart rate decreased significantly, while no such change was seen in the standing position. No significant changes were observed in platelet function during diltiazem treatment. There was no relation between the observed blood pressure reduction and the plasma concentration of diltiazem or its metabolites. A positive correlation between the change in heart rate and the metabolite N-demethyldeacetyldiltiazem was observed (r = 0.647, p = 0.005). Three patients were excluded during diltiazem treatment (skin exanthema, headache and atrial fibrillation) and 1 during placebo treatment (angina pectoris). No negative effect on diabetes control was observed. Thus, diltiazem could be used for treatment of hypertension in diabetic patients.     

Effects of diltiazem on long-term outcome after acute myocardial infarction in patients with and without a history of systemic hypertension. The Multicenter Diltiazem Postinfarction Trial Research Group

The effect of diltiazem on long-term outcome in patients with acute myocardial infarction with and without a history of systemic hypertension was investigated in 2,466 patients using the Multicenter Diltiazem Postinfarction Trial data-base. The baseline variables were comparable in the diltiazem and placebo-treated patients within the groups with and without hypertension. The initial 60-mg dose of diltiazem was associated with a significant (p less than 0.001) but modest (3%) reduction in blood pressure and heart rate in both groups with and without hypertension. Univariate and multivariate analyses revealed a meaningful overall reduction in first recurrent cardiac events (cardiac death or nonfatal reinfarction, whichever occurred first) and cardiac death in patients with hypertension treated with diltiazem compared with results in those treated with placebo. Similar effects were not observed in patients without a history of hypertension. When first recurrent cardiac events were used as the end point, the diltiazem:placebo hazard ratio (95% confidence limits) was 0.77 (0.58, 1.01) for the total hypertension group, and 0.67 (0.47, 0.96) and 1.32 (0.83, 2.10) for patients with hypertension with and without pulmonary congestion during the acute infarction, respectively. Similar results were observed using cardiac death as the end point. Beta blockers had a negligible effect on the hypertension-diltiazem relation. These findings suggest that diltiazem may exert a long-term beneficial effect in most patients with hypertension who do not have pulmonary congestion during an acute infarction, and a detrimental effect in the minority who have pulmonary congestion.     

地尔硫(艹卓)缓释胶囊治疗维持性血液透析患者顽固性高血压的疗效研究

目的观察地尔硫缓释胶囊治疗维持性血液透析患者并发顽固性高血压的临床疗效。方法将38例长期维持性血液透析患者随机分为对照组和治疗组,治疗组在对照组常规降压治疗基础上,每日清晨加用地尔硫缓释胶囊,治疗6个月,观察治疗期间血压、心率、生化指标及药物不良反应。结果治疗组血压明显下降,总有效率达78.9%,与对照组比较,差异有统计学意义(P<0.05);不良反应与对照组比较,差异无统计学意义(P>0.05)。结论慢性维持性血液透析患者应用地尔硫缓释胶囊治疗顽固性高血压安全有效,患者耐受性好,不良反应少。     

Hemodynamic effects of intravenous diltiazem in hypoxic pulmonary hypertension

The short-term effects of intravenously administered diltiazem on pulmonary and systemic hemodynamics were evaluated in patients with hypoxic pulmonary hypertension. Twelve patients were randomly assigned to two groups in a double-blind fashion. One group (eight patients) received diltiazem, and the other group (four patients) received a placebo. Three increasing doses of diltiazem (0.2, 0.3, and 0.4 mg/kg of body weight) were injected into each patient, followed each time by an infusion (2 micrograms/kg/min, 3 micrograms/kg/min, and 4 micrograms/kg/min). The effects of the drug were also compared with those of oxygen, and the combined effect of high oxygen and diltiazem was tested. The mean plasma concentrations of diltiazem were, successively, 64 +/- 4, 158 +/- 19, and 267 +/- 40 ng/ml with the three increasing doses. There was no significant effect of diltiazem on the pulmonary vascular resistance even when given with oxygen. Diltiazem was well tolerated even at high doses. The arterial oxygen pressure, systemic oxygen supply, and oxygen consumption were unchanged. We conclude that diltiazem does not seem to decrease acutely hypoxic pulmonary vasoconstriction in patients with chronic hypoxia; however, diltiazem may be given safely to these patients for other indications, such as angina pectoris.