急性心肌梗死和稳定型心绞痛血小板GPⅡb,GPⅢa动态变化的比较研究

目的：观察急性心肌梗死（ＡＭＩ）和稳定型心绞痛（ＳＡＰ）血液中血小板表面糖蛋白ＧＰⅡｂ和ＧＰⅢａ的动态变化,探讨急性心肌缺血前、后血小板的活性。方法：６１例住院的心病患者,其中ＡＭＩ３２例,ＳＡＰ２９例,采用竞争性酶联免疫方法比较ＡＭＩ及ＳＡＰ患者发病后２４ｈ,第２天、第３天、１财２周时血中血汀反ＧＰⅡｂ和ＧＰⅢａ的含量动态变化,并进行统计学分析,结果：ＳＡＰ组ＧＰⅡｂ和ＧＰⅢａ在上述５个时间段分     

梗死前心绞痛发作对急性心肌梗死近期预后的影响

目的：评价急性心肌梗死发病前４８小时内的心绞痛发作对急性心肌梗死近期预后的影响。方法：将８７１例急性心肌梗死前４８小时内有心绞痛组３７８例,梗死前无心绞痛４９３例,对两组住院期间的并发症和病死率进行比较分析,结果：发生心绞痛组的心肌梗死范围较小,住院期间病率、心力衰竭、心源性休克、室速的发生率均低于梗死前无心绞痛组。末溶栓组和溶栓未再通组,梗死前有心绞痛发作者的近期预后较无心绞痛者好,而两组溶栓冠     

A comparison of nisoldipine and nifedipine, in combination with atenolol, in the management of myocardial ischaemia

The effects of the addition of slow-release nifedipine 20 mgtwice daily and nisoldipine 10 mg twice daily to atenolol monotherapywere compared in a double-blind placebo-controlled study of24 patients with chronic stable angina pectoris. Neither nisoldipinenor nifedipine was associated with significant subjective benefitat these doses. Two hours post-dosing, exercise capacity improvedafter both nisoldipine (duration+37 s, P<0.01; time to angina+67s, P<0.01; time to sign ST depression+60 s, P<0.01) andnifedipine (duration +21 s, ns; time to angina+56 s, P<0.05;time to significant ST depression+49 s P<0.05) However, thisimprovement was not maintained 12 h post-dosing. Ambulatorymonitoring did not demonstrate a sign reduction in the amountof silent or total ischaemia following the addition of eithernifedipine or nisoldipine to atenolol monotherapy. There wasno significant difference between nifedipine and nisoldipinein any parameter tested. In conclusion, like slow-release n 20 mg, the effective durationof anti-ischaemic action of nisoldipine 10 mg is less than 12h. Since several patients experienced vasodilatory unwantedeffects, more frequent administration rather than larger individualdoses may be desirable to achieve a clinical response.     

The effects of nisoldipine on the total ischaemic burden: the results of the ROCKET study

This study was designed to examine the effects of nisoldipine(relative to placebo), a new dihydropyridine calcium entry blockingagent, in the treatment of silent ischaemia in conventionaldoses. A total of 409 patients with proven coronary artery diseasewere screened and of this 64 had at least six episodes or atotal duration of 30 mm of ST segment depression (1 mm lastingat least 1 min) over 48 h. Fifty-two patients ultimately completeda randomized double-blind cross-over study comparing nisoldipine5 mg twice a day, nisoldipine 10 mg daily and placebo. There was a reduction in the ST segment integral and numberof episodes of ST segment depression when compared to placeboon treatment with nisoldipine 5 mg twice a day and nisoldipine10 mg daily. However, the confidence limits were wide and crossedthe no-treatment effect line. In addition, the nisoldipine dosesneither affected the circadian distribution of ischaemic episodesnor caused an alteration of the workload achieved either atpeak exercise or at 1 mm ST segment depression measured 24 hafter nidoldipine 10 mg or 12 h after nisoldipine 5 mg. We conclude that frequent silent ischaemia in patients withproven coronary artery disease is relatively uncommon, it accountsfor approximately 16% of patients with positive exercise. Inthese patients nisoldipine, given as 5mg twice a day and 10mg daily, showed no significant therapeutic effects, eitheron the frequency or severity of silent ischaemia. New formulationsof slow release nisoldipine are consequently being developedso that a fuller 24 h therapeutic profile may be obtained.     

Effect ofβ-adrenergic blockade on haemodynamic responses to dynamic and isometric exercise in angina pectoris

Summary The effect of treatment for 1–4 weeks with metoprolol, a ₁-selective blocking agent, or alprenolol, on the heart rate and blood pressure response to isometric exercise was studied in two groups of 12 patients with angina. Measurements were made during the peak effect of metoprolol 10, 40 or 50 mg, and alprenolol 200 mg as Aptin^® Durules^®. After 1 min of sustained handgrip at 50% of maximal voluntary contraction, systolic (6–15%) and diastolic (8–12%) blood pressure after both drugs was significantly lower than without any -blockade; Heart rate was decreased by 19–22% by metoprolol but not by alprenolol. The blood pressurerise during handgrip was not attenuated by either drug. The rise in heart rate was significantly reduced (by 36–50%) by metoprolol 40 and 50 mg and alprenolol 200 mg. No patient experienced angina during handgrip. In contrast, all but one were restricted by angina during bicycle exercise without treatment, at a level that produced the same increase in heart rate as the handgrip test, viz. 3 min at a load of 33 W). The cardiovascular response to sustained handgrip is too small to provide a useful challenge for determination of the anti-anginal efficacy of drugs. However, slight ECG changes of ischaemia did occur during handgrip, which were reversed by -blockade.     

小剂量尿激酶联合低分子肝素治疗不稳定心绞痛的疗效观察

目的针对不稳定型心绞痛(UA)的发病机理,比较小剂量尿激酶(UK)联合低分子肝素(LMWH)与常规方法联合LMWH治疗UA的疗效,以探讨治疗UA的合理方案。方法采用随机分组,对照小剂量UK联合LMWH组及常规治疗联合LMWH组的疗效。结果采用小剂量UK联合LM-WH组比常规治疗联合LMWH组能更快控制症状(P<0.05),无明显副作用,近期疗效确切,但两组的有效率差异无显著意义(P>0.05),故仍是一种价-效比适合的方案。结论在目前介入疗法普及率有限的情况下,在基层医院尤其适用,并为有条件的患者赢得时间。     

低分子肝素阿魏酸钠治疗不稳定型心绞痛

目的 了解低分子肝素与阿魏酸钠联合应用治疗不稳定型心绞痛的疗效，提高不稳定型心绞痛治疗效果。方法 选用本院治疗的120例病人，治疗组60例．对照组60例，对照组以静脉滴注二硝酸异山梨酯为主。治疗在对照组治疗基础上，采用低分子肝素5000U皮下注射，每日2次，连续7d，阿魏酸钠0．3加入5％葡萄糖液中缓慢滴注，1日1次，连用14d为一疗程。两组对比了心绞痛控制，心绞痛缓解和消失时间及心电图变化及治疗前后纤维蛋白原血浆比黏度等情况。结果 治疗组在心绞痛控制，心绞痛缓解和消失时间及心电图变化及血液比黏度，纤维蛋白原等情况，明显优于对照组。结论 低分子肝素联合阿魏酸钠治疗不稳定型心绞痛疗效显著。     

黄芪合丹参粉针剂治疗冠心病心绞痛40例

[目的]观察黄芪合丹参粉针剂治疗冠心病心绞痛的临床疗效。[方法]80例患者随机分为治疗组、对照组各40例，治疗组给予5％葡萄糖注射液250mL，加入黄芪注射液40mL，(10mL／支，相当于黄芪2g／mL)，静点，1次／d，再予5％葡萄糖注射液250mL，加入丹参粉针剂0．8g，静脉点滴，1次／d；对照组只给予后者。两组疗程均为14d。治疗期间原用扩张冠状动脉药物不变。每天记录心绞痛发作程度、次数、持续时间及药物不良反应，治疗前后测血、尿、便常规，肝、肾功能，并作血液流变学及心电图检查。[结果]治疗组、对照组总有效率分别为92．5％、75％。在缓解心绞痛症状、心电图疗效、改善血液流变学指标等方面治疗组均优于对照组，且治疗组没有明显不良反应。[结论]黄芪合丹参粉针剂用于治疗冠心病心绞痛疗效显著，可靠，且无明显副作用。     

麝香保心丸治疗冠心病心绞痛临床疗效观察

目的 :观测麝香保心丸治疗冠心病心绞痛的疗效。方法 :将 2 0 0例冠心病心绞痛的患者随机分析治疗组 12 0例 ,对照组 80例 ,治疗组口服麝香保心丸 ,每次 2片 ,每日 3次 ,对照组口服单硝酸异酯脂 ,每次 2 0mg ,每日 2次。 结果 :麝香保心丸可显著改善冠心病心绞痛临床症状 ,显著改善心电图 ,缺血总面积。总的症状疗效 :治疗组为 83% ,对照组为6 1% ,(P <0 .0 5 ) ,心电图疗效 :治疗组为 74 % ,对照组为 4 6 % (P <0 .0 5 )。结论 :麝香保心丸治疗冠心病心绞痛优于单硝酸异山梨酯。     

不稳定性心绞痛应用他汀类药物临床观察

目的 :探讨洛伐他汀对不稳定性心绞痛 (UA)患者的血脂、心脏缺血事件发生情况的影响。方法 :将UA患者72例分为治疗组和对照组各36例 ,观察用药前后总胆固醇 (TC)、甘油三酯 (TG)、心脏缺血事件发生频率。结果 :治疗组用药后血TC和TG明显下降 ,t分别5.32和5.23(P<0.01) ,治疗组的心脏缺血事件发生率也较对照组明显下降 ( χ2=4.93 ,P<0.05)。结论 :UA患者早期长期应用他汀类药物可明显降低心脏缺血事件的发生