地尔硫(艹卓)在肺心病心房颤动伴轻、中度心衰治疗中的应用

目的：探讨地尔硫（艹卓）对慢性肺心病快速性房颤伴轻、中度心力衰竭（CHF）病人的疗效及安全性。方法：选择75例肺心病房颤伴轻、中度CHF病人，随机分为治疗组（37例），对照组（38例）。对照组给予常规治疗．治疗组在常规治疗的基础上加用地尔硫（艹卓）50-100gg／min静脉微泵维持6～8h，1次／d，疗程为1周。结果：有效率：治疗组92％，对照组为76％，两组有显著差异（P〈0．01）；房颠转为窦律：治疗组为73％，对照组为55％（P〈0．01）。治疗中未见明显副作用。结论；地尔硫（艹卓）可用于肺心病房颤伴轻、中度CHF病人的治疗，安全、有效。     

地尔硫卓缓解冠脉痉挛的临床疗效

目的：探讨地尔硫卓治疗冠脉痉挛的临床疗效及安全性。方法：选择我院的100例冠脉痉挛患者,按照抽签法随机均分为：常规治疗组（50例,予以调脂、扩冠等常规治疗）;地尔硫卓组（50例,在常规治疗基础上泵入地尔硫卓）,比较两组临床、心电图疗效及治疗前后一氧化氮（NO）,内皮素-1（ET-1）水平等的变化和安全性。结果：（1）与常规治疗组比较,地尔硫卓组临床治疗总有效率（60.00％比94.00％）、心电图总疗效（62.00％比92.00％）显著提高（P均＜0.01）;（2）两组治疗后心电图各项指标、心率、血压均较治疗前明显改善,且地尔硫卓组较常规治疗组改善更显著（P均＜0.05）;（3）地尔硫卓组治疗后血脂水平较治疗前及常规组治疗后有明显改善（P均＜0.05）;（4）与治疗前及常规治疗组比较,治疗后地尔硫卓组 NO 水平[（95.17±19.99）μmol/L、（95.17±21.22）μmol/L比（106.71±22.38）μmol/L]显著升高、ET-1水平[（64.09±16.29）ng/L、（59.98±14.28）ng/L比（44.91±6.38）ng/L]显著降低（P均＜0.05）;（6）两组治疗过程中,均未出现任何不良反应。结论：在常规药物治疗的基础上加用地尔硫卓治疗冠脉痉挛,疗效显著,安全性高,值得推广。     

快速型心房颤动患者静脉应用地尔硫卓和美托洛尔的疗效观察

目的 比较静脉注射地尔硫卓和美托洛尔控制心房颤动(简称房颤)患者快速心窒率的疗效.方法吉林人学第二医院2003年1月至2006年7月收治的48例心室率>120次/min 且收缩压≥100 mmHg的房颤患者分为地尔硫卓组(n=24)和美托洛尔组(n=24).地尔硫卓和美托洛尔的用法分别为10 nag和5 mg静脉注射.记录用药后5 min,10 min,15 min和30 min时的患者的心率和血压.治疗有效的定义为用药30 min后心室率下降至100次/min以下或较用药前的心率下降20%以上或转复为窦性心律.数据比较采用t检验、配对t检验及χ2检验.结果 和用药前比较,两种药物在上述各个时间点均能显著降低房颤时的快速心窒率(P<0.01),但除用药后30 min外,其它各时间点地尔硫卓组的心窒率显著低于美托洛尔组(P<0.05).在降低心室率的同时,这两种药物亦使血压有所降低,但两组之间的降压作用差异无统计学意义.两组均未见药物所敛的低血压者.用药后30min,地尔硫卓组和美托洛尔组的治疗有效率分别为91.7%和83.3%(P>0.05).结论 静脉注射地尔硫卓10 mg或荚托洛尔5 mg在30 min均能使房颤时的快速心室率显著降低,无以地而硫卓作用更强.     

地尔硫缓释剂对原发性高血压患者肾功能的影响

目的 :探讨地尔硫缓释剂对原发性高血压 (EH)患者肾功能的影响。方法 :6 2例 EH患者 (EH组 )随机分为两亚组 :A组 (地尔硫缓释剂组 )和 B组 (卡托普利组 ) ,疗程均为 10周。治疗前后观察肾功能指标变化。2 0例健康体检者作为对照组。结果 :1治疗前 EH组患者内生肌酐清除率 (Ccr)显著低于对照组 ,血尿 β2 -微球蛋白 (β2 - m)及尿白蛋白 (Alb)显著高于对照组 ,且上述指标改变程度与 EH的病程相关 ;2地尔硫缓释剂和卡托普利治疗 EH患者 ,可明显降低血压、血尿 β2 - m与尿 Alb,其中病程较长者下降幅度较大 ,B组尿 Alb降低程度 >A组 (P <0 .0 5 )。结论 :1EH患者早期即有肾功能损害 ,且随病程延长损害加重 ;2地尔硫缓释剂可保护 EH患者早期损害的肾功能 ,且病程较长者获益较大 ,其效果可能与卡托普利相似     

吲达帕胺、硫氮酮对缺血/再灌注心肌的保护作用

目的　采用离体大鼠心脏灌注模型 ,探讨吲达帕胺 (Indapamide)、硫氮酮 (Diltiazem)在心肌缺血 /再灌注过程中对心肌的保护作用。方法　SD大鼠 45只 ,随机分为吲达帕胺组、硫氮酮组、对照组 (灌注液中不含药物 )。比较三组动物在心肌缺血 30min及再灌注 30min后心电图、心肌酶 (CK、LDH) ,同时监测心功能指标的变化。结果　①对照组在心肌缺血 /再灌注后CK、LDH含量较缺血前明显升高 (P<0 0 5 )。吲达帕胺组、硫氮酮组在心肌缺血 /再灌注后心肌CK、LDH含量较对照组明显降低 (P <0 0 1)。②吲达帕胺组、硫氮酮组于再灌注 15、30min两时点 ,冠脉流量、心肌收缩力恢复百分比显著高于对照组 (P <0 0 5 )。结论　吲达帕胺、硫氮酮对缺血 /再灌注的心肌具有保护作用     

冠状动脉痉挛诱发心律失常的临床特点及治疗效果

目的探讨冠状动脉痉挛（CAS）诱发心律失常的临床特点及治疗效果。方法选择1998年7月至2008年12月期间入住本院的16例CAS患者,CAS的诊断根据病史和症状,结合标准12导联心电图、动态心电图及冠状动脉造影等检查确定。结果16例患者CAS发作时伴有心绞痛和心电图ST段抬高。全部病例均合并缓慢性和／或快速性心律失常,其中缓慢性心律失常6例,二、三度房室阻滞5例,窦性静止1例;快速性心律失常12例,其中持续性室性心动过速（室速）和心室颤动（室颤）5例,非持续性室速5例,室性早搏2例。冠状动脉造影显示,4例冠状动脉完全正常,4例冠状动脉狭窄等于或超过50％,其余8例冠状动脉狭窄均≤45％。全部病例均接受了大剂量钙拮抗剂和硝酸酯类的联合抗血管痉挛治疗。冠状动脉有明显狭窄的4例患者接受了介入治疗。除1例患者死亡外,其余患者平均随访（52．3±18．9）个月,无心绞痛及晕厥发作。结论有或无冠状动脉病变的CAS均可诱发缓慢性和／或快速性室性心律失常;除针对冠状动脉基础病变治疗外,地尔硫革和硝酸酯类等联合抗痉挛治疗是主要的治疗措施。     

海马内注射硫氮卓酮对马桑内酯诱发大鼠大脑皮层痫样放电的影响

目的 观察硫氮卓酮的抗癫痫作用.方法 采用皮层应用马桑内酯的方法致痫大鼠.电刺激一侧坐骨神经,引导对侧皮层感觉区诱发电位,观察海马CA1-CA2区注射硫氮卓酮对致痫大鼠皮层脑电图和诱发电位的影响.结果 在皮层脑电图出现高频痫样放电期间,皮层诱发电位振幅高达(1.8±0.7)mV,海马内微量注射硫氮卓酮能明显抑制动物皮层脑电图痫样波频率、振幅和皮层诱发电位的振幅.结论 硫氮卓酮的上述作用与减少马桑内酯致痫时Ca2+流人神经元内有关.     

Antihypertensive Effect of Diltiazem in Young or Adult Rats of Genetically Hypertensive Strains

The antihypertensive effects of diltiazem were investigated in three different strains of genetically hypertensive rats, i.e. spontaneously hypertensive rats (SHR), stroke prone SHR (SHR-sp) and genetically hypertensive rats (GHR) compared to their respective controls, normotensive Wistar-Kyoto (NT-WKY) and New Zealand strain (NT-NZ). Either adult (3-6 months) or young (4 weeks), conscious rats were used. In adult SHR, SHR-sp and GHR, the percent decrease in blood pressure produced by diltiazem, (10, 30 and 100 mg/kg orally (p.o.) or 0.1, 0.3, 1.0 and 3.0 mg/kg intravenously (i.v.)) was greater than in NT-WKY or NT-NZ, while no difference was detected in case of hydralazine (5 mg/kg p.o.). In contrast, the reactivity to diltiazem was not different between the young rats bred from the normotensive and hypertensive rats of both the Japanese and the New Zealand strains. It is concluded that diltiazem is a more effective antihypertensive agent in the hypertensive rats than in the normotensive rats. However, the increased reactivity to this compound in the adult hypertensive rats cannot be readily explained by the known pathogenetic factors leading to their hypertension.     

Exaggerated Hypotensive Responses to Calcium Antagonists in Spontaneously Hypertensive Rats

The hypotensive effects of intravenous injection and infusion of diltiazem, 1- and d-verapamil were investigated in conscious and anaesthetized rats with spontaneous hypertension (SHR) and normal blood pressure (NT-WKY). The inhibitory actions of these calcium-influx blockers on the pressor responses to angiotensin II (AII) and noradrenaline (NA) were also examined in anaesthetized SHR and NT-WKY. The intravenous injections of these three drugs (0.03, 0.1, 0.3, 1.0 mg/kg) lowered mean arterial pressure (MAP) in a dose related manner in conscious NT-WKY and SHR. The small dose of the blockers administered by intravenous infusion (0.02 mg/kg per min) also decreased MAP in both groups. The potency of the antihypertensive action was in the order 1-verapamil>d-verapamil=diltiazem. The fall in blood pressure expressed as percentage of the intial MAP produced by the compounds was significantly enhanced in SHR compared to NT-WKY. The pressor responses to All (0.03, 0.1, 0.3, 1.0 ug/kg i.v.) were suppressed by the intravenous infusinon of 20 ug/kg per min with 1-verapamil but not with d-veramil, diltiazem and vehicle in NT-WKY, while no calcium blocker significantly diminished the vasopressor action of All in SHR. The pressor effects of NA (0.3, 1.0, 10.0 ug/kg i.v.) were inhibited with d-verapamil and vehicle in NT-WKY. Diltiazem reduced the response to NA in SHR but the other compounds (and d-verapamil) did not alter the pressor response to NA in SHR. The pressor responses to arginine vasopressin (3, 10, 30 and 100 mU/kg i.v.) were not altered by diltiazem infusion in either SHR or NT-WKY. It is concluded that these compounds are different in the potency of their hypotensive action and also the inhibition of the pressor responses to All and NA. Calcium entry blockers are more effective antihypertensive agents in SHR than in NT-WKY. It appears that their inhibitory effects on the responses to All and NA do not explain the exaggerated hypotensive responses in SHR.     

注射用盐酸地尔硫治疗变异型心绞痛合并窦性心动过缓一例

<正>1临床资料患者男性,65岁。主因"间断胸痛10年,加重2 d"来我院就诊。患者于10年前出现间断胸痛,曾于当年行介入检查诊断冠心病,并于左前降支置入支架1枚。后症状间断发作,2 d前明显加重,发作频繁,自行应用硝酸甘油喷雾剂口喷治疗效果不佳。既往有窦性心动过缓病史,自青年时查体