曲美他嗪联合地尔硫卓治疗心绞痛的疗效研究

目的研究曲美他嗪联合地尔硫卓治疗心绞痛的效果。方法 80例心绞痛患者,随机分为观察组与对照组,每组40例。两组患者均接受常规治疗,对照组采取曲美他嗪治疗,观察组采取曲美他嗪联合地尔硫卓治疗。比较两组治疗效果,心绞痛发作次数、发作时间,不良反应发生情况。结果观察组的总有效率95.00%高于对照组的77.50%,差异具有统计学意义(P<0.05)。观察组心绞痛发作次数显著少于对照组,心绞痛发作时间短于对照组,差异具有统计学意义(P<0.05)。观察组的不良反应发生率5.00%显著低于对照组的25.00%,差异具有统计学意义(P<0.05)。结论对于心绞痛患者运用曲美他嗪联合地尔硫卓治疗,可以有效控制病情,疗效显著,安全可靠。     

A double-blind placebo controlled trial of diltiazem in duchenne dystrophy

Summary The role of calcium accumulation in the pathogenesis of Duchenne muscular dystrophy (DMD) has already been discussed. Several trials with different calcium-blocking drugs have revealed no clinical benefit. In addition, the present study includes histological investigations and computer tomography to verify therapeutic effects. In a randomized placebo-controlled double-blind study, 13 DMD patients aged from 3–10 years (mean, 7 years) were treated with 5 mg/kg diltiazem daily for 1 year. Compared with before therapy, the number of calcium-positive muscular fibres was remarkably reduced in the treated DMD patients, but not in the placebo group. The evaluation of all other biochemical and clinical parameters revealed no significant effects of the diltiazem therapy. The muscularX-ray density measured by computer tomography decreased under treatment. After the evaluation of the double-blind study, the code was broken. Therapy, however, was continued in the treated group and started in the placebo group. After 3 years of diltiazem therapy the clinical status of all 26 patients of the study and 20 additional DMD patients who were treated with diltiazem was compared with 46 untreated DMD patients of the same age and stage in our department. No obvious clinical benefit of diltiazem therapy could be observed.Abbreviations ALD Aldolase - Ca Calcium - CK Creatine kinase - CKMB Creatine kinase MB - GOT Glutamic-oxaloacetic transaminase - GPT Glutamic-pyruvic transaminase - LDH Lactate dehydrogenase - Mg Magnesium     

The efficacy of diltiazem and glyceryltrinitrate for the medical management of chronic anal fissure: a meta-analysis

Objective The objective of this review is to systematically analyze the prospective randomized controlled trials on the effectiveness of diltiazem (DTZ) and glyceryltrinitrate (GTN) for the pharmacological management of chronic anal fissure (CAF). Materials and methods A systematic review of the literature was undertaken. Prospective randomized controlled trials on the effectiveness of DTZ for the management of CAF were selected according to specific criteria and analyzed to generate summative data. Results Five studies encompassing 263 patients with CAF were retrieved from the electronic databases. Only two randomized controlled trials on 103 patients qualified for the meta-analysis. There were 53 patients in the DTZ group and 50 patients in the GTN group. Both DTZ and GTN were equally effective for the treatment of CAF (random-effect model risk ratio [RR] 0.29 [90.06–1.33] 95% confidence interval [CI], z = 0.62, p = 0.536). However, there was significant heterogeneity between the trials. GTN was associated with higher side effects rate (fixed-effect model RR 0.45 [0.28–0.73] 95% CI, z = −3.22, p = 0.001) and higher headache rate (fixed-effect model RR 0.33 [0.17–0.64] 95% CI, z = −3.27, p = 0.001) as compared to DTZ. There was no statistically significant recurrence rate of CAF between two pharmacotherapies (fixed-effect model RR 0.66 [0.18–2.41] 95% CI, z = −0.62, p = 0.535). Conclusion Both DTZ and GTN are equally effective and can be used for the management of CAF. However, GTN is associated with a higher rate of side effects (headache/anal irritation), and it should be replaced by DTZ. The recurrence rate of CAF after the use of both pharmacotherapies is equal.     

静脉应用地尔硫(艹卓)治疗心房纤颤伴快速心室率疗效观察

目的　观察静脉应用地尔硫艹卓对减慢心房纤颤伴快速心室率患者心室率的疗效及其安全性。方法　４０ 例心房纤颤伴快速心室率者被随机分为地尔硫艹卓治疗组和毛花甙丙治疗组,观察用药后心室率和血压变化。结果　毛花甙丙组有效率为７５ ％ ,地尔硫艹卓组为９５ ％ , Ｐ＜ ００１ 。毛花甙丙组最大效应时间为９６０ ±２８０ 分钟,地尔硫艹卓组为８０ ±２５ 分钟。地尔硫艹卓组有５ 例病人出现一过性无症状性低血压,无需处理。结论　地尔硫艹卓对降低心房纤颤伴快速心室率患者的心室率具有疗效高、起效迅速、安全等优点。     

静脉地尔硫(卓)治疗老年人快速心室率房颤、房扑和室上速的临床观察

目的　观察静脉地尔硫艹卓 对老年人快速心室率的房颤、房扑及室上速的疗效与安全性。方法　 1 5例患者 (7例房颤、3例房扑、5例室上速 )静脉注射地尔硫艹卓 1 0～ 1 5mg,有反应者继以 1 0～ 1 5mg/ h浓度持续静点 6～ 1 2 h。结果　用药后心室率比用药前基础心率减少 >2 0 % ;转复为窦性心律或心室率 <1 0 0次 / min为治疗有反应 ,本组 1 5例患者 1 2例 (80 % )有反应 ;用药后心室率下降最大效应时间 1 1 min,心室率下降幅度 42± 1 6次 / min。结论　地尔硫艹卓 能安全地应用于快速心室率的房颤或房扑及室上速的老年人 ,并在大多数病人能迅速有效地达到心率的控制和中止室上速的发作 ,而且不会引起或加重心功能障碍。     

合心爽与倍他乐克联合治疗不稳定型心绞痛临床研究

目的探讨合心爽与倍他乐克治疗不稳定型心绞痛（UPA）的疗效和安全性。方法将UPA患者随机分为两组,治疗组65例,对照组63例,治疗组用合心爽30～60mg,1次/8h,倍他乐克6.25～25mg,1次/12h,共7d;对照组用安慰剂口服,共7d。结果治疗组疗效明显优于对照组,治疗组总有效率95.4%,对照组总有效率85.7%,两组在疗效上差异有统计学意义（P〈0.05）。结论治疗组比对照组起效快、作用强、效果好、安全性可靠。     

急诊老年心房颤动快速心室率患者临床用药效果观察

摘要 目的：观察并比较静脉注射毛花甙C、地尔硫卓及胺碘酮控制老年房颤伴快速心室率的有效性和安全性。方法：收集于天津医科大学第二医院心脏科急诊诊治的心房颤动伴快速心室率的老年患者(≥60岁)97例,患者随机分为3组,分别静脉用毛花甙C(A组,30例)组、地尔硫卓(B组,32例)和胺碘酮(C组,35例)组。观察用药前及用药后5、l0、15、30、60、90min患者的心室率、血压、心律变化以及药物起效时间及不良反应。结果：毛花甙C、地尔硫卓和胺碘酮均能有效控制心房纤颤伴快速心室率患者的心室率。总有效率分别为75％、90％和85％,平均用药有效时间分别为(35.4±15.7)min、(9.7±3.6) min和(18.8±7.6)min。西地兰组恢复窦律6例,低血压l例;地尔硫卓组恢复窦律5例,出现低血压2例,窦缓l例;胺碘酮组恢复窦律8例,窦缓l例;均自行缓解,未发生心衰加重。结论：毛花甙C、地尔硫卓及胺碘酮均能有效、迅速、安全控制老年房颤伴快速心室率患者的心室率。但地尔硫卓、胺碘酮更迅速,而胺碘酮相对安全。     

地尔硫卓对失血性休克犬肝、胰、小肠组织的保护作用（英文）

目的：探讨钙拮抗剂地尔硫卓（Diltiazem, Dil）对失血性休克犬肝、胰、小肠组织的保护作用及机理。方法：犬股动脉放血,平均动脉压（mean artery pressure, MAP）降至5.33-6.67 kPa（40-50 mmHg）,分别输Dil和生理盐水。休克90 min时将放出的血液全部回输。整个实验观察240 min。结果：从150 min到240 min,Dil明显提高MAP（P<0.01）;降低肝、胰、小肠组织中丙二醛（malondialdehyde, MDA）含量（P<0.01）;胰腺组织超氧化物歧化酶（SOD）活性升高。电镜显示：使用Dil后,休克犬肝、胰、小肠组织结构正常。结论：在犬失血性休克中,钙拮抗剂Dil能保护肝、胰、小肠组织结构和功能的完整性。     

地尔硫对人体房室结电生理特性的频率依赖性作用

目的评价频率对地尔硫心脏电生理作用的影响。 方法对17例患者进行电生理检查,分析应用地尔硫前后在不同频率情况下房室结的电生理变化。 结果地尔硫不影响窦性心律周长、窦房结恢复时间、HV间期,但房室结文氏周长由312.2±18.6ms延长到408.3±17.5ms(P＜0.01)。在慢频率心房起搏时,地尔硫使房室结有效不应期(AVNERP)和AH间期延长,延长量分别为44.2±10.8ms和19.2±6.7ms。在快频率心房起搏时,AVNERP和AH延长更为显著,分别为91.7±14ms和47.5±10.6ms(P＜0.01,与慢频率相比)。地尔硫延长AVNERP的程度大于AH间期,在快频率时该作用更为明显。 结论地尔硫对人体房室结功能影响具有快频率依赖性特点,这种作用使其在心动过速时选择性抑制房室结。     

Rapidly progressing neurological disturbance due to intraspinal calcification in a patient with systemic sclerosis

A 53-year-old woman with diffuse cutaneous systemic sclerosis (dsSSc) who developed muscle weakness in her lower extremities was admitted to our hospital. Computed tomography (CT) of her thoracic spine showed paraspinal and intraspinal calcifications producing severe spinal stenosis. After admission, her neurological symptoms, including muscle weakness and sensory disturbance, rapidly progressed and finally her lower extremities became completely paraplegic. After initiation of diltiazem and bucillamine, her neurological disturbance showed a marked improvement. A CT scan of the thoracic spine after medication showed dominant decrements in both intraspinal and paraspinal calcifications. Received: April 27, 2000 / Accepted: January 25, 2001