法舒地尔联合硝酸甘油治疗不稳定型心绞痛

目的 探讨Rho/Rho激酶抑制剂法舒地尔联合常规血管扩张剂硝酸甘油治疗不稳定型心绞痛的效果.方法 选择20例不稳定型心绞痛(左冠状动脉前降支血管痉挛)患者,年龄(61±11)岁,按随机数字表法分为法舒地尔组和对照组,每组10例.20例患者均接受乙酰胆碱负荷试验,于给予乙酰胆碱后、首次硝酸甘油(300g)治疗后,给予法舒地尔(30 mg,法舒地尔组)或0.9%氯化钠(对照组),再次硝酸甘油(300g)治疗后分别行冠状动脉造影,测定痉挛冠状动脉直径,并进行比较.结果 两组首次硝酸甘油治疗后痉挛冠状动脉直径改变比率比较差异无统计学意义(38.2±23.6)%比(42.6±17.2)%](P＞0.05).法舒地尔组在给予法舒地尔和再次硝酸甘油治疗后痉挛冠状动脉直径显著扩张,与首次硝酸甘油治疗后比较差异有统计学意义(2.48±0.79)、(2.51±0.78)mm比(2.11±0.62)mm](P＜0.01),而对照组痉挛冠状动脉直径比较差异无统计学意义(P＞0.05).两组在治疗期间和治疗后均没有观察到不良反应,法舒地尔治疗期间血压和心率是稳定的.结论 不稳定型心绞痛在硝酸甘油治疗后,给予法舒地尔可以进一步舒张痉挛的冠状动脉.

Fasudil combined with nitroglycerin in treatment of unstable angina pectoris

Objective To investigate the effect of Rho/Rho-kinase inhibitor fasudil combined with conventional vasodilating agents nitroglycerin in treatment of unstable angina pectoris.Methods Twenty patientsmean age (61 ± 11) years old]with unstable angina pectoris (angiospasm in the left anterior descending coronary artery) were selected and divided into fasudil group and control group with 10 cases each by random digits table.All the patients were examined by the acetylcholine stress test.Coronary diameter at the spasm site was measured and compared at baseline and after the administration of nitroglycerin in the following order: intracoronary nitroglycerin (300 g), intravenous fasudil (30 mg, fasudil group) or saline (control group), and again nitroglycerin (300 g) during coronary angiography.Results There was no significant difference in coronary diameter at the first nitroglycerin administration between fasudil group and control group(38.2 ± 23.6)% vs.(42.6 ± 17.2)% ,P ＞0.05].Coronary diameter at intravenous fasudil and again nitroglycerin administration in fasudil group was expanded, and there was significant difference compared with that of the first nitroglycerin administration(2.48 ±0.79), (2.51 ± 0.78 ) mm vs.( 2.11 ± 0.62 ) mm](P ＜ 0.01 ), but there was no significant difference in control group (P ＞ 0.05).There was no adverse effect in two groups,and blood pressure and heart rate was stable in fasudil group.Conclusions Fasudil further dilates the site of coronary spasm, which had already been treated with nitroglycerin in patients with vasospastic angina.These findings support and extend the previous results that shows the feasibility of employing fasudil as a novel therapeutic approach for coronary spasm.