静脉滴注地尔硫治疗难治性心绞痛的临床观察

目的　观察静脉滴注地尔硫治疗难治性心绞痛的临床疗效及安全性。方法　10例难治性心绞痛患者停用静脉点滴硝酸甘油及口服β-受体阻滞剂后，静点地尔硫40～150μg/min（2.4～9mg/h）持续48h。结果　与用药前48小时相比，7例患者心绞痛发作显著改善，其中5例完全控制，2例明显改善。3例（30％）无效，经联合应用静脉硝酸甘油后1例完全控制，2例明显改善。无严重低血压、缓慢心律失常及心功能恶化等不良反应发生；无急性心肌梗死、需要急诊介入治疗及死亡发生。8例患者在病情稳定后1周内行介入检查与治疗，其中5例接受PTCA及支架置入术，3例接受冠状动脉旁路移植术。结论　静脉滴注地尔硫40～150μg/min(2.4～9mg/h)或者联合应用静脉硝酸甘油为难治性心绞痛提供了一种较为安全有效的药物治疗手段，值得临床进一步深入探讨。

Clinical investigation ofthe efficacy and safety of continuous intravenous Diltiazem for patients with refractoryangina pectoris

Objective To investigate the efficacy of infusion Diltiazem for patients with refractory angina pectoris. Methods　10 patients with refractory angina pectoris received continuous intravenous Diltiazem 40～150 μg/min (2.4～9 mg/h) for 48 hours after cessation of intravenous nitroglycerin and oral β-blokers. Results　With the single therapy of Diltiazem, 7 patients (70%) got satisfied results: 5 were free from and 2 were relieved of symptom; With the combination therapy of Diltiazem and intravenous nitroglycerin 60～120 μg/min after failed with Diltiazem alone, 3 (30%) patietns got satisfied results: 1 was free from and 2 were relieved of symptom. There is no severe side effects, including hypotension, bradycardia, cardiac function deterioration. Acute myocardial infarction, death and emergency interventional therapy did not occurred in all the 10 patients during the therapy period. Coronary angiography were performed in 8 patients within 1 week after the patients were stabled, 5 patients received PTCA and stent implantation and 3 patients received CABG. Conclusions　Continuous intravenous Diltiazem 40～150 μg/min (2.4～9 mg/h) or combination with intravenous nitroglycerin 60～120 μg/min is an efficient and safe therapy for patients with refractory angina pectoris.