静脉注射地尔硫治疗不稳定性心绞痛临床疗效观察
地尔硫|不稳定性心绞痛|血液动力学,关键词：
关键词：地尔硫；不稳定性心绞痛；血液动力学
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摘要】 目的 观察静脉地尔硫对不稳定性心绞痛(UAP)患者的疗效与安全性。方法 选择15例严重且硝酸甘油疗效不好的UAP患者，静注地尔硫10～20mg(0.25 mg/Kg体重)后，继以5～10 mg/h维持48小时。观察心绞痛症状，心电图及血流动力学变化，其中8例行漂浮导管检查。结果(1)15例中11例(73.3%)UAP患者静注地尔硫后约8.5±8.1分钟时，心绞痛症状缓解。与用药前48小时内相比，开始用药48小时后的心绞痛次数减少，每次最长持续时间明显缩短。(2)静脉地尔硫使10/15例的异常ST段恢复，3/15明显改善。(3)静脉使用地尔硫后血压、心率降低，10-15分钟起效，维持持续静滴的48小时，尤其血压×心率值降低更为明显。(4)8例漂浮导管监测显示，静脉使用地尔硫中心静脉压(CVP)短暂升高。(5)出现4例窦性心动过缓，1例一过性低血压，经处理后恢复。结论 静脉地尔硫治疗对某些较顽固的UAP有效，且相对安全。The clinical efficacy and safety of intravenous diltiazem intreatment of unstable angina Hu Dayi, Cui Liang, XuZhimin, et al. The Heart center, Beijing Red Cross Chaoyang Hospital, Institute ofCardiovascular Diseases, Capital University of Medical Sciences, Beijing 100020
【Abstract 】 Objective To investigate theclinical efficacy and safety of intravenous diltiazem in patients with unstable anginapectoris (UAP). Methods Fifteen UAP cases whosesymptom was serious and resistant to nitroglycerin were studied. Intravenous diltiazem wasadministred first with a bolus of 10-20 mg(0.25 mg/kg), then infusion of 5-10 mg/h for 48hours. The changes of angina symptom, electrocardiogram (ECG) and hemodynamics wereobserved, and Swan-Ganz monitoring was performed in 8 cases. Results (1) Angina symptoms were relieved in 11 of the 15 cases with UAP in8.5±8.1 minutes after the bolus diltiazem. The onset frequency of angina and the longestduration per-onset after administration of diltiazem were significantly decreased. (2)Abnormal S-T segments on ECG restored to normal in 10 cases, obviously improved in 3. (3)Heart rate (HR) and blood pressure (BP) were significantly lowered after 10 min ofintravenous diltiazem until infusion withdrawal, especially the decrease was more notablein the product of HR×BP. (4) It was proved by Swan-Ganz catheter that intravenousdiltiazem had no marked effect on cardiac function in 8 cases, except for mild increase incentral venous pressure. (5) Side effects: Sinus bradycardia was present in 3 cases butrecovered after immediate inanagement. Conclusion Intravenousdiltiazem therapy is effective for patients with UAP and is relatively safe for those withrefractory unstable angina pectoris.
【Key words 】 diltiazem angina pectoris,unstable hemodynamics
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