静脉泵入地尔硫卓治疗难治性不稳定型心绞痛的临床观察(1)
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【摘要】 目的 探讨地尔硫卓对难治性不稳定型心绞痛的疗效和安全性。方法 42例对常规抗心绞痛治疗无效的不稳定型心绞痛患者,给予静脉持续泵入地尔硫卓72 h治疗。严格控制地尔硫卓的剂量。观察治疗前后心绞痛发作次数、发作时ST段压低及血流动力学指标的变化,并注意药物不良反应。结果 静脉滴注地尔硫卓治疗后,心绞痛得到有效控制,总有效率90.5%。与治疗前比较,治疗后的平均心绞痛发作次数减少、每次发作持续时间缩短、发作时ST段压低程度减轻(P<0.05);治疗后血压、心率(P<0.05)和收缩压×心率均明显降低(P<0.01),未发现严重不良反应。结论 地尔硫卓静脉泵入治疗难治性不稳定型心绞痛安全、有效,但需严格控制药物剂量。
【关键词】难治性不稳定型心绞痛;地尔硫卓;疗效;安全性
Clinical observation of infusion of intravenous diltiazem in treatment of refractory unstable angina
WU Ye-xin,ZHANG Su-hua.Departm ent of Cardiology,The People’s Hospital of Linzi District in Zibo City,Shandong 255400,China
【Abstract】 Objective To investigate the efficacy and safety of diltiazem to refractory unstable angina pectoris.Methods 42 unstable angina patients,who were failed to conventional anti-angina pectoris treatment,were treated with continuous infusion of intravenous diltiazem for 72 hours.Gradual titration of diltiazem was controlled.Angina attack frequency,ST segment depression and changes in blood rheologic indexes were observed before and after treatment.Results The attack of angina was effectively controlled after diltiazem treatment.The total effective rate was 90.1%.The average attack frequency,average attack duration and depression of ST segment were significantly decreased after diltizaem treatment(P<0.05).The blood pressure,heart rate(P<0.05)and the systolic blood pressure ×heart rate significantly decreased(P<0.01)after diltizaem treatment,without serious adverse reactions.Conclusion It was effective and safe to treat refractory unstable angina pectoris with diltizaem intravenous injection,but the dose titration should be strictly controlled.
【Key words】
Refractory unstable angina; Diltiazem; Efficacy; Security
不稳定型心绞痛(unstable angina pectoris,UAP)是心内科的常见疾病,是介于稳定型心绞痛和急性心肌梗死之间的心血管重症之一,其病情往往进展迅速,发生急性心肌梗死甚至猝死的危险性较大,因此不但要做出迅速正确的诊断,而且及时有效的治疗才能在很大程度上改善患者的预后。本研究旨在探讨静脉应用地尔硫卓治疗UAP的临床疗效和安全性。
1 资料与方法
1.1 研究对象 共收集我院心内科自2006年10月至2009年3月住院的UAP患者42例,其中男27例,女15例,年龄42~78岁,平均(61.5 ±7.4)岁。入选标准符合中华医学会心血管病学分会《不稳定性心绞痛诊断和治疗建议》[1]关于不稳定型心绞痛的诊断标准,42例患者均经常规休息、抗凝、抗血小板、他汀类药物调脂和足量硝酸酯类、美托洛尔等治疗7 d,仍有反复心绞痛发作(每天至少发作1次)。心绞痛临床分型标准:其中静息心绞痛9例,初发劳力性心绞痛5例,恶化劳力性心绞痛18例,梗死后心绞痛2例,混合性心绞痛8例,合并高血压22例,高脂血症18例,2型糖尿病14例,吸烟者28例。排除标准:①急性心肌梗死; ②静息心率低于50次/min、反复出现大于1 ......
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