应用地尔硫治疗老年不稳定性心绞痛的疗效观察

The effect diltiazem on aged unstable angina patients

目的探讨持续静脉应用地尔硫(合贝爽)治疗老年不稳定性心绞痛(UA)的临床疗效和安全性。方法26例经硝酸甘油治疗效果不佳的老年UA患者用合贝爽30mg加入液体中持续静脉滴注,初始剂量1μg/(kg.m in)-1,若效果欠佳,速度则增至3μg/(kg.m in)-1,直至最大速度5μg/(kg.m in)-1。症状缓解后按有效剂量维持48h后改用合心爽片剂30mg,tid口服。用药过程中观察心绞痛症状、心电图及血流动力学变化。结果26例老年UA患者用药前72h内平均心绞痛发作次数为5.26±2.57次,给予合贝爽治疗后(9.2±6.8)m in时症状缓解;其中7例患者加大合贝爽的剂量至5μg/(kg.m in)-1后心绞痛得到控制。与用药前72h内相比,开始用药48h后心绞痛次数明显减少,每次发作持续时间明显缩短。静滴合贝爽后有3例UA患者异常ST段和T波恢复,6例明显改善;患者血压、心率降低,与基础值相比差异显著(P<0.05),但无急性心肌梗死、死亡等严重不良反应发生。结论对经硝酸甘油治疗效果不佳的老年UA,持续静脉应用合贝爽是一种有效的治疗措施。

OBJECTIVE To investigate the clinical therapeutic effect and safety of diltiazem to treat unstable angina（UA） of old people by continuous intravenous injection. METHODS 26 aged UA patients who did not get well with the glyceryl trinitrate therapy accepted the continuous intravenous injection of dihiazem with a dosage of 30mg. The initial dosage was 1μg/（ kg · min）^-1, if the effect was not obvious, the dosage would be increased to 3μg/（ kg · min）^-1 - 5μg/（ kg · min）^-1. When the symptom was relieved, the effective dosage was maintained to 48h, then 30mg （tif） of dihiazem tablets was given. The angina symptom, ECG and the hemodynamics changes were observed during the process. RESULTS The advent frequency of angina during the 72 hours before therapy was （5.26 ± 2.57）, while the symptom relieved after the dihiazem injection for an average of （9.2 ± 6.8） minutes. Among them 7 patient＇s angina did not get controlled until the dosage was adjusted to 5μg/（ kg·min）^-1. Compared with the 72 hours before therapy, the angina frequency descended after the injection for 48 hours and the duration of angina got decreased. 3 patients got normal ST and T waves after injection and 6 patients recovered obviously. Their blood pressures and heart rates decreased after therapy（ P 〈 0.05） and no adverse-effects such as AMI and death occurred. CONCLUSION It is an effective therapy of continuous diltiazem intravenous injection to the aged UA patients whose symptoms can not be relieved after given of glyceryl trinitrate.