曲美他嗪对冠心病稳定性劳力型心绞痛患者心肌缺血的影响

Effect of trimetazidine on myocardial ischemia in patients with stable angina pectoris

目的探讨曲美他嗪对冠心病(CHD)稳定性劳力型心绞痛患者心肌缺血的影响。方法选择在1周的时间内经2次运动试验,结果为阳性,且运动持续时间变异低于10%的CHD稳定性劳力型心绞痛患者40例,在原有治疗不变的情况下,加用曲美他嗪20mg每日3次,治疗12周。治疗前后均行平均运动试验,观察用药前后下述指标的变化:①用药前后每周心绞痛发作的次数;②每周硝酸甘油片的用量;③心率及心率与收缩压的乘积;④运动诱发心绞痛发作所需的时间;⑤运动后ST段下降1mm所需的时间;⑥运动持续时间;⑦总工作量。结果曲美他嗪应用12周后,患者每周心绞痛发作次数及硝酸甘油片的用量无明显下降(P<0.05);而对心率及心率与收缩压的乘积的影响无统计学显著意义(P>0.05)。与试验前相比,运动耐量和总工作量显著提高(P<0.01),至心绞痛发作时间及ST段下降1mm的时间均明显延长(P<0.01)。不良反应较少。结论曲美他嗪对CHD稳定性劳力型心绞痛患者能增加运动耐量,改善运动诱发心绞痛的心肌缺血,且安全有效,易于耐受。

Objective To evaluate the efficacy trimetazidine on myocardial ischemia in patients with stable angina pectoris, Methods： 40 stable exertional angina patients with two positive exercise tests within one week and the difference of duration of exercise between two tests≤ 10% were included, with routine treatment were given trimetazidine 20mg tid for 12 weeks. TreadmiU exercise testing was adopted and the following indexes were investigated before and after therapy： ①times of angina petoris attack every week; ②consumption of nitroglycerin every week; ③heart rate, systolic pressure and their product; ④time for inducing angina by exercise; ⑤time for inducing 1 mm ST segment depression by exercise; ⑥the total exercise time; ⑦total work load. Result： After 12 weeks therapy of trimetazidine, angina petoris attack and consumption of nitrolycerin every week were decreased obviously （P〈0.05）; Howerer, heart rate, systolic pressure and their product did not change significantly （P〉0.05）. The results showed that trimetazidine significantly increased exercise duration, total work load, time to onset of angina and time to 1 mm ST segment depression （P〈0.01）. There were very few adverse drug effects reported. Conclusion： For patients with stable exertional angina. Trimetazidine can increased the exercise capacity, improves myocardial ischemia induced by exercise. The drug is safe and effective and weU tolerated by patients.