曲美他嗪、5-单硝酸异山梨醇酯治疗稳定型心绞痛90例临床观察

Clinical efficacy of? trimetazidne and metoprolol in patiens with stable angina pectoris

[目的]观察曲美他嗪、5-单硝酸异山梨醇酯、曲美他嗪加5-单硝酸异山梨醇酯对冠心病稳定型心绞痛患者抗心绞痛运动耐力的影响。[方法]选择90例冠心病稳定型心绞痛患者,随机将其分成3组,每组30例。曲美他嗪组服用曲美他嗪20mg,每日3次;5-单硝酸异山梨醇酯组服用5-单硝酸异山梨醇酯25～37.5mg,每日2次;曲美他嗪加5-单硝酸异山梨醇酯组服用曲美他嗪20mg,每日3次,5-单硝酸异山梨醇酯25～37.5mg,每日2次。疗程8周,治疗前后观察每周心绞痛发作次数和硝酸甘油用量,结合运动负荷试验(运动平板)参数:心率、血压、运动到达出现心绞痛的时间、运动到达ST段压低1mm所需时间以及总作功进行评价。[结果]治疗8周后,3组不同药物治疗心绞痛有效率分别为86.7%(26/30)、83.3%(25/30)和93%(28/30)。运动至心绞痛发作时间分别延长15.6%、14.3%和19.2%,至ST段压低1mm时间分别延长18.1%、16.2%和25.6%。运动总作功(METS)分别提高29.7%、28.9%和50%。与治疗前各组比较差别有统计学意义(P<0.01),联合用药与单独用药组间比较差别有统计学意义(P<0.01)。[结论]曲美他嗪为安全、有效、耐受良好的抗心绞痛药,与5-单硝酸异山梨醇酯联用有良好的协同作用。它不影响血流动力学,无负性肌力作用。曲美他嗪为治疗心绞痛有效药物,也可以用于传统抗心绞痛药控制不满意患者的辅助治疗。

[Objective] To investigate the clinical efficacy of trimetazidne and metoprolol in patients with stable angina pectoris. [ Methods] 90 coronary heart disease patients with stable angina pectoris were randomized into 3 groups and treated with trimetazidine, 20mg, 3 times daily, metoprolol, 25 -37.5mg, twice daily, and the united treatment respectively. Before and after receiving 8 - week therapy, the numbers of attacks of angina pectoris, the amount of nitroglycerin consumption and the duration of treadmill exercise tolerance test including the total exercise time, time for ST segment depression of lmm and METS were recorded. [Results] After receiving treatment with trimetazidine, or metoprolol, or the combined, the effective rate in reducing angina pectoris attacks in the three groups was 86.7% ,83.3% ,93.0% respectively and was significantly prolonged compared with that of part - treatment { all P 〈 0. 01 }. The time between exercise to attack of angina pectoris prolonged 15.6%, 14.3%, and 19.2% respectively. The time between exercise to depression of ST segment for Imm prolonged 18.1% ,16.2% and 25.6% respectively. METs rose 29.7% ,28.9% and 50.0% in the 3 groups after drug treatment. All were markedly different from those of pre - therapy （ all P 〈0.01, There were no significant difference between the two single - drug treatment groups in the above mentioned parameters. However the difference was significant between the united group and the single - drug group. [ Conclusion] Timetazidine is a safe, effective and well endurable anti -angina drug and can well co -operate with metoprolonot. It does not affect the blood dynamics and has no negative myodynamic action.