静脉注射地尔硫治疗不稳定性心绞痛临床疗效观察

The clinical efficacy and safety of intravenous diltiazem in treatment of unstable angina

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（０．２５ｍｇ／Ｋｇ体重）后，继以５～１０ｍｇ／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。

Objective To investigate the clinical efficacy and safety of intravenous diltiazem in patients with unstable angina pectoris (UAP). Methods Fifteen UAP cases whose symptom was serious and resistant to nitroglycerin were studied. Intravenous diltiazem was administred first with a bolus of 10 20 mg(0.25 mg/kg), then infusion of 5 10 mg/h for 48 hours. The changes of angina symptom, electrocardiogram (ECG) and hemodynamics were observed, and Swan Ganz monitoring was performed in 8 cases. Results (1) Angina symptoms were relieved in 11 of the 15 cases with UAP in 8.5±8.1 minutes after the bolus diltiazem. The onset frequency of angina and the longest duration 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 of intravenous diltiazem until infusion withdrawal, especially the decrease was more notable in the product of HR×BP. (4) It was proved by Swan Ganz catheter that intravenous diltiazem had no marked effect on cardiac function in 8 cases, except for mild increase in central venous pressure. (5) Side effects: Sinus bradycardia was present in 3 cases but recovered after immediate inanagement. Conclusion Intravenous diltiazem therapy is effective for patients with UAP and is relatively safe for those with refractory unstable angina pectoris.