慢性稳定型心绞痛的治疗

Treatment of chronic stable angina

慢性稳定型心绞痛是冠状动脉粥样硬化性心脏病(冠心病)心肌缺血引起的胸前区不适感,邻近区域也可能波及。通常因冠状动脉粥样硬化狭窄,在心脏氧耗增加时无法充分供氧所致。该文重点讲述慢性稳定型心绞痛的药物治疗以及药物治疗的选择策略,并简述非药物治疗方法如血管重建、增强型体外反搏(EECP)以及危险因素的预防。该病的治疗目标是降低死亡率及其他心血管事件发生率,改善生活质量以及减少疼痛。所有患者都应服用他汀类降胆固醇药物和阿司匹林抗血小板。氯吡格雷可作为阿司匹林用药禁忌患者的替代治疗。对置入支架的患者,术后除同时接受阿司匹林和氯吡格雷二联抗血小板治疗,还应接受β受体阻断药及ACEI改善预后,尤其对于合并高血压、左心室收缩功能不全及心力衰竭的患者。在此基础上,如患者仍有心绞痛发作,需考虑行血管重建术,包括PCI治疗和冠状动脉旁路移植术。EECP也是一种有效的治疗方法。

Chronic stable angina pectoris is a discomfort located in the chest, which is caused by myocardial ischemia, adjacent areas possibly involved. It is most commonly caused by the inability of narrowed atherosclerotic coronary arteries to supply adequate oxygen to the heart under conditions of increase demand. This review article focused on the medical treatment of chronic stable angina, with a focus on new strategies or medications. The goals of treatment are mainly to decrease mortality and other cardiovascular events as well as to improve quality of life and relief chest pain. All patients should be on aspirin unless they are allergic or with other contraindications. If so, clopidogrel should be an alternative to aspirin. In addition, clopidogrel is ap-plied to patients who are intolerant to aspirin and those who need combined antiplatelet therapy after stent im-plantation. Patients should be started on beta blockers and angioteusin converting enzyme inhibitors （ACEI）, especially for those complicated with hypertension, left ventricular systolic dysfunction and heart failure. For those patients with refractory angina, revascularization should be considered, including percutaneous coronary intervention （PC/） and coronary artery bypass grafting （CABG）. Also, the enhanced external counterpulsation （EECP） is a kind of effective measure for chronic stable angina.