持续静脉应用地尔硫芏卓治疗不稳定型心绞痛的疗效观察

Clinical Observation of Continuous Intravenous Application of Diltiazem in Treatment of Unstable Angina

目的 :探讨持续静脉应用地尔硫苴卓(Dil)治疗不稳定型心绞痛 (UA)的临床疗效及可能的作用机制。方法 :5 4例硝酸酯药物治疗效果不佳的UA患者静脉应用Dil,首先按初始剂量 1μg /kg·min-1的速度持续静脉注入。Dil静脉维持治疗期间若仍有心绞痛发作 ,则剂量由 1μg /kg·min-1增加至 3μg /kg·min-1;最大至 5 μg /kg·min-1,心绞痛发作消失即按有效剂量维持 4 8h后改为口服。如果在 5 μg /kg·min-1剂量下心绞痛仍不缓解或仍有发作 ,则认为治疗无效 ,需更改治疗方案。用药过程中同时观察患者的心率、血压、心电图变化及有无低血压、心律失常、心功能不全等副作用。结果 :5 4例UA患者开始应用Dil前 4 8h内平均心绞痛发作次数为 3.19± 3.35 (1～ 2 0 )次 ,给予Dil治疗后 ,初始剂量 1μg /kg·min-1的有效率为 83% (45 / 5 4 ) ,其余 9例患者加大Dil剂量至 3μg /kg·min-1后心绞痛亦全部得到控制 ,总有效率高达 10 0 %。治疗过程中 ,随用药时间的延长和 /或药物剂量的增加 ,其心率、血压和率压积均逐渐下降 ,与基础值相比差异显著 (P <0 .0 5 ) ,无 1例在Dil治疗期间新发生急性心肌梗死 ,除 2例发生可逆性I°房室传导阻滞外无其它严重副作用。结论 :对于硝酸酯药物治疗效果不佳的不稳定型心绞痛 ,Dil是?

Objective: To evaluate the effects of diltiazem (Dil) applied continuously and intravenously on unstable angina (UA). Methods: 54 hospitalized UA patients who had failed to respond to nitrates received Dil intravenously. The initial dose was 1 μg /kg·min -1 constantly, and the dose was increased from 1 μg /kg·min -1 to 3 μg /kg·min -1 and then 5 μg /kg·min -1 if angina recurred during treatment. Corresponding doses of oral Dil was prescribed if the angina kept in silence for more than 48 hours under IV infusion of any of those three dosages. 'Inefficiency' was defined as uncontrollable angina attacks at dosage of 5 μg /kg·min -1 . Besides the symptoms, heart rate, blood pressure, ECG and some side effects such as hypotension, arrhythmias, and heart failure were also observed during the trail. Results: After the medication of Dil, the angina attacks were controlled in 45 and 9 patients at dosage of 1 μg /kg·min -1 and 3 μg /kg·min -1 respectively. The total effective rate was 100%. Either the heart rate, blood pressure, or the rate pressure product was significantly decreased with the prolongation of the medication or the increment of dosage, as compared with the baseline value( P < 0.05 ). Except two cases who experienced reversible I° AVB, no acute myocardial infarction and no severe side effects were observed during the treatment. Conclusions: The clinical efficacy of Diltiazem therapy is satisfactory in nitrate resistant UA patients.