静脉输注地尔硫治疗冠状动脉搭桥术前不稳定性心绞痛

Continuous intravenous infusion of diltiazem for unstable angina pectoris before coronary artery bypass graft

目的 :评价静脉输注地尔硫治疗冠状动脉搭桥 (CABG)术前不稳定性心绞痛的疗效和安全性。方法 :68例CABG术前不稳定性心绞痛病人停服肾上腺素 β受体阻滞剂、钙通道阻滞剂及抗血小板药物 ,静脉给予地尔硫 ,以 33～ 167μg·min- 1,持续微泵注入 72h以上。观察心绞痛症状、心电图、血压、心率及不良反应。结果 :65例 (96% )病人有效。与用药前相比 ,心绞痛发作平均次数减少 (5 .4±s 1.8)次·d- 1(P <0 .0 1) ,发作持续时间缩短 (7.6± 2 .5 )min(P <0 .0 1)。心肌耗氧指数降低。心电图异常者ST T明显改善 ,4 9例病人在病情稳定后 1wk内接受CABG。无严重不良反应。结论

AIM: To investigate the efficacy and safety of continuous intravenous infusion of diltiazem for the treatment of unstable angina pectoris before coronary artery bypass graft (CABG). METHODS:Sixty eight patients with unstable angina pectoris before CABG received continuous intravenous infusion of diltiazem 33-167 μg·min -1 (2-10 mg·h -1 ) for 72 h after cessation of oral β blockers, calcium channel blocker(CCB), aspirin, and ticlopidine. The changes of angina symptom, electrocardiogram(ECG), heart rate (HR), blood pressure (BP), and adverse reaction were observed. RESULTS: With the single therapy of diltiazem, sixty five(96%) patients got satisfied results. The onset frequency of angina pectoris was significantly decreased(5.4± s 1.8 ) times·d -1 ( P < 0.01) compared with pre therapy. The duration of onset was significantly shorten (7.6±2.5) min( P < 0.01)compared with pre therapy. Forty nine patients received CABG within 1 wk after the patients were stable.Three ( 4% ) patients got failed results. Among them, one was acute myocardial infarction,two received emergency CABG. Abnormal ST T on ECG obviously improved. The index of myocardial oxygen consumption significantly lowered. There were no severe adverse reactions. CONCLUSION: Continuous intravenous infusion of diltiazem is effective and safe for unstable angina pectoris before CABG.