Esmolol—新型超短时作用的β阻滞剂

β阻滞剂是一类发展最快的心血管药物,主要用于治疗心律失常、心绞痛、心肌梗塞和高血压等。目前使用的半衰期为2—9小时的常规β阻滞剂,存在着诱发严重心动过缓、心脏阻滞和慢性充血心衰的危险性。

Analysis of species-dependent hydrolysis and protein binding of esmolol enantiomers

The stereoselective hydrolysis of esmolol in whole blood and in its separated components from rat,rabbit and human was investigated.Blood esterase activities were variable in different species in the order of rat>rabbit>human.Rat plasma showed the high esterase activity and had no stereoselectivity to enantiomers.Rabbit red blood cell（RBC） membrane,RBC cytosol and plasma all hydrolyzed esmolol but with different esterase activity,whereas the hydrolysis in RBC membrane and cytosol showed significant stereoselectivity towards R-（+）-esmolol.Esterase in RBC cytosol from human blood mainly contributed to the esmolol hydrolysis,which was demonstrated with no stereoselctivity.Esterase in human plasma showed a low activity,but a remarkable stereoselectivity with R-（+）-esmolol.In addition,the protein concentration affected the hydrolysis behavior of esmolol in RBC suspension.Protein binding of esmolol enantiomers in human plasma,human serum albumin（HSA） and α;-acid glycoprotein（AGP） revealed that there was a significant difference in bound fractions between two enantiomers,especially for AGP.Our results indicated that the stereoselective protein binding might play a role in the different hydrolysis rates of esmolol enantiomers in human plasma.

Safety and efficacy of intravenous esmolol before prospective electrocardio- gram-triggered high-pitch spiral acquisition for computed tomography coro- nary angiography

Background In order to acquire a high quality image with a low radiation dose, prospective electrocardiogram （ECG）-triggered computed tomography coronary angiography （CTCA） requires a stable heart rate （HR） 〈 65 beats/min. Esmolol has the advantage of reduc-ing HR. The objective of this article is to assess the value of intravenous esmolol treatment before prospective ECG-tr/ggered high-pitch spiral acquisition for CTCA. Methods From March 2013 to June 2013, 313 patients underwent prospective ECG-triggered CTCA. Two hundred and thirty two of them received esmolol before angiography. We retrospectively analyzed clinical characteristics, esmolol dose, radiation exposure dose, and the change in HR and blood pressure in these 232 patients. Results A total of 232 patients with a HR 〉 65 beats/rain before CTCA examination received intravenous esmolol treatment （mean dose of 57.26±15.39 rag）, The mean initial HR （HR1）, slowest HR （HR2）, and the HR 30 min after HR2 （HR3） were 75.06± 5.59, 60.75 ±4.00, and 75.54 ± 5.96 beats/min, respectively （HR1 vs. HR2, P 〈 0.0001; HRI vs. HR3, P = 0.377）. The mean time from esmolol administration to HR2 was 24.25 ± 4.97 s and the mean effective radiation dose was 2.28 ± 0.02 mSv. Conclusions HR could be rapidly controlled at an optimum level with intravenous esmolol before prospective ECG-triggered high-pitch spiral acquisition for CTCA. Consequently, the patients received a very low radiation dose.

Efficiency of Esmolol in Treating Postoperative Arterial Hypertension in Patients with Ischemic Heart Disease

To investigate the efficiency and safety of(β+α)-adrenoblocker esmolol for postoperative arterial hypertention(PAH)in patients with ischemic heart disease.The study included 25 patients(45-65 years,mean age 51.5±7.3)who underwent coronary artery bypass grafting surgery with continuous blood purification(CPB).PAH developed during first post-op hours,all patients were ventilated with 2-4 scale sedation by RASS.All patients had arterial hypertension and were on constant therapy.Esmolol was administered IV push 20 mg within a minute.When required,injection was repeated in 5 min until full required effect.Maximum dose was 100 mg.For intraoperative treatment of hypertension 80 mg bolus within 30 sec was injected followed by 150 mg/kg/min infusion when required.Post-op dosage was administered similarly.Esmolol treatment was efficient in 82.6%of cases.Most frequent target AH was achieved using up to 40 and 60 mg in 20%and 36.9%of cases accordingly.Antihypertension effect maintained within 24 hours after injection.Esmolol cause moderate reduction of heart rate(4-7%),making it possible to use in case of hypertension without tachycardia.It is well tolerated and safe as no side effects were observed.The study showed high efficiency and safety of using esmolol to manage post-op arterial hypertension in cardiac surgery patients.

Chiral Separation of Esmolol and Terazosin by Cyclodextrinmodified Capillary Zone Electrophoresis

Cyclodextrin-modified CZE was applied to the chiral separation of two basic drugs, i.e., esmolol and terazosin. Selector screening and concentration optimization experiments were performed. Resolution 3.1 for esmolol, 1.2 for terazosin were achieved when using 60 mmol/L gamma-CD and 60 mmoL/L DM-P-CD, respectively, in 50 mmol/L pH 2.5 sodium phosphate buffer.

EFFECTS OF ALFENTANIL AND ESMOLOL ON HEMODYNAMIC AND CATECHOLAMINE RESPONSE TO TRACHEAL INTUBATION

Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to one of three groups,Group A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(in Group B)or 30 μg/kg alfentanil(in Group C)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0 1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation. Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0 05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,147±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0 01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0 05).NE in Groups A and B increased significantly to 5 75±3 51 and 6 75±3 30 nmol/L 3 min after intubation(P<0 01).In Group C,3 min after intubation NE was not significantly different from the baseline but E decreased significantly(P<0 01). Conclusion.2 mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.

艾司洛尔对蛛网膜下腔出血患者心功能的改善作用

目的分析艾司洛尔对蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者心功能的影响及安全性。方法回顾性选取接受治疗的98例SAH患者,均行介入栓塞术,按治疗方法分为2组。A组(50例)术中予以艾司洛尔,B组(48例)术中予以美托洛尔。比较2组术前,术后1、3、7 d的心功能指标[左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)]、心肌损伤指标[肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)、脑钠肽(brain natriuretic peptide,BNP)]、儿茶酚胺水平[去甲肾上腺素(norepinephrine,NE)、多巴胺(dopamine,DA)]和炎症因子[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]水平,并统计2组不良反应的发生情况。结果术后1、3、7 d,A组的LVESD、LVEF、LVEDD、cTnⅠ、BNP、NE、DA、IL-6及TNF-α水平均优于B组(P<0.05);A组不良反应的发生率为10.42%,B组为6.00%,组间比较差异无统计学意义(P>0.05)。结论艾司洛尔应用于SAH的治疗中,可改善患者的心功能,减轻心肌损伤,降低儿茶酚胺与炎症因子水平,且安全性较高。

艾司洛尔对急性心肌梗死PCI患者炎性因子及血清miR-29a、GDF-15的影响

目的 探究艾司洛尔对急性前壁ST段抬高型心肌梗死经皮冠状动脉介入(PCI)术患者的治疗效果,以及对患者炎性因子及血清微小核糖核酸-29a(miR-29a)、生长分化因子-15(GDF-15)的影响。方法 前瞻性选取2021年4月至2023年6月于新乡市中心医院行PCI术治疗的120例急性前壁ST段抬高型心肌梗死患者。按照随机数字表法分为艾司洛尔组和对照组,每组60例。对照组予以常规治疗,艾司洛尔组在常规治疗基础上予以艾司洛尔注射液治疗24 h,比较两组安全性、心功能指标、炎性因子水平、心肌酶学、miR-29a、GDF-15的差异。结果 两组在症状性低血压、症状性心动过缓以及恶性心律失常发生率方面比较差异没有统计学意义(P>0.05)。两组治疗1周后左心室射血分数与治疗前比较升高,左心室收缩末期容积指数、左心室舒张末期内径和BNP与治疗前比较降低(P<0.05);且艾司洛尔组治疗1周后左心室射血分数、左心室收缩末期容积指数、左心室舒张末期内径和BNP的变化优于对照组(P<0.05)。两组治疗1周后CRP、髓过氧化物酶、IL-6、CK-MB、cTnI与治疗前比较均降低(P<0.05);且艾司洛尔组治疗1周后CRP、髓过氧化物酶、IL-6、cTnI的变化均优于对照组(P<0.05)。重复测量分析结果显示,两组治疗3 d、1周miR-29a、GDF-15与治疗前相比均降低(P<0.05),且治疗1周miR-29a、GDF-15低于治疗3 d(P<0.05)。艾司洛尔组治疗3 d、治疗1周miR-29a、GDF-15优于对照组(P<0.05)。结论 艾司洛尔应用于行PCI术的急性前壁ST段抬高型心肌梗死患者可有效改善心功能,降低炎性因子水平,减少心肌损伤,并降低血清miR-29a、GDF-15水平,同时安全性较好。

艾司洛尔不良反应/事件报告分析

目的分析艾司洛尔不良反应/事件发生特点,为临床安全用药提供参考。方法检索Web of Science、PubMed、Springer Link、中国知网、万方数据、维普网从建库至2023年10月31日中艾司洛尔致不良反应/事件个案报道,进行统计和分析,并基于美国食品药品监督管理局(FDA)不良事件报告系统(FAERS)数据(2004年第1季度至2023年第4季度)进行挖掘验证其一致性。结果文献检索共纳入14篇个案报道,14例患者发生艾司洛尔不良反应/事件;男性10例,女性4例;年龄15~94岁,平均年龄59.79岁;发生时间最短为立即发生,最长9 d;不良反应主要有癫痫发作、谵妄、低钠血症、心脏骤停、严重室性心律失常、多巴酚丁胺应激超声心动图假阳性冠状动脉痉挛等。美国FAERS数据库中艾司洛尔不良事件报告208例,发生不良事件559例次,累及系统--器官分类(SOC)21个;不良事件信号强度排序为:交界异位性心动过速、心搏出量降低、无脉性电活动、外渗、热射病、心室机能障碍、室颤、输液部位渗出、心源性休克、冠状动脉痉挛等,与文献收集的病例报告一致性较高。结论艾司洛尔临床应用广泛,发生的不良反应/事件多为轻微且短暂,但有严重的且说明书未记载的不良反应/事件。建议临床使用时仍需谨慎,对不良反应/事件早期判断、及时停药、尽早给予相关对症处理。

艾司洛尔围术期应用热点与趋势文献计量学分析

目的探讨艾司洛尔在围术期应用的热点及研究趋势。方法检索Web of Science(WOS)数据库自建库起至2023年5月23日的相关文献,采用Citespace 5.8.R3软件,对涉及的国家/地区发文及合作情况,关键词共现、突现、聚类情况及文献共被引情况进行可视化分析。结果共获得有效文献422篇。研究始于1993年,呈波动上升趋势,2013年最多(24篇)。共涉及42个国家/地区,发文量排名前3的为美国(101篇)、日本(55篇)、中国(37篇);美国与其他国家合作最紧密,但多数国家/地区间的合作较少。共198种期刊发表了该领域的文章,Anesthesia and Analgesia(28篇)、Journal of Clinical Anesthesia(17篇)、Canadian Journal of Anesthesia-Journal Canadien D Anesthesie(14篇)是该领域研究发文量较高的3个期刊(期刊引证报告中均位列Q1区)。出现频次较高的关键词有“anes⁃thesia”(89次)、“surgery”(73次)、“remifentanil”(49次)、“propofol”(44次)、“sodium nitroprusside”(31次)、“cardiac surgery”(30次)等;共获得16个突现词,“lidocaine”为2018年至2023年突现度较高(3.67)的关键词;共有19个重要的聚类标签,主要集中于艾司洛尔药理作用及手术、艾司洛尔对比用药、联合使用麻醉剂等方面研究。文献总被引频次7885次,共被引文献的概括性主题包括non-cardiac surgery、eamolot pretreatment等。结论艾司洛尔围术期应用主要集中在心脏手术、心肺旁路手术等,艾司洛尔在非心脏手术中的应用、血流动力学响应、对麻醉药物作用的影响等是目前研究的热点。

艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响

目的:探讨艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响。方法:回顾性分析2020年12月至2023年1月该院收治的74例脓毒症休克患者的临床资料,根据治疗方案不同将其分为对照组与研究组各37例。两组均予以常规抗感染、抗炎、液体复苏等治疗,在此基础上对照组采用重酒石酸去甲肾上腺素注射液治疗,研究组在对照组基础上加用盐酸艾司洛尔注射液治疗。比较两组治疗前后血流动力学指标[心率、平均动脉压(MAP)]水平、病情危重度[急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估量表(SOFA)]评分、心功能指标[每搏指数(SVI)、心脏指数(CI)]水平、心肌损伤标志物[高敏肌钙蛋白T(hs-cTnT)、N末端B型脑钠肽前体(NT-proBNP)]水平、血清炎性因子[高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)]水平、血乳酸水平、不良反应发生率及28 d生存率。结果:治疗后研究组心率,APACHEⅡ、SOFA评分,血清hs-cTnT、NT-proBNP、HMGB1、IL-6、血乳酸水平均低于对照组,SVI、CI水平均高于对照组,差异有统计学意义(P<0.05);治疗6 h后,两组MAP水平均高于治疗前,但组间比较差异无统计学意义(P>0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);研究组28 d生存率为78.39%(29/37),对照组28 d生存率为67.57%(25/37),差异无统计学意义(P>0.05)。结论:艾司洛尔联合去甲肾上腺素治疗脓毒症休克患者可促进心率恢复正常,且不影响血压水平,并减轻心肌损伤,提高心功能,降低血清炎性因子和血乳酸水平,从而加快病情缓解,效果优于单用去甲肾上腺素。

盐酸艾司洛尔残留溶剂测定方法优化

目的:优化盐酸艾司洛尔残留溶剂检测方法,以便于内部质量控制。方法:使用气相色谱顶空进样方式,选择合适的顶空平衡温度和时间,降低样品对仪器的污染,优化溶剂比例,降低基质效应,调整了载气流速和分流比,采用极性毛细管柱程序升温的方法,延长了高温段保持时间等,并进行方法学验证。结果:乙醚、乙酸乙酯、甲醇、甲苯均能得到有效分离,精密度良好,峰面积和质量浓度均呈很好的线性关系,分别考察样品加标50%、100%、150%3个浓度的准确度,平均回收率均能在94.8%~105.6%。结论:该方法准确,灵敏度高,克服了《中国药典》方法的缺陷,可用于盐酸艾司洛尔残留溶剂检测。

β1受体阻滞剂防治脓毒症心肌病作用的研究进展

脓毒症心肌病是脓毒症引起的可逆性心肌损伤,是一种非缺血性急性心功能障碍,可显著增加脓毒症患者的病死率。β1受体阻滞剂具有抗应激、抗氧化、调节免疫和抑制细胞死亡及保护心肌的作用。该文对β1受体阻滞剂防治脓毒症心肌病作用的研究进展作一综述。

Efficacy and Safety of Esmolol in Treatment of Patients wi Septic Shock

Background： Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. Methods： Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate （HR） 〉100 beats/rain. Esmolol therapy achieved the target HR of 10-15% lower than the baseline HR. Clinical and physiological data of patients were collected prospectively within 1 h prior to esmolol therapy and 2 h after achieving the targeted HR. Results： Sixty-three patients were recruited. After esmolol therapy, blood pressure was unaltered, whereas stroke volume （SV） was increased compared with betbre esmolol therapy （43.6 ± 22.7 vs. 49.9 ±23.7 ml, t = -2.3, P = 0.047）. Tissue perfusion, including lactate levels （1.4 ± 0.8 vs. 1.1 ± 0.6 mmol/L, t = 2.6, P = 0.015） and the central venous-to-arterial carbon dioxide difference （5.6 ±3.3 vs. 4.3 ± 2.2 mmHg, t - 2.6 P = 0.016）, was also significantly decreased after esmolol therapy. For patients with increased SV （n = 42）, cardiac efficiency improved, and esmolol therapy had a lower risk for a decrease in cardiac output （CO）. Therefore, pretreatment cardiac systolic and diastolic parameters with （n = 42）/without 01 = 21 ） an increase in SV were compared. Mitral lateral annular plane systolic excursion （MAPSEIat） in patients with increased SV was significantly higher than that in those without increased SV （1.3 ±0.3 vs. 1.1 ± 0.2 cm, t = 2.4, P = 0.034）. Conclusions： SV of septic shock patients is increased is llowing esmolol therapy. Although CO is also decreased with HR, tissue perfusion is not worse.

Effect of nicardipine combined with esmolol on systemic and tissue oxygenation during off-pump coronary artery bypass grafting surgery

Background The hemodynamics and oxygenation severely fluctuated during the offpump coronary artery bypass grafting (OPCABG) This study aimed at investigating whether or not nicardipine combined with esmolol (1∶10) can maintain systemic and tissue oxygenation during OPCABGMethods Twenty patients scheduled for OPCABG were divided ramdomly into Group nicardipine (N) and Group nitroglycerine (X) respectively combined with esmolol (E) (Dosage ratio: 1 to 10) (Group N+E and Group X+E) with 10 patients in each group The mixed solution of N+E or X+E were titrated to maintain mean arterial blood pressure between 70 and 80 mmHg following anesthesia induction The variables of hemodynamics, arterial blood lactate content (Lac) and gastric intramucosal partial pressure of carbon dioxide were measured at the following time points: after induction of anesthesia (T1), prerevascularization (T2), grafting of left anterior descending (T3), right coronary descending (T4) and left coronary circumflexus branches (T5), postrevascularization (T6), the end of operation (T7) The delivery of oxygen (DO2), consumption of oxygen (VO2) and gastric intramucosal pH (pHi) were calculatedResults The cardiac index (CI) in Group N+E was significantly increased (P<005) as compared with T1 during OPCABG, while it was mildly decreased in Group X+E The stroke volumes at T4, T5 in Group N+E and at T3T6 in Group X+E were significantly decreased (P<005) The systemic vascular resistance indices in Group N+E were significantly decreased as compared with T1 (P<005) The heart rates in these two Groups were significantly elevated intraoperatively (P<005) The DO2 after the infusion of N+E was significantly increased (P<005) or leveled to T1, and the Lac were within the normal range But the DO2 in Group X+E was decreased throughout the procedure, reaching significant level at T5 (P<005), and the Lac was significantly increased beyond normal range (P<005) The pHi in Group N+E was maintained above 735 during OPCABG, while it was less than 735 from T4 to T7 in Group X+EConclusion Nicardipine combined with esmolol (1∶10) regimen may maintain systemic and tissue oxygenation during OPCABG

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children:a double-blind,randomized clinical study

Background:Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways.However,there is a high risk of agitation after emergence from anesthesia.Strabismus surgery,in particular,can trigger agitation because patients have their eyes covered in the postoperative period.The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children.Methods:Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group(saline only),a group that received intravenous lidocaine 1.5 mg/kg,and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg.Agitation was measured using the objective pain score,Cole 5-point score,and Richmond Agitation Sedation Scale score at the end of surgery,on arrival in the recovery room,and 10 and 30 min after arrival.Results:The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia(OPS=0(0-4),RASS=-4[(-5)-1])and were transferred to the recovery room(OPS=0(0-8),RASS=-1[(-5)-3])(P<0.05).There was no significant difference in the severity of agitation among the three groups at other time points(P>0.05).Conclusions:When pediatric strabismus surgery is accompanied by sevoflurane anesthesia,an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room.

不同剂量艾司洛尔对精神疾病患者无抽搐电休克治疗的影响

目的探讨不同剂量艾司洛尔对无抽搐电休克治疗(modifiled electroconvulsive therapy,MECT)患者心血管反应和癫痫发作时间的影响。方法选取2016年1月至2018年1月于哈尔滨医科大学精神卫生中心进行MECT的80例住院患者作为研究对象,根据诱导时艾司洛尔的使用剂量分为E1组(0.5 mg/kg)、E2组(0.8 mg/kg)、E3组(1.0 mg/kg)和E0组(0 mg/kg),每组20例。比较4组麻醉前(T0)、麻醉后(T1)、电刺激即刻(T2)、电刺激后3min(T3)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)及脑电图(electroencephalogram,EEG)发作时间。结果T0、T1时,各组HR、SBP、DBP比较差异均无统计学意义;T2时,E1、E2、E3组HR、SBP、DBP均明显低于E0组,E2、E3组BP、DBP低于E1组,E3组HR低于E1组,差异均有统计学意义(P<0.05);T3时,E1、E2、E3组HR、SBP、DBP低于E0组,E2、E3组SBP低于E1组,差异有统计学意义(P<0.05);T2、T3时,E2、E3组HR、SBP、DBP比较差异无统计学意义。E2组EEG发作时间明显长于E0组、E1组、E3组,E3组EEG发作时间短于E0组、E1组、E2组,差异均有统计学意义(P<0.05),E1组与E0组EEG发作时间比较差异无统计学意义。结论艾司洛尔可有效抑制MECT治疗期间的心血管反应,静脉注射艾司洛尔0.8 mg/kg较0.5 mg/kg血流动力学更加平稳,与1.0 mg/kg相比,可以引发更加充分的脑电发作。因此,艾司洛尔0.8 mg/kg可以安全有效地运用于MECT中。

阿托伐他汀联合艾司洛尔对冠心病心绞痛患者血脂代谢和血液流变学的影响分析

目的 观察对冠心病心绞痛患者应用阿托伐他汀联合艾司洛尔治疗的效果。方法 86例冠心病心绞痛患者,根据抽签法分成对照组和观察组,每组43例。对照组给予阿托伐他汀进行治疗,观察组在对照组基础上加用艾司洛尔进行治疗。比较两组治疗前后临床症状积分、血脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血液流变学指标(全血低切粘度、血浆粘度以及纤维蛋白原)、心功能指标(心输出量、每搏输出量、左心室短轴缩短率、左心室射血分数)以及生存质量。结果 治疗后,观察组胸区疼痛、心慌、心悸、胸闷、呼吸困难积分分别为(1.23±0.45)、(1.18±0.54)、(1.56±0.82)、(1.38±0.52)、(1.07±0.31)分,低于对照组的(2.57±0.79)、(2.68±0.93)、(2.37±0.92)、(2.45±0.62)、(2.05±0.46)分(P<0.05)。治疗后,观察组TC(4.37±0.82)mmol/L、TG(1.75±0.30)mmol/L、LDL-C(2.45±0.24)mmol/L低于对照组的(5.56±1.19)、(2.96±0.33)、(3.16±0.20)mmol/L, HDL-C(1.51±0.15)mmol/L高于对照组的(1.26±0.22)mmol/L(P<0.05)。治疗后,观察组全血低切粘度、血浆粘度以及纤维蛋白原水平分别为(7.94±0.80)mPa·s、(5.60±1.17)mPa·s、(4.25±0.46)g/L,低于对照组的(9.83±1.06)mPa·s、(6.78±1.32)mPa·s、(4.72±0.12)g/L(P<0.05)。治疗后,观察组每搏输出量(53.91±3.40)ml、心输出量(4.22±0.61)L/min、左心室短轴缩短率(26.01±3.65)%、左心室射血分数(50.89±2.62)%均高于对照组的(49.56±3.78)ml、(3.59±0.50)L/min、(24.38±2.70)%、(45.71±2.20)%(P<0.05)。与对照组治疗后比较,观察组治疗后身体功能、疼痛、睡眠、社会孤立状况、情绪反应及活力水平评分均更低(P<0.05)。结论 阿托伐他汀联合艾司洛尔治疗冠心病心绞痛的疗效佳,患者临床症状、血脂代谢、血液流变学均改善,心功能、生存质量得以提升,值得应用。

艾司洛尔联合卡维地洛对冠心病心肌缺血患者心率收缩压乘积及血清应激诱导蛋白2水平的影响

目的探讨艾司洛尔联合卡维地洛对冠心病(冠状动脉粥样硬化性心脏病)心肌缺血患者心率收缩压乘积(RPP)及血清应激诱导蛋白2(Sestrin2)水平的影响。方法选择2021年3月至2023年3月西安交通大学第一附属医院榆林医院收治的冠心病心肌缺血患者106例,按照随机数字表法分为观察组和对照组,各53例。对照组采用卡维地洛治疗,观察组在对照组的基础上加用艾司洛尔治疗。2组均持续治疗8周。比较2组总有效率、心电图检查结果、心肌供氧相关指标、血清Sestrin2水平及不良反应发生情况。结果观察组总有效率高于对照组[90.6%(48/53)比75.5%(40/53)],差异有统计学意义(P=0.038)。治疗后2组心肌缺血总负荷、24 h内ST段压低次数、压低持续时间、心率、收缩压、RPP水平均低于治疗前,且观察组均低于对照组(均P<0.05)。治疗后2组血清Sestrin2水平均低于治疗前,且观察组血清Sestrin2水平低于对照组[(8.1±1.0)μg/L比(10.1±1.6)μg/L](均P<0.001)。观察组不良反应总发生率低于对照组[11.3%(6/53)比47.2%(25/53)](P<0.001)。结论冠心病心肌缺血患者接受艾司洛尔和卡维地洛两种药物联合治疗,效果较好,可有效改善患者心肌缺血状况,调节心率与血压水平,减少心肌耗氧量,且不良反应较少。

辅酶Q10联合艾司洛尔对冠心病不稳定性心绞痛患者血脂水平及T淋巴细胞亚群的影响

目的 观察辅酶Q10联合艾司洛尔治疗冠心病不稳定性心绞痛患者的疗效及其对血脂水平、T淋巴细胞亚群的影响。方法 选取2021年1月至2023年1月惠济区人民医院收治的冠心病不稳定性心绞痛患者116例为研究对象,依据随机单双数分配原则分为单一组58例(艾司洛尔治疗)、联合组58例(辅酶Q10联合艾司洛尔治疗)。观察两组临床疗效,心功能[左室舒张末内径(LVDd)、每搏输出量(SV)、短轴缩短率(FS)、射血分数(EF)],血脂水平[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)],血小板活化[血小板表面细胞分化抗原40配体(CD40L)、血小板活化依赖性颗粒表面膜蛋白(CD62p)、血小板激活复合物-1(PAC-1)],T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)),微炎症状态[五聚素-3(PTX-3)、脂蛋白相关磷脂酶A2(Lp-PLA2)、血管细胞黏附分子-1(VCAM-1)]及不良反应。结果 联合组心绞痛症状疗效、心电图疗效高于单一组(P<0.05);联合组治疗后LVDd、TC、TG、LDL-C、CD40L、CD62p、PAC-1低于单一组,SV、FS、EF、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于单一组(P<0.05);联合组治疗后血清PTX-3、Lp-PLA2、VCAM-1水平低于单一组(P<0.05)。两组不良反应发生率比较无明显差异(P>0.05)。结论 辅酶Q10联合艾司洛尔治疗冠心病不稳定性心绞痛的疗效确切,可改善心功能、血脂代谢,抑制血小板活化,纠正T淋巴细胞亚群紊乱状态,缓解微炎症状态,且安全性良好。