钙拮抗剂治疗舒张性心力衰竭的临床研究  

Treatment of diastolic heart failure by calcium antagonist

作　　者：钟明[1] 张运[1] 赵静[1] 葛志明[1] 黎莉[1] 季晓平[1] 卜培莉[1] 张梅[1] 钟敬泉[1] 安丰双[1] 张薇[1] 

机构地区：[1]山东大学齐鲁医院心内科,山东济南250012

出　　处：《山东大学学报（医学版）》2004年第5期546-548,共3页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金资助项目(39970294);卫生部临床学科重点项目(97090247);山东省优秀中青年科学家科研奖励基金资助项目(01BS52)。

摘　　要：目的:探讨钙拮抗剂对舒张性心力衰竭(diastolicheartfailure,DHF)患者血流动力学和左室收缩及舒张功能的影响,为治疗DHF筛选有效药物。方法:采用超声心动图鄄心导管同步血流动力学技术,测定13例合并DHF的肥厚型心肌病(hypertrophiccardiomyopathy,HCM)患者(9例非梗阻性,4例梗阻性)静脉注射地尔硫前后左室收缩和舒张功能的改变。结果:静脉予以地尔硫后,HCM患者收缩压减低(120.62±24.45)mmHgvs(101.94±15.74)mmHg(P<0.05),舒张压、左室收缩压和左室射血分数无明显变化;左室流出道压差无明显变化,但3例梗阻性HCM患者用药后左室流出道压差明显增加;左室松弛时间常数明显减低眼(57.12±14.85)msvs(46.20±7.43)ms,P<0.05演,左室压力最大下降速率、左室舒张末压和心腔僵硬度常数无明显改善(P>0.05)。结论:钙拮抗剂地尔硫是治疗DHF的有效药物,对合并DHF的非梗阻性HCM患者效果尤为明显。Objective: To study the effects of diltiazem on hemodynamic and left ventricular (LV) systolic and diastolic function in patients with diastolic heart failure. Methods: Thirteen patients with hypertrophic cardiomyopathy (HCM) of diastolic heart failure were studied using LV catherization simultaneously with echocardiography. Results: In patients with HCM, diltiazem induced a systemic vasodilation (aortic systolic pressure: 120.62±24.45 mmHg to 101.94±15.74 mmHg), which was not associated with changes in the LV outflow tract gradient. Some patients with obstructive HCM, however, had a marked increase in obstruction. LV relaxation time constant significantly decreased (57.12±14.85 ms to 46.20±7.43 ms) which was induced by infusion diltiazem, but-dp/dtmax did not change. LV end-diastolic pressure and modulus of chamber stiffness kept no change throughout the infusion of diltiazem. Conclusion: Active relaxation function is improved by the acute administration of diltiazem, but passive diastolic function is not affected by diltiazem. This supports the notion that chamber stiffness is principally determined by passive structural elements in the heart rather than by active processes.

关 键 词：心力衰竭 充血性 地尔硫革 心肌病 肥厚型 

分 类 号：R541.61[医药卫生—心血管疾病]