氨氯地平、阿替洛尔对运动心电图试验及动态心电图监测中心肌缺血的影响  

Effect of Amlodipine and Atenolol on Myocardial Ischemia During Treadmill Exercise and Ambulatory Monitoring

作　　者：杨树森[1] 王岚峰[1] 赵进军[1] 孟繁超[1] 黄永麟[1] 王玉环 林继红[1] 李翠云 

机构地区：[1]哈尔滨医科大学附属第一医院心内科 [2]黑龙江省尚志市苇河林业局职工医院内科

出　　处：《中国循环杂志》1996年第9期543-546,共4页Chinese Circulation Journal

摘　　要：目的：主要探讨钙通道阻滞剂氨氯地平及β受体阻滞剂阿替洛尔（氨酰心安）对运动心电图试验及动态心电图监测中心肌缺血的影响。方法：２５例经冠状动脉造影或核素显像确诊为冠状动脉粥样硬化性心脏病（冠心病）、心电平板运动试验及２４小时动态心电图监测阳性的病人随机分为氨氯地平组（１３例）和阿替洛尔组（１２例），观察用药前及用药后２周下述指标变化：①心率及收缩压和两者乘积变化；②运动诱发心绞痛发作所需时间变化；③运动后ＳＴ段下降０．１ｍＶ所需时间变化；④动态心电图监测中平均缺血发作次数及总的缺血时间变化。以ｔ检验进行用药前后自身对照检验。结果：①氨氯地平只引起心率、收缩压及心率与收缩压乘积轻度变化（Ｐ＞０．０５）；阿替洛尔能明显减慢心率、降低收缩压及心率与收缩压乘积（Ｐ＜０．０１）。②氨氯地平与阿替洛尔均能延缓运动诱发心绞痛出现时间，以氨氯地平更为显著（分别为Ｐ＜０．０１及Ｐ＜０．０５）。③氨氯地平能明显延长运动试验时ＳＴ段下降０．１ｍＶ所需时间（Ｐ＜０．０１），阿替洛尔组无变化（Ｐ＞０．０５）。④阿替洛尔能明显抑制动态心电图监测中心肌缺血发作频率，缩短缺血时间（Ｐ＜０．０１），氨氯地平无明显作用（Ｐ＞０．０５）。结论：氨?Objectives:The effects of amlodipine and atenolol on myocardial ischemia during treadmill testing and 24 h ambulatory EKG monitoring were studied. Methods:Twenty five patients with coronary artery disease documented by angiography or radionuclide imaging and with ischemia during treadmill testing and ambulatory EKG monitoring were randomized to receive amlodipine (5 mg QD for the first 3 days and then 5 mg bid, n =13) or atenolol (initial daily dose of 25 mg,and then increase of 25 mg every 2 days,up to maximal tolerable dose of 50 100 mg/day, n =12) for 2 weeks.The following indexes were observed:①Heart rate,systolic pressure and double product;②Time for inducing angina by exercise;③Time for inducing 0 1 mV ST segment depression by exercise;④Frequency and duration of ischemic episodes during ambulatory monitoring. Results:①Amlodipine caused only slight changes in heart rate,systolic pressure and double product ( p >0 05),while atenolol significantly reduced heart rate,systolic pressure and double product( p <0 01);②During treadmill testing,both amlodipine and atenolol delayed the onset of angina( p <0 01 and p <0 05,respectively);③Comparing with atenolol,amlodipine significantly prolonged time for inducing 0 1 mV ST segment depression by exercise;④During ambulatory monitoring,atenolol markedly decreased the frequency and duration of ischemic episodes( p <0 01),but amlodipine had no significant effect on myocardial ischemia. Conclusion:Amlodipine mainly improves myocardial ischemia induced by treadmill exercise and atenolol significantly decreases the episodes of myocardial ischemia during ambulatory monitoring.The combined use of amlodipine and atenolol could markedly inhibit the onset of angina pectoris and episode of asymptomatic myocardial ischemia in patients of coronary heart disease.

关 键 词：心肌缺血 氨氯地平 阿替洛尔 动态心电图 

分 类 号：R541.405[医药卫生—心血管疾病]