卡维地洛联合尼可地尔治疗冠状动脉粥样硬化性心脏病心肌缺血合并左心室舒张功能不全的临床有效性及安全性观察  

Efficacy and safety of carvedilol combined with nicorandil in treating coronary atherosclerotic heart disease with myocardial ischemia and left ventricular diastolic dysfunction

作　　者：雷锐[1] 殷实[1] 刘鸿玲[1] 李志[1] 

机构地区：[1]黑龙江省佳木斯市中心医院心内科,154002

出　　处：《中国医药》2017年第1期19-23,共5页China Medicine

摘　　要：目的 探讨卡维地洛联合尼可地尔治疗冠状动脉粥样硬化性心脏病（冠心病）心肌缺血合并左心室舒张功能不全的临床有效性及安全性。 方法 选取2013年1月至 2015年1月黑龙江省佳木斯市中心医院心内科冠心病心肌缺血合并左心室舒张功能不全患者118例作为研究对象，采用随机数字表法分为对照组和观察组，各59例。对照组采用硝酸 异山梨酯、辛伐他汀与阿司匹林等心内科常规治疗，观察组在对照组基础上口服卡维地洛（5 mg/次，1次/d）联合尼可地尔（5 mg/次，3次/d）治疗，2组均连续治疗12周。比较2 组临床疗效、心脏彩色多普勒超声检查参数、ST段压低频次与持续时间的差异。 结果 观察组治疗总有效率［89.8%（53/59）］明显高于对照组［55.9%（33/59）］，差异有 统计学意义（P〈0.05）。治疗后，观察组室间隔舒张末期厚度、左心室后壁舒张末期厚度、舒张晚期二尖瓣血流速度峰值（A峰）明显低于对照组，舒张早期二尖瓣血流速度峰值（ E峰）、E/A比值明显高于对照组，ST段压低频次明显少于对照组，ST段压低持续时间明显短于对照组，差异均有统计学意义［（8.0±0.5）mm比（9.5±0.5）mm、（8.0±0.3）mm 比（9.4±0.6）mm、（59±10）cm/s比（69±14）cm/s、（70±12）cm/s比（60±11）cm/s、（1.17±0.41）比（0.87±0.28）、（2.0±1.1）次/24 h比（3.6±1.3）次/24 h、 （15±4）min比（27±10）min］（均P〈0.05）。2组药物不良反应总发生率差异无统计学意义（P〉0.05）。 结论 卡维地洛联合尼可地尔治疗冠心病心肌缺血合并左心室舒张 功能不全的临床效果较好，且药物安全性较高。Objective To analyze the efficacy and safety of carvedilol combined with nicorandil in the treatment of coronary atherosclerotic heart disease with myocardial ischemia and left ventricular diastolic dysfunction. Methods Totally 118 cases of coronary atherosclerotic heart disease with myocardial ischemia complicated with left ventricular diastolic dysfunction from January 2013 to January 2015 in Jiamusi Central Hospital were randomly divided into observation group and control group, with 59 cases in each group. The control group was treated with routine therapy with isosorbide dinitrate, simvastatin and aspirin; the observation group was added carvedilol and nicorandil for 12 weeks. Clinical effect, heart color Doppler ultrasound parameters, ST-segment depression frequency and duration were analyzed. Results The total effective rate in observation group was significantly higher than that in control group[89.8%（53/59） vs 55.9%（33/59）]（P〈0.05）. Inter-ventricular septum end-diastolic, left ventricular posterior wall end-diastolic, mitral A peak, ST-segment depression frequency and duration were significantly lower and mitral E peak, E/A ratio were significantly higher in observation group than those in control group after treatment[（8.0±0.5）mm vs （9.5±0.5）mm,（8.0±0.3）mm vs （9.4±0.6）mm,（59±10）cm/s vs （69±14）cm/s,（2.0±1.1） times/24 h vs （3.6±1.3）times/24 h,（15±4）min vs （27±10）min,（70±12）cm/s vs （60±11）cm/s,（1.17±0.41） vs （0.87±0.28）]（P〈0.05）. There was no significant difference of adverse drug reaction incidence between groups（P〉0.05）. Conclusion Carvedilol combined with nicorandil treating coronary atherosclerotic heart disease myocardial ischemia complicated with left ventricular diastolic dysfunction is safe and effective.

关 键 词：冠状动脉疾病 卡维地洛 尼可地尔 心肌缺血 左心室舒张功能不全 

分 类 号：R541.4[医药卫生—心血管疾病]