地尔硫卓对冠心病心绞痛患者冠状动脉血流储备与血管内皮的影响  

Influence of diltiazem on coronary flow reserve and vascular endothelial function in patients with coronary heart disease and angina pectoris

作　　者：张富山[1] 张宇[2] 蔡俊 黄建领 赵俊涛[1] 刘广文[1] 张伟峰[1] Zhang Fushan;Zhang Yu;Cai Jun;Huang Jianling;Zhao Juntao;Liu Guangwen;Zhang Weifeng(Department of Heart Surgery,Seventh People's Hospital of Zhengzhou City,Zhengzhou 450000,China;不详)

机构地区：[1]郑州市第七人民医院心脏外科,郑州450000 [2]郑州市第七人民医院心脏内科,郑州450000

出　　处：《中国循证心血管医学杂志》2023年第3期325-328,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨地尔硫卓对冠状动脉粥样硬化性心脏病(冠心病)心绞痛患者冠状动脉(冠脉血流储备与血管内皮的影响。方法选自2018年1月至2021年12月于郑州市第七人民医院心脏外科收治的100例冠心病心绞痛患者随机分成对照组(富马酸比索洛尔治疗)与观察组(富马酸比索洛尔+地尔硫卓治疗),每组各50例,均治疗4周。观察两组的心绞痛发生情况(发作次数、疼痛程度、持续时间)、冠脉血流储备(D/R PDV、D/R PSV)、血管内皮指标(内皮素-1、血管内皮生长因子、一氧化氮)、临床疗效以及不良反应(恶心呕吐、头晕头痛、疲倦、失眠、皮疹)。结果观察组患者的心绞痛发作次数、疼痛程度评分、持续时间均低于对照组(P<0.05);两组治疗后的D/R PDV、D/R PSV均较治疗前增加(P<0.05),且观察组治疗后的D/R PDV、D/R PSV均高于对照组(P<0.05);两组治疗后的内皮素-1、血管内皮生长因子均降低(P<0.05),一氧化氮升高(P<0.05),且观察组治疗后的内皮素-1、血管内皮生长因子均低于对照组(P<0.05),一氧化氮高于对照组(P<0.05);观察组总有效率为86.00%,高于对照组的68.00%(P<0.05);两组不良反应发生率比较,无统计学差异(P>0.05)。结论地尔硫卓联合富马酸比索洛尔对冠心病心绞痛的疗效确切,可减少患者心绞痛的发作次数、持续时间,减轻疼痛程度,并能改善冠脉血流储备,减轻血管内皮损伤,有效性与安全性均较好,值得临床应用。Objective To discuss the influence of diltiazem on coronary flow reserve(CFR)and vascular endothelial function in patients with coronary heart disease and angina pectoris(CHD-AP).Methods CHD-AP patients(n=100)were chosen from Department of Heart Surgery in the Seventh People’s Hospital of Zhengzhou City from Jan.2018 to Dec.2021,ad then randomly divided into control group(treated with bisoprolol fumarate for 4 weeks)and observation group(treated with bisoprolol fumarate+diltiazem for 4 weeks,each n=50).The occurrence of AP(including attack times,pain degree,duration),coronary flow reserve(CFR,including D/R PDV,D/R PSV),vascular endothelial indexes[including endothelin-1(ET-1),vascular endothelial growth factor(VEGF),nitric oxide(NO)],clinical efficacy and adverse reactions(including nausea and vomiting,dizziness,headache,fatigue,insomnia,rash)were observed in 2 groups.Results The attack times,scores of pain degree and duration of AP were lower in observation group than those in control group(P<0.05).After treatment,D/R PDV and D/R PSV increased in 2 groups(P<0.05),and D/R PDV and D/R PSV were higher in observation group than those in control group(P<0.05).ET-1 and VEGF decreased(P<0.05),NO increased(P<0.05)in 2 groups after treatment,and ET-1 and VEGF were lower(P<0.05)and NO was higher(P<0.05)in observation group than those in control group.The total effective rate was 86.00%in observation group and 68.00%in control group(P<0.05).The comparison in adverse reaction incidence showed no statistical difference between 2 groups(P>0.05).Conclusion Diltiazem combined with bisoprolol fumarate has reliable curative effect on CHD-AP,and can reduce attack times,duration and pain degree of AP,improve CFR and relieve vascular endothelial injury.Diltiazem combined with bisoprolol fumarate has higher effectiveness and safety and is worth clinical administration.

关 键 词：地尔硫卓 冠心病 心绞痛 冠脉血流储备 血管内皮 

分 类 号：R541.4[医药卫生—心血管疾病]