直到最近为止,冠心病的内科治疗原则仍是降低心肌需氧量。由于粥样硬化病变一直认为是固定不变的狭窄,不可能增加冠脉血流量,因此认为用药物扩张冠状动脉是徒劳的。在近几年内这些概念有了基本转变。然而仅能引起远端心肌内小动脉扩张的药物却起着相反的作用。当心外膜冠状动脉有粥样硬化时,冠状小动脉扩张可加重血流分布异常,导致心肌缺血。冠状循环由近端大冠状动脉及其分枝小动脉组成的心肌内动脉网构成。近端大冠状 Until recently, the principle of medical treatment of coronary heart disease is still to reduce myocardial oxygen demand. As atherosclerotic lesions have been considered fixed stenosis, it is impossible to increase coronary blood flow, so that the use of drugs to expand the coronary artery is futile. These concepts have undergone a fundamental shift in recent years. However, drugs that can only cause dilatation of the distal arteries in the distal myocardium have the opposite effect. Beware of adventitial coronary atherosclerosis, coronary artery dilatation can increase the abnormal distribution of blood flow, leading to myocardial ischemia. Coronary circulation from the proximal large coronary arteries and their branches composed of intra-arterial artery network. Proximal large coronary