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缺血性心脏病的现代治疗是通过应用β-肾上腺能阻滞剂和硝酸盐类以降低心肌需氧量,其基础是推测在冠状动脉(简称冠脉)已有阻塞性病变时心肌供氧所受的限制。然而愈来愈多证据表明,心肌缺血也可以因异常冠脉收缩所致。业已证明冠脉痉挛是变异型心绞痛、静息性心绞痛和某些已有阻塞性冠脉病变患者心肌梗塞的原因。心痛定是钙离子拮抗剂,具有强烈扩张血管作用,能预防冠脉痉挛。据此,作者选择15例对冷加压试验有异常血管收缩反应的冠脉病和稳定型劳力性心绞痛患者为对象,以评价本药的作用。结果在对照冷加压试验时,15例均有异常冠脉收缩(尽管14/15例一直服用心得安,12/15例服用长效硝酸盐制剂),其平均冠脉阻力增加18±6%(SD)(从0.80±0.12增至0.94±0.20mmHg/ml/min,P<0.05);冠状窦血流量无改变,但动脉-冠状窦氧差显著增加(从11.5±1.2增至12.3±1.2ml/100ml,P<0.05),4例发生心绞痛伴有负性动脉-冠状窦乳酸盐差。10例服用心痛定10mg 后,其冠状血管对重复冷加压试验的反应均正常,平均冠状窦血流量增加27±12%(从122±32增至153±35ml/min,
Modern treatment of ischemic heart disease is through the application of β-adrenergic blockers and nitrates to reduce myocardial oxygen demand, which is based on the speculation that coronary artery (referred to as coronary artery) has obstructive lesions of myocardial oxygen Restrictions. However, more and more evidence shows that myocardial ischemia can also be caused by abnormal coronary contractions. Coronary spasm has been shown to be responsible for variant angina, rest angina, and myocardial infarction in some patients with obstructive coronary disease. Heartache is a calcium antagonist, with a strong dilation of blood vessels, can prevent coronary spasm. Accordingly, the authors selected 15 cases of coronary artery disease and stable angina pectoris patients with abnormal vasoconstrictor response to cold stress test to evaluate the effect of this medicine. Results In the control cold compression test, all 15 patients had abnormal coronary systolic (although 14/15 had been treated with propranolol and 12/15 with long-acting nitrate), the mean coronary resistance increased by 18 ± 6% (SD) increased from 0.80 ± 0.12 to 0.94 ± 0.20 mmHg / ml / min, P <0.05. There was no change in coronary sinus blood flow, but the arterial-coronary sinus oxygen increased significantly from 11.5 ± 1.2 to 12.3 ± 1.2 ml / 100ml, P <0.05), 4 cases of angina accompanied with negative artery - coronary sinus lactic acid salt difference. 10 patients taking nifedipine 10mg, the response of coronary vessels to repeated cold compression tests were normal, mean coronary sinus blood flow increased by 27 ± 12% (from 122 ± 32 to 153 ± 35ml / min,