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钙通道阻滞剂在心血管疾病中的应用已有10余年,对本类药物的作用机理及血流动力学作用已有进一步的认识。本类药物对高血压、心绞痛和部分心律失常的疗效已基本得到肯定,但对慢性心衰的疗效尚有争议。虽有改善心衰的少数报告,但近年来大量的临床研究显示,本类药物对慢性心衰患者的临床症状和运动耐力无改善作用,且可使血流动力学恶化,这已得到理论和实验研究的证实。一、钙通道阻滞剂改善心衰的理论、实验和临床研究早先的实验研究显示,大剂量的乙醇和异丙肾上腺素对心肌细胞的损伤与钙离子的大量内流所致的细胞内钙离子超负荷有关,钙通道阻滞剂则可阻滞钙离子内流和防治心肌细胞的损伤。细胞内钙离子的超负荷可使微小血管痉挛,导致心衰进展,本类药物则可消除这一作用。此外,本类药物的强效扩血管作用,使心脏的前后负荷下降,理论上可改善心衰患者的血流动力学和临床症
The use of calcium channel blockers in cardiovascular diseases has been more than 10 years, the mechanism of action of these drugs and hemodynamic effects have been further understanding. The efficacy of this class of drugs on hypertension, angina and some arrhythmias has been basically confirmed, but the efficacy of chronic heart failure is still controversial. Although there are a few reports of improvement of heart failure, a large number of clinical studies in recent years show that the drugs do not improve the clinical symptoms and exercise tolerance of patients with chronic heart failure and can worsen the hemodynamics, which has been proved theoretically and / Experimental research confirmed. First, the calcium channel blocker to improve the theory of heart failure, experimental and clinical studies Previous experimental studies have shown that large doses of ethanol and isoproterenol on myocardial cell injury and calcium influx caused by a large number of intracellular calcium Ion overload, calcium channel blockers can block calcium influx and prevent myocardial cell injury. Intracellular calcium overload can make micro-vascular spasm, leading to heart failure, the class of drugs can eliminate this effect. In addition, the potent vasodilator effect of these drugs, the heart before and after the load decreased, in theory, can improve hemodynamic and clinical symptoms of heart failure