目的 研究地尔硫卓静治疗非ST段抬高型急性冠状动脉综合征难治性心肌缺血(NSTEACS-RMI)的临床疗效.方法 选择2012年1月~2015年12月于广州市番禺区第二人民医院内科接受治疗的老年NSTEACS-RMI患者124例,按照随机数字表法分为地尔硫卓组(n=64)与对照组(n=60),对照组患者给予阿司匹林、低分子肝素、氯吡格雷、血管紧张素转化酶抑制剂、倍他乐克及他汀类降酯药物等常规药物治疗,地尔硫卓组行常规治疗联合地尔硫卓治疗.治疗7 d后观察两组治疗前后血压、心率、胸痛频率及每次持续时间、心肌缺血程度及范围(以NST表示常规12导联ST段压低在0.2 mV以上导联数;以∑ST表示12导联ST段压低之和),NST、∑ST以飞利浦TC30心电图机检测、以美国PI AECG系统检测心率变异性(HRV),记录传导阻滞、心动过缓、心力衰竭、心律失常等不良反应及评估临床疗效.结果 治疗后,地尔硫卓组血压、心率、胸痛频率及每次持续时间、含服硝酸甘油次数、NST、∑ST均低于对照组,差异有统计学意义(P均<0.05).治疗后,地尔硫卓组各心率变异性指标均较对照组显著改善,差异有统计学意义(P均<0.05).地尔硫卓组总有效率(90.63%)高于对照组(61.67%),差异有统计学意义(P<0.05).地尔硫卓组不良反应发生率(6.25%)与对照组不良反应发生率(1.56%)比较,差异无统计学意义(P>0.05).结论 地尔硫卓可显著改善NSTEACS-RMI患者心肌缺血状态,改善临床症状,不良反应发生率低,值得应用于临床.%Objective To study the clinical efficacy of diltiazem on non-ST-segment elevation acute coronary syndrome and refractory myocardial ischemia (NSTEACS-RMI).Methods The patients with NSTEACS-RMI (n=124) were chosen from the Department of Internal Medicine, Second People's Hospital of Panyu District in Guangzhou from the Jan. 2012 to Dec. 2015, and then divided randomly into diltiazem group (n=64) and control group (n=60). The control group was treated with routine drugs including aspirin, low molecular weight heparin (LMWH), clopidogrel, angiotensin converting enzyme inhibitor (ACEI), metoprolol and statins, and diltiazem group, additionally with diltiazem (10 mg). The indexes of blood pressure (BP), heart rate (HR), frequency and duration of chest pain and extent of myocardial ischemia were observed, changes of NST, ∑ST and heart rate variability (HRV) were detected, and adverse reactions including conduction block, bradyarrhythmia, heart failure and arrhythmias were recorded, and clinical efficacy was reviewed in 2 groups after treatment for 7 d.Results After treatment, BP, HR, frequency and duration of chest pain, times of taking nitroglycerin, NST and ∑ST were all lower in diltiazem group than those in control group (all P<0.05). The all indexes of HRV were ameliorated significantly in diltiazem group compared with control group after treatment (allP<0.05). The total effective rate was 90.63% in diltiazem group and 61.67% in control group (P<0.05). The incidence of adverse reactions was 6.25% in diltiazem group and 1.56% in control group (P>0.05).Conclusion Diltiazem can significantly relieve myocardial ischemia and clinical symptoms with lower incidence of adverse reactions in patients with NSTEACS-RMI, and it is worth clinical application.
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