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目的:探讨超短效β受体阻滞剂艾司洛尔缓解严重冠状动脉病变所致心肌缺血的效果。方法:连续入选冠状动脉病变严重的冠心病患者57例,男34例,女23例,年龄55~87,平均(69±19)岁。所有入选患者均具有与心肌缺血相关的典型症状,心电图有缺血性ST-T改变,不具备条件或不愿意行血运重建,常规使用硝酸酯、吗啡等药物后症状未能完全缓解;给予盐酸艾司洛尔注射液,以用药前及之后4h为疗效评价时间点;其指标包括症状评分、血常规及心肌标记物,心电图和超声心动图等指标。结果:41例显效,9例有效,7例无效,有效率达87.7%。41例显效患者在用药后(66±23)min症状完全缓解(P<0.0001),心率和血压均显著下降(P<0.0001),心电图ST段恢复至基线(P<0.0001)。9例有效患者在用药后4h症状获得部分缓解,与缺血相关症状减轻(59.1±13.9)%(P<0.0001),心率和血压均显著下降(P<0.0001),心电图ST段较用药前恢复60.1%(P<0.0001)。所有患者用药期间均无严重不良反应。结论:艾司洛尔可迅速、安全、有效缓解因严重冠脉病变导致的心肌缺血症状和心电图ST-T变化。
Objective: To investigate the effect of esmolol, an ultra-short-acting β-blocker, on myocardial ischemia induced by severe coronary artery disease. Methods: Fifty-seven consecutive patients with coronary artery disease and coronary artery disease were enrolled in this study. There were 34 males and 23 females, ranging in age from 55 to 87 with an average of 69 ± 19 years. All selected patients had the typical symptoms associated with myocardial ischemia. The electrocardiogram had ischemic ST-T changes, without conditions or reluctance to revascularization. The symptoms were not completely relieved after the regular use of nitrates and morphine. Esmolol hydrochloride injection was given 4h before and after treatment for evaluation of efficacy time points; indicators include symptom score, blood and myocardial markers, ECG and echocardiography and other indicators. Results: 41 cases were effective, 9 cases were effective, 7 cases were ineffective, the effective rate was 87.7%. In 41 patients with marked effect, symptoms completely relieved (P <0.0001), heart rate and blood pressure decreased significantly (P <0.0001), ST segment recovered to baseline (P <0.0001) after electrocardiogram (66 ± 23) min. Symptoms were partially relieved at 4h after treatment in 9 patients (59.1 ± 13.9)% (P <0.0001), heart rate and blood pressure decreased significantly (P <0.0001), ECG ST segment recovered before treatment 60.1% (P <0.0001). All patients during the medication without serious adverse reactions. Conclusion: Esmolol can quickly and safely relieve the symptoms of myocardial ischemia and ECG ST-T changes caused by severe coronary lesions.