联合万爽力全面治疗缺血性心脏病 课件.ppt

谢 谢 20mg 一天三次 * 临床实践证明，单独使用某一类药物控制心绞痛往往难以取得满意疗效，常需联合用药。Topol心血管病学也明确指出，联合用药是治疗心绞痛的最佳方案。 * * Courage研究入选来自加拿大50多个医疗中心近2300例明显心肌缺血或冠心病患者，随机分为PCI（1149人）和最佳药物治疗（1138人）两组。随访期间，仍有30%的受试者会再发心绞痛。而真实世界中的发生率也远高于此。 此外该研究也说明了症状控制是一个综合管理过程，目前一线药物“阿司匹林，BB,ACEI和他汀”联合疗效仍不够理想 * 传统的药物治疗涉及一些血液动力学制剂，这些制剂或减少心肌耗氧或增加血流量，但疗效往往不令人满意，很多患者的心绞痛症状不能得到控制。多项研究表明，血液动力学药物联用有累加，并非有显著疗效。 IMAGE OBJECTIVES. This study was designed to investigate whether combination therapy with metoprolol and nifedipine provides a greater anti-ischemic effect than does monotherapy in individual patients with stable angina pectoris. BACKGROUND. Combination therapy with a beta-adrenergic blocking agent (which reduces myocardial oxygen consumption) and a dihydropyridine calcium antagonist (which increases coronary blood flow) is a logical approach to the treatment of stable angina pectoris. However, it is not clear whether, in individual patients, this combined therapy is more effective than monotherapy. METHODS. Two hundred eighty patients with stable angina pectoris were enrolled in a double-blind trial in 25 European centers. Patients were randomized (week 0) to metoprolol (controlled release, 200 mg once daily) or nifedipine (Retard, 20 mg twice daily) for 6 weeks; placebo or the alternative drug was then added for a further 4 weeks. Exercise tests were performed at weeks 0, 6 and 10. RESULTS. At week 6, both metoprolol and nifedipine increased the mean exercise time to 1-mm ST segment depression in comparison with week 0 (both p 0.01); metoprolol was more effective than nifedipine (p 0.05). At week 10, the groups randomized to combination therapy had a further increase in time to 1-mm ST segment depression (p 0.05 vs. placebo). Analysis of the results in individual patients revealed that 7 (11%) of 63 patients adding nifedipine to metoprolol and 17 (29%) of 59 patients (p 0.0001) adding metoprolol to nifedipine showed an increase in exercise tolerance that was greater than the 90th percentile of the distribut