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作者研究维拉帕米(verapamil)对心肌缺血发作时动脉血和冠状静脉血儿茶酚胺含量的影响,检查32例男性病人,年龄34～62岁。第1组22例,冠心病和稳定性心绞痛,心功能Ⅱ～Ⅲ级。第2组10例,神经性循环张力障碍和心痛综合征,没有心肌梗塞史。两组均无心瓣膜病和高血压病。所有病人记录12导联心电图,施行选择性冠状动脉造影。插入导管到冠状窦进行心房刺激试验。第1组出现心绞痛或心电图ST 段降低1mm 时停止刺激;第2组刺激频率达160/min 时停止。测定心搏量,冠状窦血流速度。同时从主动脉和冠状窦取血样,测定多巴胺、肾上腺素和去甲肾上腺素含量。然后第1组静脉注射维拉帕米10mg,15min 后复查儿茶酚胺含量。结果第1组冠状动脉造影发现左冠状动脉系统有1支血管闭塞者12例,2支血管损害者9例,左冠状动脉干损害者1例。第2组冠状动脉造影无变化。心房刺激试验,由于能量需求增加,第2组心搏量增加(P<0.05),冠状窦血流速度加快(P<0,05),无心肌缺血症状。第1组心搏量和冠状窦血流速度只有轻度增加,出现心肌缺血性心电图变化和心绞痛。
The authors investigated the effects of verapamil on arterial and coronary venous blood catecholamines during myocardial ischemia and examined 32 male patients aged 34 to 62 years. The first group of 22 cases, coronary heart disease and stable angina, cardiac function Ⅱ ~ Ⅲ grade. The second group of 10 patients, nervous circulatory dystonia and heartache syndrome, no history of myocardial infarction. Both groups had no heart valve disease and hypertension. All patients recorded a 12-lead electrocardiogram with selective coronary angiography. A catheter was inserted into the coronary sinus to perform an atrial stimulation test. Group 1 angina pectoris or ST-segment electrocardiogram decreased 1mm stop stimulation; Group 2 stimulation frequency of 160 / min stop. Measurement of stroke volume, coronary sinus blood flow velocity. Blood samples were also taken from the aorta and coronary sinus to determine dopamine, epinephrine and norepinephrine levels. Then the first group intravenous verapamil 10mg, 15min review catecholamines. Results In the first group of coronary angiography, there were 12 cases of 1 vessel occlusion in the left coronary artery system, 9 cases of 2 vessel lesion and 1 case of left coronary artery lesion. Group 2 coronary angiography no change. In the atrial stimulation test, the cardiac volume increased in group 2 (P <0.05) due to the increase of energy requirement, and the coronary sinus blood flow accelerated (P <0,05), with no symptoms of myocardial ischemia. Group 1 echocardiography and coronary sinus blood flow velocity only mild increase in myocardial ischemic electrocardiogram changes and angina pectoris.