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目的:评价不同钙拮抗剂对冠状动脉痉挛(CAS)患者的临床疗效和不良反应。方法:518例CAS患者分别接受地尔硫类(306例)、硝苯地平控释剂(132例)及贝尼地平(80例)3种钙拮抗剂治疗,每3个月随访1次,以胸痛或胸闷发作次数减少50%以上为治疗有效,比较3种钙拮抗剂的疗效、不良反应发生率及长期维持率,并根据胸痛或胸闷发作时是否伴有ST段抬高分为典型和非典型CAS组,比较2组患者对不同钙拮抗剂的疗效。结果:3类钙拮抗剂的有效率为:贝尼地平(90%)和地尔硫类(83%)均高于硝苯地平控释剂(74%,P<0.01及0.05);不良反应发生率地尔硫组与硝苯地平控释剂组(均为9%)显著高于贝尼地平组(0,P<0.01);贝尼地平的长期维持率(90%)显著高于地尔硫类(74%,P<0.01)和硝苯地平控释剂(67%,P<0.01);3种钙拮抗剂对典型CAS患者的疗效相似且均优于非典型患者,对于非典型患者,硝苯地平控释剂有效率(62%)显著低于地尔硫(81%,P<0.01)和贝尼地平(88%,P<0.01)。结论:3种钙拮抗剂均能有效地治疗CAS,但地尔硫疗效优于硝苯地平控释剂,而贝尼地平的疗效和依从性最好。
Objective: To evaluate the clinical efficacy and adverse reactions of different calcium antagonists in patients with coronary artery spasm (CAS). Methods: A total of 518 patients with CAS were treated with three kinds of calcium antagonists such as diltiazem (n = 306), nifedipine controlled release (n = 132) and benidipine (n = 80) Times, in order to reduce the incidence of chest pain or chest tightness more than 50% for the treatment of effective comparison of the efficacy of three kinds of calcium antagonists, the incidence of adverse reactions and long-term maintenance rate, and chest pain or chest distress is accompanied by ST segment elevation is divided into Typical and atypical CAS groups, the efficacy of different calcium antagonists in two groups was compared. RESULTS: The efficacies of the three types of calcium antagonists were higher than that of nifedipine (74%, P <0.01 and 0.05) for benidipine (90%) and diltiazem (83%), respectively. Adverse reactions occurred in diltiazem group and nifedipine controlled-release group (both 9%) was significantly higher than the benidipine group (0, P <0.01); long-term maintenance of benidipine (90%) was significantly Higher than diltiazem (74%, P <0.01) and nifedipine controlled release (67%, P <0.01). The three calcium antagonists showed similar efficacy to typical CAS patients and were superior to those of atypical Patients (62%) were significantly less effective than Diltiazem (81%, P <0.01) and benidipine (88%, P <0.01) for atypical patients. CONCLUSION: All three calcium antagonists can effectively treat CAS. However, diltiazem is superior to nifedipine in controlled release, while benidipine has the best efficacy and compliance.