Bonnier J J, Huizer T, Troquay R, van Es G A, de Jong J W
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Am J Cardiol. 1990 Jul 15;66(2):145-50. doi: 10.1016/0002-9149(90)90578-o.
The possible cardioprotective effect of diltiazem during ischemia caused by percutaneous transluminal coronary angioplasty was tested. Electrocardiograms and myocardial lactate, hypoxanthine and urate production were determined in 26 patients with a stenosis in the left anterior descending artery without angiographically demonstrable collaterals. Measurements took place before angioplasty, after each of 4 occlusions and 15 minutes after the last balloon inflation. Patients were randomly given placebo or DL-diltiazem (0.4 mg/kg as a bolus intravenously, followed by an infusion of 15 mg/hr). During angioplasty the ST-segment elevation for the anterior wall leads V2, V4 and V6, and the intracoronary lead was similar for both groups, as was lactate release. Diltiazem significantly reduced cardiac hypoxanthine release immediately after angioplasty from 63 to 88% (p less than 0.05). The drug diminished urate production after the last dilatation by 82% (p less than 0.05). In conclusion, intravenous infusion of diltiazem reduced cardiac adenosine triphosphate breakdown during angioplasty as shown by diminished hypoxanthine and urate production. In contrast, diltiazem was unable to attenuate ST-segment elevation and lactate release.
对在经皮腔内冠状动脉成形术引起的局部缺血期间地尔硫䓬可能的心脏保护作用进行了测试。在26例左前降支狭窄且血管造影未显示有侧支循环的患者中测定了心电图以及心肌乳酸、次黄嘌呤和尿酸盐的生成。测量在血管成形术前、4次阻断每次之后以及最后一次球囊扩张后15分钟进行。患者被随机给予安慰剂或DL-地尔硫䓬（0.4mg/kg静脉推注，随后以15mg/hr输注）。在血管成形术期间，两组前壁导联V2、V4和V6以及冠状动脉内导联的ST段抬高以及乳酸释放情况相似。地尔硫䓬在血管成形术后立即使心脏次黄嘌呤释放量显著降低，从63%降至88%（p<0.05）。该药物使最后一次扩张后尿酸盐生成减少了82%（p<0.05）。总之，静脉输注地尔硫䓬在血管成形术期间减少了心脏三磷酸腺苷的分解，表现为次黄嘌呤和尿酸盐生成减少。相比之下，地尔硫䓬无法减轻ST段抬高和乳酸释放。
