Weaver W D
Circulation. 1986 Dec;74(6 Pt 2):IV94-7.
Calcium channel-blocking drugs have potent antiarrhythmic and antianginal effects and in addition may reduce the extent of cellular injury after anoxia/ischemia. Verapamil is the treatment of choice (90% effective) for uncomplicated episodes of paroxysmal supraventricular tachycardia. All three calcium-channel blockers available, diltiazem, nifedipine, and verapamil, can reduce the frequency of angina occurring both at rest and with exertion. Calcium may mediate several cytotoxic events during the reperfusion period after prolonged ischemia that lead to irreversible cell injury. There is experimental evidence that calcium-channel blockers may reduce the cellular influx of calcium after ischemia and reperfusion, and thereby attenuate cerebral and myocardial injury, although most studies have failed to show benefit of treatment unless the drug is administered before the onset of ischemia. Most trials using calcium-channel blockers in the setting of acute myocardial infarction have failed to show a benefit of treatment. The safety and efficacy of calcium-channel blockers have yet to be shown in controlled studies of human resuscitation, although the potential for such treatment, if it is effective in attenuating myocardial cerebral cellular injury, could be enormous.
钙通道阻滞剂具有强大的抗心律失常和抗心绞痛作用，此外还可能减轻缺氧/缺血后的细胞损伤程度。维拉帕米是治疗单纯性阵发性室上性心动过速发作的首选药物（有效率达90%）。现有的三种钙通道阻滞剂，地尔硫䓬、硝苯地平和维拉帕米，都能降低静息时和运动时心绞痛发作的频率。在长时间缺血后的再灌注期，钙可能介导多种细胞毒性事件，导致不可逆的细胞损伤。有实验证据表明，钙通道阻滞剂可能减少缺血和再灌注后细胞内钙的流入，从而减轻脑和心肌损伤，不过大多数研究未能显示出治疗益处，除非在缺血发作前给药。大多数在急性心肌梗死情况下使用钙通道阻滞剂的试验都未能显示出治疗益处。钙通道阻滞剂在人体复苏对照研究中的安全性和有效性尚未得到证实，尽管如果这种治疗在减轻心肌和脑细胞损伤方面有效，其潜力可能巨大。
