Hirota Y, Saito T, Kita Y, Kino M, Kitaura Y, Kubo S, Kawamura K
Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
Jpn Circ J. 1987 Jun;51(6):617-23. doi: 10.1253/jcj.51.617.
During the past 2 years, 102 patients were treated for unstable angina pectoris (AP) in our department. Fifteen of them had recurrent chest pain at rest despite treatment with various anti-anginal agents, or prolonged chest pain unresponsive to sublingual nitroglycerin; they received intravenous isosorbide dinitrate (ISDN) infusion. A rapid bolus injection of 2 to 6 mg followed by an infusion of 2 to 5 mg/hr was given to 10 patients with acute chest pain, and 5 patients, who were free of chest pain at the time, but had repeated episodes of angina in the past 24 hours, were given ISDN infusion without a bolus injection. Chest pain disappeared completely in 13 patients, but recurred in 2 of them when the dose was tapered. Two other patients experienced recurrent chest pain during ISDN infusion, and additional boluses were given. The hospital course was uneventful in 11 patients. Four patients who had recurrent anginal attacks underwent emergency coronary cineangiography under intraaortic ballon counterpulsation and aorto-coronary bypass surgery. There were no hospital deaths, no one had subsequent acute myocardial infarctions, and only 2 patients had mild to moderate headache as a side effect. Although the patient population is small, intravenous ISDN infusion is useful in the management of severe unstable AP.
在过去两年中，我科对102例不稳定型心绞痛（AP）患者进行了治疗。其中15例患者尽管使用了各种抗心绞痛药物治疗，但仍有静息时复发性胸痛，或胸痛持续时间延长且对舌下含服硝酸甘油无反应；他们接受了静脉注射硝酸异山梨酯（ISDN）治疗。对10例急性胸痛患者给予2至6mg的快速推注，随后以2至5mg/小时的速度输注；另外5例患者当时无胸痛，但在过去24小时内有反复发作的心绞痛，未给予推注直接接受ISDN输注。13例患者胸痛完全消失，但2例在剂量减小时胸痛复发。另外2例患者在ISDN输注期间出现复发性胸痛，给予了额外的推注。11例患者住院过程平稳。4例反复发作心绞痛的患者在主动脉内球囊反搏和主动脉冠状动脉搭桥手术下接受了急诊冠状动脉造影。无住院死亡病例，无患者随后发生急性心肌梗死，仅有2例患者出现轻度至中度头痛作为副作用。尽管患者数量较少，但静脉注射ISDN输注在严重不稳定型AP的治疗中是有用的。
