Tilmant P Y, Lablanche J M, Thieuleux F A, Dupuis B A, Bertrand M E
Am J Cardiol. 1983 Aug;52(3):230-3. doi: 10.1016/0002-9149(83)90113-3.
This study determines, with quantitative variables, if propranolol is detrimental in patients with documented coronary arterial spasm and if this drug can be used in combination with calcium antagonists. Eleven patients with documented coronary spasm were entered prospectively in a study with 4 phases of 2 days each: (1) control, (2) diltiazem or propranolol (mean 225 +/- 75 mg/day), (3) propranolol or diltiazem (360 mg/day), (4) propranolol and diltiazem. The effects of the drugs were assessed by the detection of ischemic electrocardiographic episodes (24-hour electrocardiographic monitoring) and provocative tests with ergonovine. During the period of treatment with propranolol, the number and the duration of attacks increased and provocative tests had positive results in all patients. Diltiazem completely abolished spontaneous episodes, but 6 of 11 patients remained sensitive to the administration of ergonovine. The association of the 2 drugs led to a disappearance of ischemic episodes. In conclusion, propranolol is ineffective in patients with coronary artery spasm. It can be used in combination with diltiazem, but without any advantage over diltiazem alone.
本研究通过定量变量来确定普萘洛尔对已确诊冠状动脉痉挛患者是否有害，以及该药物是否可与钙拮抗剂联合使用。11例已确诊冠状动脉痉挛的患者前瞻性地进入一项研究，该研究分为4个阶段，每个阶段为期2天：(1) 对照期；(2) 地尔硫䓬或普萘洛尔（平均225±75毫克/天）；(3) 普萘洛尔或地尔硫䓬（360毫克/天）；(4) 普萘洛尔和地尔硫䓬。通过检测缺血性心电图发作（24小时心电图监测）和麦角新碱激发试验来评估药物疗效。在使用普萘洛尔治疗期间，发作次数和持续时间增加，且激发试验在所有患者中均呈阳性结果。地尔硫䓬完全消除了自发发作，但11例患者中有6例对麦角新碱给药仍敏感。两种药物联合使用导致缺血发作消失。总之，普萘洛尔对冠状动脉痉挛患者无效。它可与地尔硫䓬联合使用，但并不比单独使用地尔硫䓬有任何优势。
