Ciopor M, Fischer A, Turina J, Hess O M
Inselspital, Bern.
Praxis (Bern 1994). 1997 Nov 19;86(47):1849-53.
Angina pectoris in patients with severe 3-vessel-disease refractory to treatment is a challenge for the treating physician. We have therefore tested the treatment efficacy of isosorbide dinitrate combined with molidomine on the frequency of angina pectoris in patients with symptoms refractory to treatment.
15 patients with severe coronary heart disease were included in the study. The protocol included a 2-weeks stabilisation phase, followed by a 4-weeks treatment phase with 100 mg isosorbide dinitrate in the morning as well as 8 mg slow-release molsidomine at 6 p.m.
Initially all of the 15 patients reported about daily angina pectoris attacks. After 4 weeks of treatment 4 out of 15 patients became free of symptoms. From the other 11 patients 6 reported an improvement, 5 an unchanged frequency of attacks.
Combination treatment with isosorbide dinitrate with molsidomine in a slow-release form (in the nitrate free interval) showed a distinct improvement in patients with angina pectoris refractory to treatment with reduction of complaints. The effect of the combination is possibly based on a prolonged vasodilatation of the stenosed vessels and a prolonged reduction of filling pressure (reduction of preload).
对于患有严重三支血管病变且治疗难治的心绞痛患者，治疗医生面临着挑战。因此，我们测试了硝酸异山梨酯联合吗多明对治疗难治性症状患者心绞痛发作频率的治疗效果。
15例严重冠心病患者纳入研究。方案包括为期2周的稳定期，随后是为期4周的治疗期，早上服用100mg硝酸异山梨酯，下午6点服用8mg缓释吗多明。
最初，15例患者均报告每日有心绞痛发作。治疗4周后，15例患者中有4例症状消失。另外11例患者中，6例报告病情改善，5例发作频率未变。
硝酸异山梨酯与缓释吗多明（在无硝酸盐间隔期）联合治疗对治疗难治性心绞痛患者有明显改善，症状减轻。联合治疗的效果可能基于狭窄血管的血管舒张延长和充盈压的持续降低（前负荷降低）。
