冠心病心绞痛速效制剂的临床应用调查及应用建议
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摘要
目的分析冠心病心绞痛患者应用缓解心绞痛速效制剂的临床情况并提出应用建议。方法收集明确诊断为冠心病心绞痛的患者,对其临床应用速效制剂情况进行横断面调查,同时对不同心绞痛分型、心绞痛程度分级(CCS分级)患者选用速效制剂的种类、选用原因、不良反应等进行统计分析。结果纳入的1455例患者中,曾经用过速效制剂者1239例,其中最常用的为速效救心丸406例(32. 77%),硝酸甘油355例(28. 65%),前者在各型、各级心绞痛中的应用比例均高于后者。正在应用速效制剂者1195例,其中选效救心丸537例(44. 94%),硝酸甘油532例(44. 52%),前者在稳定劳力型、初发劳力型、自发型及CCS分级Ⅱ级患者中应用比例均高于后者,但在恶化劳力型及CCS分级Ⅲ级和Ⅳ级患者中的应用比例则低于后者。患者反馈选择中药制剂的原因,效果良好者401例(56. 56%),无明显不良反应者146例(20. 59%);选择西药制剂的原因,效果良好者443例(61. 19%),无明显不良反应者87例(12. 02%)。不良反应分析,服用硝酸酯类药物患者中,297例(25. 47%)曾出现程度较轻的不良反应,26例(2. 23%)曾出现反应强烈的不良反应;服用中药速效制剂患者中,27例(2. 33%)曾出现程度较轻的不良反应,6例(0. 52%)曾出现反应强烈的不良反应。结论冠心病心绞痛患者中以速效救心丸为代表的中药制剂在相对稳定、程度较轻的患者中应用较多,对较重程度心绞痛的应用情况不及硝酸甘油,但不良反应较少。
Objective To analyze the clinical situation of patients with coronary heart disease angina pectoris treated by fast-acting preparation of releasing angina pectoris and to put forward application recommendations.Methods Patients with a definitive diagnosis of coronary heart disease and angina pectoris were enrolled. A crosssectional survey was conducted on the clinical application of fast-acting preparations. The types of fast-acting preparations,reasons for selection,adverse reactions,that selected for patients with different angina pectoris types and angina pectoris pain classification( Canadian Cardiovascular Society,CCS classification) were statistically analyzed.Results Among the included 1455 patients,1239 patients had used quick-acting preparations. The most commonly used was Suxiao Jiuxin Pills( 速效救心丸) for 406 cases( 32. 77%),and nitroglycerin for 355 cases( 28. 65%).The former had the higher ratio than the latter in the application of types and grades of angina pectoris. Totally 1195 cases were using fast-acting preparations,among which 537 cases( 44. 94%) used Suxiao Jiuxin Pills and 532 cases( 44. 52%) used nitroglycerin. The former had the higher ratio than the latter in the application in stable labor type,initial labor type,self-occurrence type and CCS grade Ⅱ patients,but lower in the application in patients with deteriorating labor type and CCS grades Ⅲ and Ⅳ. The patient responded to the choice of traditional Chinese medicine preparations that 401 cases( 56. 56%) achieved good efficacy,146 cases( 20. 59%) without obvious adverse reactions;and the reasons for choosing western medicine preparations were 443 cases( 61. 19%) with good effects,and 87 cases( 12. 02%) without obvious adverse reactions. For the analysis of adverse reactions,in patients taking nitrates,297 cases( 25. 47%) had milder adverse reactions,and 26 cases( 2. 23%) had strong reaction reactions; in patients taking traditional Chinese medicine quick-acting preparations,27 cases( 2. 33%) had a milder adverse reaction,and6 cases( 0. 52%) had a strong adverse reaction. Conclusion The traditional Chinese medicine preparations represented by Suxiao Jiuxin Pills in coronary heart disease patients with angina pectoris are more widely used in patients with relatively stable and milder degree. The application of heavier angina is less than that of nitroglycerin,but the adverse reactions are less.
Objective To analyze the clinical situation of patients with coronary heart disease angina pectoris treated by fast-acting preparation of releasing angina pectoris and to put forward application recommendations.Methods Patients with a definitive diagnosis of coronary heart disease and angina pectoris were enrolled. A crosssectional survey was conducted on the clinical application of fast-acting preparations. The types of fast-acting preparations,reasons for selection,adverse reactions,that selected for patients with different angina pectoris types and angina pectoris pain classification( Canadian Cardiovascular Society,CCS classification) were statistically analyzed.Results Among the included 1455 patients,1239 patients had used quick-acting preparations. The most commonly used was Suxiao Jiuxin Pills( 速效救心丸) for 406 cases( 32. 77%),and nitroglycerin for 355 cases( 28. 65%).The former had the higher ratio than the latter in the application of types and grades of angina pectoris. Totally 1195 cases were using fast-acting preparations,among which 537 cases( 44. 94%) used Suxiao Jiuxin Pills and 532 cases( 44. 52%) used nitroglycerin. The former had the higher ratio than the latter in the application in stable labor type,initial labor type,self-occurrence type and CCS grade Ⅱ patients,but lower in the application in patients with deteriorating labor type and CCS grades Ⅲ and Ⅳ. The patient responded to the choice of traditional Chinese medicine preparations that 401 cases( 56. 56%) achieved good efficacy,146 cases( 20. 59%) without obvious adverse reactions;and the reasons for choosing western medicine preparations were 443 cases( 61. 19%) with good effects,and 87 cases( 12. 02%) without obvious adverse reactions. For the analysis of adverse reactions,in patients taking nitrates,297 cases( 25. 47%) had milder adverse reactions,and 26 cases( 2. 23%) had strong reaction reactions; in patients taking traditional Chinese medicine quick-acting preparations,27 cases( 2. 33%) had a milder adverse reaction,and6 cases( 0. 52%) had a strong adverse reaction. Conclusion The traditional Chinese medicine preparations represented by Suxiao Jiuxin Pills in coronary heart disease patients with angina pectoris are more widely used in patients with relatively stable and milder degree. The application of heavier angina is less than that of nitroglycerin,but the adverse reactions are less.
引文
[1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性稳定性心绞痛诊断与治疗指南[J].中华心血管病杂志,2007,35(3):195-206.
[2]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[3]毕颖斐,毛静远,王贤良,等.冠心病中医病因及证候临床流行病学调查表的设计与制作[J].中华中医药杂志,2013,28(12):3626-3628.
[4]毕颖斐,王贤良,毛静远,等.冠心病现代中医证候特征的临床流行病学调查[J].中医杂志,2017,58(23):2010-2015.
[5]Nomenclature and criteria for diagnosis of ischemic heart disease.Report of joint international society and feberation of cardioligy/world health organization task force on standardization of clinical nomenclature[J].Circulation,1979,59(3):607-611.
[6]CAMPEAU L.Letter:Gradin of anina pectoris[J].Circulation,1976,54(3):522-523.
[2]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[3]毕颖斐,毛静远,王贤良,等.冠心病中医病因及证候临床流行病学调查表的设计与制作[J].中华中医药杂志,2013,28(12):3626-3628.
[4]毕颖斐,王贤良,毛静远,等.冠心病现代中医证候特征的临床流行病学调查[J].中医杂志,2017,58(23):2010-2015.
[5]Nomenclature and criteria for diagnosis of ischemic heart disease.Report of joint international society and feberation of cardioligy/world health organization task force on standardization of clinical nomenclature[J].Circulation,1979,59(3):607-611.
[6]CAMPEAU L.Letter:Gradin of anina pectoris[J].Circulation,1976,54(3):522-523.