桂附地黄丸加减对冠心病PCI术后患者生活质量的影响及用药安全性评价
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摘要
目的:探讨桂附地黄丸加减(温肾活血方)对冠心病患者经皮冠状动脉介入治疗(PCI)术后生活质量的影响及该方的用药安全性。方法:选取2017年6月至2018年5月重庆市中医院心内科门诊及住院部PCI术后患者147例,采取随机单双号的方法分为治疗组和对照组,对照组采取基础治疗(西医药物),治疗组在对照组的基础上加用桂附地黄丸加减,疗程均为4周。记录比较两组患者治疗前后的明尼苏达心力衰竭生活质量调查表总评分,6 min步行距离,西雅图心绞痛量表得分,中医证候评分,心功能评价,并观察不良反应,评价PCI术后患者的生活质量及其用药安全性。结果:与本组治疗前和对照组治疗后比较,治疗组患者明尼苏达心功能质量表评分显著降低(P<0.01),6 min步行距离显著增长(P<0.01),西雅图心绞痛量表评分显著提高(P<0.01),中医证候评分显著降低(P<0.01),左心室射血分数(LVEF)和舒张早期/舒张晚期最大血流速度(E/A)明显提高(P<0.05)。结论:在常规西医药物治疗的基础上,服用温肾活血方能有效改善PCI术后患者体力、情绪、中医症状、减轻心绞痛程度,增强心功能且无不良反应,可以达到改善术后患者生活质量的目的,值得推广。
Objective:To explore effect of modified Guifu Dihuang Wan(Wenshen Huoxue Fang) on life quality in patients with coronary hear disease(CHD) after percutaneous coronary intervention(PCI) and evaluate the safety of its clinical use.Method:The 147 postoperative patients with PCI in Chongqing Traditional Chinese Medicine Hospital cardiology outpatient and the inpatient departments between June 2017 to May 2018 were selected and randomly divided into the treatment group and control group by random even and odd number.The patients in control group took the basic treatment(western medicine),and the patients in the treatment group additionally received modified Guifu Dihuang Wan based on the treatment in control group,with a course of 4 weeks in both groups.Minnesota Living with Heart Failure Questionnaire(MLHFQ) total score,6 minutes walk test(6 m WT),Seattle Angina Scale(SAQ) score,and traditional Chinese medicine(TCM) syndrome score were recorded and compared between two groups before and after treatment;their cardiac function was evaluated and adverse reactions were observed to assess the drug safety and quality of life after PCI.Result:The MLHFQ scores in treatment group after treatment were significantly lower than those before treatment and those in control groups after treatment(P<0.01);6 m WT walking distance was significantly increased(P<0.01);SAQ scores were improved significantly(P<0.01);TCM syndrome score was reduced significantly(P<0.01);left ventricular ejective fraction(LVEF) and late diastolic/late diastolic maximal blood flow velocity(E/A) in treatment group were also improved after treatment(P<0.05).Conclusion:On the basis of conventional western medicine therapy,the modified Guifu Dihuang Wan can effectively improve the physical strength,mood,TCM symptoms,relieve angina pectoris,and enhance cardiac function with no adverse reactions in PCI postoperative patients.It can achieve the purpose of improving quality of life in postoperative patients,worthy of promotion.
Objective:To explore effect of modified Guifu Dihuang Wan(Wenshen Huoxue Fang) on life quality in patients with coronary hear disease(CHD) after percutaneous coronary intervention(PCI) and evaluate the safety of its clinical use.Method:The 147 postoperative patients with PCI in Chongqing Traditional Chinese Medicine Hospital cardiology outpatient and the inpatient departments between June 2017 to May 2018 were selected and randomly divided into the treatment group and control group by random even and odd number.The patients in control group took the basic treatment(western medicine),and the patients in the treatment group additionally received modified Guifu Dihuang Wan based on the treatment in control group,with a course of 4 weeks in both groups.Minnesota Living with Heart Failure Questionnaire(MLHFQ) total score,6 minutes walk test(6 m WT),Seattle Angina Scale(SAQ) score,and traditional Chinese medicine(TCM) syndrome score were recorded and compared between two groups before and after treatment;their cardiac function was evaluated and adverse reactions were observed to assess the drug safety and quality of life after PCI.Result:The MLHFQ scores in treatment group after treatment were significantly lower than those before treatment and those in control groups after treatment(P<0.01);6 m WT walking distance was significantly increased(P<0.01);SAQ scores were improved significantly(P<0.01);TCM syndrome score was reduced significantly(P<0.01);left ventricular ejective fraction(LVEF) and late diastolic/late diastolic maximal blood flow velocity(E/A) in treatment group were also improved after treatment(P<0.05).Conclusion:On the basis of conventional western medicine therapy,the modified Guifu Dihuang Wan can effectively improve the physical strength,mood,TCM symptoms,relieve angina pectoris,and enhance cardiac function with no adverse reactions in PCI postoperative patients.It can achieve the purpose of improving quality of life in postoperative patients,worthy of promotion.
引文
[1]胡根胜,邵正斌.中医药对冠心病PCI术后炎症因子的影响[J].中医药临床杂志,2017,29(10):1592-1595.
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[4]沈薇薇.山海经译注[M].哈尔滨:黑龙江人民出版社,2002:13.
[5]张机.金匮要略方论[M].北京:人民卫生出版社,1982:26.
[6]崔小磊,毛静远,王贤良,等.心力衰竭中医证候的专家调查分析[J].上海中医药大学学报,2009,23(2):31-33.
[7]沈迎,张奇,沈卫峰.美国和欧洲稳定性冠心病诊治指南解读[J].中华心血管病杂志,2014,42(1):70-72.
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[9]苏荏,何延忠.益心通脉颗粒对冠心病介入术后气虚血瘀证的影响[J].中国实验方剂学杂志,2017,23(20):201-206.
[10]石永,刘凡,彭杰,等.温肾活血汤对老年慢性心衰阳虚血瘀证患者活动耐量的改善[J].中国实验方剂学杂志,2017,23(9):184-189.
[11]中华医学会心血管病分会,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(2007年)[J].中华心血管病杂志,2007,35(3):195-206.
[12]国家技术监督局.GB/T 16751.2-1997中医临床诊疗术语证候部分[S].北京:中国标准出版社,1997:15.
[13]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:77-85.
[14]中华医学会心血管病学分会介入心脏病学组.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[15]中国医师协会心血管内科医师分会预防与康复专业委员会.经皮冠状动脉介入治疗术后运动康复专家共识[J].中国介入心脏病学杂志,2016,24(7):361-369.
[16]颜红兵.临床冠心病诊断与治疗指南[M].北京:人民卫生出版社,2010:17-55.
[17]Rector T S,Kubo S H,Cohn J N.Validity of the minnesota living with heart failure questionnaire as a measure of therapeutic response to enalapril or placebo[J].Am J Cardiol,1993,71(12):1106-1107.
[18]惠海鹏,许顶立,刘煜,等.6分钟步行实验在充血性心力衰竭病人中的使用价值[J].现代康复,2001,5(6):36-37.
[19]李静,常改.西雅图量表测量冠心病患者生活质量的评价[J].中国公共卫生,2004,20(5):594.
[20]张明丽,姜瑞雪.益气活血汤对慢性心力衰竭气虚血瘀证患者心功能及生活质量的影响[J].中国实验方剂学杂志,2015,21(19):162-166.
[21]邹文清.附子的临床运用举隅[J].吉林中医药,2005,25(4):39-40.
[22]冯修洁.《伤寒论》运用附子的辨证[J].中医杂志,1962,1(1):37,18.
[23]崔丽君,张艳,韩涛.基于中医传承辅助平台的《温病条辨》方剂组方规律分析[J].时珍国医国药,2015,26(1):176-178.
[24]张焕,王玉龙,刘秋燕,等.黄芪药对在方剂配伍中的应用分析[J].中医药导报,2016,22(16):52-54.
[25]陈云华,黄明进,王文全,等.不同来源甘草药材成分含量及其保肝降酶作用比较[J].中国实验方剂学杂志,2013,19(18):113-116.
[26]马加庆,云宇,后文俊,等.三七总皂苷对药物性肝损伤小鼠的保护作用[J].中国实验方剂学杂志,2013,19(23):246-249.
[27]Guyatt G H,Sullivan M J,Thompson P J,et al.The 6-minute walk:a new measure of exercise capacity in patients with chronic heart failure[J].Can Med Assoc J,1985,132(8):919-923.
[28]Garratt A M,Hutchinson A,Russell I.The UK version of the seattle angina questionnaire(SAQ-UK):reliability,validity and responsiveness[J].J Clin Epidemiol,2001,54(9):907-915.
[2]山东中医学院,河北医学院.黄帝内经素问校释(下册)[M].北京:人民卫生出版社,1995:1-2.
[3]王冰.灵枢经[M].北京:人民卫生出版社,1993:1-2.
[4]沈薇薇.山海经译注[M].哈尔滨:黑龙江人民出版社,2002:13.
[5]张机.金匮要略方论[M].北京:人民卫生出版社,1982:26.
[6]崔小磊,毛静远,王贤良,等.心力衰竭中医证候的专家调查分析[J].上海中医药大学学报,2009,23(2):31-33.
[7]沈迎,张奇,沈卫峰.美国和欧洲稳定性冠心病诊治指南解读[J].中华心血管病杂志,2014,42(1):70-72.
[8]Mozaffarian D,Benjamin E J,Go A S,et al.Heart disease and stroke statistics-2016 update:a report from the American heart association[J].Circulation,2016,13(4):38.
[9]苏荏,何延忠.益心通脉颗粒对冠心病介入术后气虚血瘀证的影响[J].中国实验方剂学杂志,2017,23(20):201-206.
[10]石永,刘凡,彭杰,等.温肾活血汤对老年慢性心衰阳虚血瘀证患者活动耐量的改善[J].中国实验方剂学杂志,2017,23(9):184-189.
[11]中华医学会心血管病分会,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(2007年)[J].中华心血管病杂志,2007,35(3):195-206.
[12]国家技术监督局.GB/T 16751.2-1997中医临床诊疗术语证候部分[S].北京:中国标准出版社,1997:15.
[13]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:77-85.
[14]中华医学会心血管病学分会介入心脏病学组.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[15]中国医师协会心血管内科医师分会预防与康复专业委员会.经皮冠状动脉介入治疗术后运动康复专家共识[J].中国介入心脏病学杂志,2016,24(7):361-369.
[16]颜红兵.临床冠心病诊断与治疗指南[M].北京:人民卫生出版社,2010:17-55.
[17]Rector T S,Kubo S H,Cohn J N.Validity of the minnesota living with heart failure questionnaire as a measure of therapeutic response to enalapril or placebo[J].Am J Cardiol,1993,71(12):1106-1107.
[18]惠海鹏,许顶立,刘煜,等.6分钟步行实验在充血性心力衰竭病人中的使用价值[J].现代康复,2001,5(6):36-37.
[19]李静,常改.西雅图量表测量冠心病患者生活质量的评价[J].中国公共卫生,2004,20(5):594.
[20]张明丽,姜瑞雪.益气活血汤对慢性心力衰竭气虚血瘀证患者心功能及生活质量的影响[J].中国实验方剂学杂志,2015,21(19):162-166.
[21]邹文清.附子的临床运用举隅[J].吉林中医药,2005,25(4):39-40.
[22]冯修洁.《伤寒论》运用附子的辨证[J].中医杂志,1962,1(1):37,18.
[23]崔丽君,张艳,韩涛.基于中医传承辅助平台的《温病条辨》方剂组方规律分析[J].时珍国医国药,2015,26(1):176-178.
[24]张焕,王玉龙,刘秋燕,等.黄芪药对在方剂配伍中的应用分析[J].中医药导报,2016,22(16):52-54.
[25]陈云华,黄明进,王文全,等.不同来源甘草药材成分含量及其保肝降酶作用比较[J].中国实验方剂学杂志,2013,19(18):113-116.
[26]马加庆,云宇,后文俊,等.三七总皂苷对药物性肝损伤小鼠的保护作用[J].中国实验方剂学杂志,2013,19(23):246-249.
[27]Guyatt G H,Sullivan M J,Thompson P J,et al.The 6-minute walk:a new measure of exercise capacity in patients with chronic heart failure[J].Can Med Assoc J,1985,132(8):919-923.
[28]Garratt A M,Hutchinson A,Russell I.The UK version of the seattle angina questionnaire(SAQ-UK):reliability,validity and responsiveness[J].J Clin Epidemiol,2001,54(9):907-915.