温痹愈梗汤治疗寒凝心脉型急性心肌梗死溶栓后再灌注损伤的临床研究
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摘要
目的:研究温痹愈梗汤治疗寒凝心脉型急性心肌梗死溶栓后再灌注损伤的保护作用。方法:选择我院2014年1月~2017年1月收治的寒凝心脉型急性心肌梗死患者68例,按照随机数字表法分为对照组(n=34)和观察组(n=34),对照组给予常规溶栓治疗,观察组在对照组治疗基础上给予温痹愈梗汤治疗,比较两组治疗效果,心电图,肌酸磷酸激酶(CK)及肌钙蛋白I (c Tn I)峰值、发病至峰值出现的时间和恢复时间,治疗前后脑尿钠肽(BNP)、基质金属蛋白酶9 (MMP-9)和丙二醛(MDA)水平,再灌注损伤发生率。结果:观察组弓背型ST段抬高最高幅度和心肌梗死总负荷小于对照组(P<0. 05),弓背型ST段抬高持续时间短于对照组(P<0. 05);观察组CK和c Tn I峰值均低于对照组(P<0. 05),发病至CK、c Tn I峰值出现的时间和恢复时间均短于对照组(P<0. 05);治疗第7d,两组BNP、MMP-9和MDA水平均显著下降(P <0. 05),且观察组BNP、MMP-9和MDA水平均明显低于对照组(P <0. 05);观察组总有效率94. 12%显著高于对照组的73. 53%(P<0. 05);观察组再灌注损伤发生率5. 88%显著高于对照组的23. 53%(P<0. 05)。结论:温痹愈梗汤治疗寒凝心脉型急性心肌梗死溶栓后再灌注损伤临床效果较好。
Objective: To study the protective effects of Wenbi Yugeng Decoction on reperfusion injury after thrombolysis in patients with cold-coagulation and heart-vein type acute myocardial infarction. Methods: 68 cases of patients with cold-coagulation and heart-vein type acute myocardial infarction in our hospital from January 2014 to January 2017 were selected and divided into controlled group( n = 34) and observation group( n = 34) according to the random number table method. The controlled group was given the routine thrombolytic therapy,and the observation group was given Wenbi Yugeng Decoction on the basis of treatment in the controlled group. The treatment effects,electrocardiogram( ECG),creatine kinase( CK) and cardiac troponin I( c Tn I) peak values,the time from onset to the peak and the recovery time,and the levels of brain natriuretic peptide( BNP)and matrix metalloproteinase 9( MMP-9) and malondialdehyde( MDA) before and after the treatment,and the incidence rate of reperfusion injury were compared between the two groups. Results: The highest degree of arched ST segment elevation and the total load of myocardial infarction in the observation group were less than those in the controlled group( P<0. 05),and the duration of arched ST segment elevation was shorter than that in the controlled group( P<0. 05). The peak values of CK and c Tn I in the observation group were lower than those in the controlled group( P<0. 05),and the time from onset to peak of CK and c Tn I and the recovery time were shorter than those in the controlled group( P< 0. 05). The levels of BNP,MMP-9 and MDA in the two groups at the 7 th day of treatment were significantly decreased( P<0. 05),and the levels of BNP,MMP-9 and MDA in the observation group were significantly lower than those in the controlled group( P<0. 05). The total treatment effective rate in the observation group was significantly higher than that in the controlled group( 94. 12% vs 73. 53%)( P<0. 05). The incidence rate of reperfusion injury in the observation group was significantly higher than that in the controlled group( 5. 88% vs 23. 53%)( P<0. 05). Conclusions: Wenbi Yugeng Decoction have good clinical effects in the treatment of reperfusion injury afterthrombolysis in patients with cold-coagulation and heart-vein type acute myocardial infarction.
Objective: To study the protective effects of Wenbi Yugeng Decoction on reperfusion injury after thrombolysis in patients with cold-coagulation and heart-vein type acute myocardial infarction. Methods: 68 cases of patients with cold-coagulation and heart-vein type acute myocardial infarction in our hospital from January 2014 to January 2017 were selected and divided into controlled group( n = 34) and observation group( n = 34) according to the random number table method. The controlled group was given the routine thrombolytic therapy,and the observation group was given Wenbi Yugeng Decoction on the basis of treatment in the controlled group. The treatment effects,electrocardiogram( ECG),creatine kinase( CK) and cardiac troponin I( c Tn I) peak values,the time from onset to the peak and the recovery time,and the levels of brain natriuretic peptide( BNP)and matrix metalloproteinase 9( MMP-9) and malondialdehyde( MDA) before and after the treatment,and the incidence rate of reperfusion injury were compared between the two groups. Results: The highest degree of arched ST segment elevation and the total load of myocardial infarction in the observation group were less than those in the controlled group( P<0. 05),and the duration of arched ST segment elevation was shorter than that in the controlled group( P<0. 05). The peak values of CK and c Tn I in the observation group were lower than those in the controlled group( P<0. 05),and the time from onset to peak of CK and c Tn I and the recovery time were shorter than those in the controlled group( P< 0. 05). The levels of BNP,MMP-9 and MDA in the two groups at the 7 th day of treatment were significantly decreased( P<0. 05),and the levels of BNP,MMP-9 and MDA in the observation group were significantly lower than those in the controlled group( P<0. 05). The total treatment effective rate in the observation group was significantly higher than that in the controlled group( 94. 12% vs 73. 53%)( P<0. 05). The incidence rate of reperfusion injury in the observation group was significantly higher than that in the controlled group( 5. 88% vs 23. 53%)( P<0. 05). Conclusions: Wenbi Yugeng Decoction have good clinical effects in the treatment of reperfusion injury afterthrombolysis in patients with cold-coagulation and heart-vein type acute myocardial infarction.
引文
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[2]甄淑新,张勇.急性心肌梗死患者体内CRP、血脂水平变化的临床意义[J].中国实验诊断学,2014,18(10):1693~1694
[3]中华心血管病杂志编委会.急性心肌梗塞溶栓疗法参考方案(1996年7月修订)[J].内科急危重症杂志,1996(4):328~329
[4]潘淘涛,汤爱玲,老成暖,等.乌司他丁对急性心肌梗死患者溶栓治疗后再灌注损伤的保护作用[J].实用医学杂志,2014,30(15):2484~2486
[5]傅晓霞,吕健,杨帆,等.血栓通注射液对急性心肌梗死再灌注损伤防治作用[J].中成药,2014,36(5):933~936
[6]彭小平.郑惠伯主任中医师治疗冠心病及急性心肌梗死临床经验[J].中国中医急症,2014,23(1):79~80
[7]陈运枝.多种心肌标志物检测对心肌梗死及心力衰竭的临床诊断及应用价值[J].中国煤炭工业医学杂志,2014,17(12):1935~1938
[8]李斌,王高明,肖闯.急性ST段抬高型心肌梗死患者溶栓成功后肌钙蛋白Ⅰ水平的变化[J].内科急危重症杂志,2014,20(1):44~45
[9]刘璐,柳茵.联合检测hs CRP、BNP、甲状腺激素辅助诊断心肌梗死的意义[J].中西医结合心脑血管病杂志,2016,14(7):720~722
[10]高翠菊,高大中,王勇.姜黄素对急性心肌梗死模型大鼠的保护作用研究[J].中国药房,2015,26(13):1782~1785