枳实薤白桂枝汤联合曲美他嗪片治疗急性心肌梗死患者的疗效观察
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摘要
探讨枳实薤白桂枝汤联合曲美他嗪片治疗急性心肌梗死患者的临床疗效。方法:选取符合纳入标准的96例急性心肌梗死并进行PCI术治疗患者为研究对象,采用随机数字表分为对照组与观察组,患者术前30 min均予以曲美他嗪片,术后两组均长期服用曲美他嗪,同时予以抗血小板聚集、抗凝等综合治疗,观察组加用枳实薤白桂枝汤,两组均干预12周。疗程结束后评估其疗效,并检测其血脂、心功能,及中医症状改善情况。结果:治疗后对照组TC、LDL-C依次为(4. 23±0. 82) mmol/L、(2. 76±0. 34) mmol/L,均显著高于观察组(3. 87±0. 78) mmol/L、(2. 23±0. 28) mmol/L(P <0. 05),但两组TG、HDL-C水平无显著性差异(P> 0. 05);干预后对照组LVEF(46. 3±9. 2)%显著低于观察组(52. 8±9. 7)%(P <0. 05); LVEDV、LVESV依次为(168. 5±21. 3) m L、(86. 7±14. 5) m L,均显著高于观察组(151. 3±18. 6) m L、(80. 3±12. 1) m L(P <0. 05);治疗后对照组CRP(9. 7±1. 5) g/L、ET(7. 4±1. 1) ng/m L均显著高于观察组(6. 3±1. 1) g/L、(5. 6±0. 9) ng/m L,NO水平为(46. 8±7. 2)μmol/L显著低于观察组(53. 9±7. 8)μmol/L(P <0. 05);对照组中医证候总积分(11. 2±1. 7)分,显著高于观察组(8. 1±1. 3)分(P <0. 05);且治疗期间两组均未出现头晕、恶心呕吐等不良反应。结论:枳实薤白桂枝汤联合曲美他嗪片治疗急性心肌梗死患者可显著改善心肌梗死患者临床症状,且未增加不良反应,具有较高的临床应用价值。
Objective: To explore the clinical efficacy of Zhishi Xiebai Guizhi Decoction combined with Trimetazidine Tablets in the treatment of acute myocardial infarction. Methods: 96 cases of patients with acute myocardial infarction treated with PCI were selected for the study and were randomly divided into the control group and the observation group. The patients in the two groups were treated with Trimetazidine Tablets 30 min before the operation and were given long-term administration of Trimetazidine after the operation,and the treatments of antiplatelet aggregation and anticoagulation were applied at the same time; on which basis,the observation group was also intervened with Zhishi Xiebai Guizhi Decoction. The intervention was 12 weeks. The efficacy was evaluated,and the blood lipid,cardiac function and the improvement of TCM symptoms were detected after the intervention. Results: After the treatment,the levels of TC and LDL-C were(4. 23 ± 0. 82) mmol/L and(2. 76 ± 0. 34) mmol/L in the control group respectively,which were significantly higher than(3. 87 ±0. 78) mmol/L and(2. 23 ± 0. 28) mmol/L in the observation group(P < 0. 05); but there were no significant differences in the levels of TG and HDL-C between two groups(P > 0. 05). The level of LVEF was(46. 3 ± 9. 2) % in the control group,which was significantly lower than(52. 8 ± 9. 7) % in the observation group(P < 0. 05). The levels of LVEDV and LVESV were(168. 5 ± 21. 3) m L and(86. 7 ± 14. 5) m L in the control group,which were significantly higher than(151. 3 ± 18. 6) m L and(80. 3 ± 12. 1) m L in the observation group(P < 0. 05). The CRP level was(9. 7 ± 1. 5) g/L and ET level was(7. 4 ± 1. 1) ng/m L in the control group,which were higher than(6. 3 ± 1. 1) g/L and(5. 6 ± 0. 9) ng/m L in the observation group(P <0. 05). The NO level was(46. 8 ± 7. 2) mol/L in the control group,which was significantly lower than(53. 9 ± 7. 8) mol/L in the observation group(P < 0. 05). The total score of TCM syndromes was(11. 2 ±1. 7) in the control group,which was significantly higher than(8. 1 ± 1. 3) in the observation group(P <0. 05). There were no adverse reactions,such as dizziness,nausea and vomiting,in the two groups during the treatment. Conclusion: Zhishi Xiebai Guizhi Decoction combined with Trimetazidine Tablets can significantly improve the clinical symptoms,without increasing the adverse reactions,in the treatment of acute myocardial infarction,and it has high value in clinical application.
Objective: To explore the clinical efficacy of Zhishi Xiebai Guizhi Decoction combined with Trimetazidine Tablets in the treatment of acute myocardial infarction. Methods: 96 cases of patients with acute myocardial infarction treated with PCI were selected for the study and were randomly divided into the control group and the observation group. The patients in the two groups were treated with Trimetazidine Tablets 30 min before the operation and were given long-term administration of Trimetazidine after the operation,and the treatments of antiplatelet aggregation and anticoagulation were applied at the same time; on which basis,the observation group was also intervened with Zhishi Xiebai Guizhi Decoction. The intervention was 12 weeks. The efficacy was evaluated,and the blood lipid,cardiac function and the improvement of TCM symptoms were detected after the intervention. Results: After the treatment,the levels of TC and LDL-C were(4. 23 ± 0. 82) mmol/L and(2. 76 ± 0. 34) mmol/L in the control group respectively,which were significantly higher than(3. 87 ±0. 78) mmol/L and(2. 23 ± 0. 28) mmol/L in the observation group(P < 0. 05); but there were no significant differences in the levels of TG and HDL-C between two groups(P > 0. 05). The level of LVEF was(46. 3 ± 9. 2) % in the control group,which was significantly lower than(52. 8 ± 9. 7) % in the observation group(P < 0. 05). The levels of LVEDV and LVESV were(168. 5 ± 21. 3) m L and(86. 7 ± 14. 5) m L in the control group,which were significantly higher than(151. 3 ± 18. 6) m L and(80. 3 ± 12. 1) m L in the observation group(P < 0. 05). The CRP level was(9. 7 ± 1. 5) g/L and ET level was(7. 4 ± 1. 1) ng/m L in the control group,which were higher than(6. 3 ± 1. 1) g/L and(5. 6 ± 0. 9) ng/m L in the observation group(P <0. 05). The NO level was(46. 8 ± 7. 2) mol/L in the control group,which was significantly lower than(53. 9 ± 7. 8) mol/L in the observation group(P < 0. 05). The total score of TCM syndromes was(11. 2 ±1. 7) in the control group,which was significantly higher than(8. 1 ± 1. 3) in the observation group(P <0. 05). There were no adverse reactions,such as dizziness,nausea and vomiting,in the two groups during the treatment. Conclusion: Zhishi Xiebai Guizhi Decoction combined with Trimetazidine Tablets can significantly improve the clinical symptoms,without increasing the adverse reactions,in the treatment of acute myocardial infarction,and it has high value in clinical application.
引文
[1]戎伊华.急性心肌梗死介入治疗术中严重并发症的急救护理[J].中国急救医学,2016,36(z2):170-171.
[2]韦喻镪.利拉鲁肽对急性心肌梗死PCI术后心肌的保护作用[J].中国临床药理学与治疗学,2018,23(2):184-188.
[3]韩崇明.高龄急性心肌梗死患者PCI治疗效果及安全性评估[J].中国医学创新,2018,15(3):50-53.
[4]徐伟豪,郭文杰.糖尿病对急性心肌梗死患者PCI术后远期生存的影响[J].解放军医药杂志,2017,29(3):57-61.
[5]李明琰,崔永生,何文凯,等.口服曲美他嗪对急性心肌梗死患者急诊PCI近期疗效的影响[J].山东医药,2015,55(36):44-46.
[6]魏立业,夏岳,戚国庆,等.尼可地尔联合曲美他嗪对非ST段抬高心肌梗死冠状动脉介入患者心肌微循环的影响[J].实用医学杂志,2017,33(9):1483-1486.
[7]李婷婷,刘彬,王丽,等.疏肝活血化瘀法对急性心肌梗死PCI术后血清PAPP-A、IL-6及ICAM-1表达的影响[J].中医药信息,2017,34(6):99-101.
[8]金风.延迟经皮冠脉介入在急性心肌梗死患者中的疗效观察及对死亡率的影响[J].中国医学创新,2018,15(18):50-53.
[9]杨亚囡,吴强.替格瑞洛和氯吡格雷对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术中术后冠脉血流影响[J].现代仪器与医疗,2018,24(1):29-31.
[10]胡玉宝,陈伟,伍于斌,等.雷贝拉唑在急性心肌梗死患者经皮冠状动脉介入术后预防消化道出血的效果分析[J].解放军医药杂志,2017,29(8):83-85+96.
[11]徐萍,石月萍.加减枳实薤白桂枝汤对大鼠心肌缺血再灌注过氧化损伤的影响[J].中药药理与临床,2017,33(3):14-18.
[12]邢冬梅,李彬,朱明军,等.中医药预防急性心肌梗死后心力衰竭的新思路[J].中华中医药杂志,2017,32(1):196-198.
[13]王吉元,李树斌,谢相智,等.枳实薤白桂枝汤合桂枝茯苓丸治疗冠心病的疗效及对内皮损伤炎症反应和血小板活化的影响[J].四川中医,2017,35(5):79-81.
[14]王付.枳实薤白桂枝汤方证探索与实践[J].中医杂志,2013,54(13):1160-1162.
[15]王程,张玉峰,赵筱萍.枳实薤白桂枝汤抗心肌细胞损伤活性成分的发现研究[J].中国中药杂志,2013,38(10):1601-1605.
[16]刘阳春,李浪,苏强,等.曲美他嗪影响巴马小型猪冠状动脉微栓塞后心肌细胞凋亡的机制[J].中国动脉硬化杂志,2015,23(7):657-662.
[2]韦喻镪.利拉鲁肽对急性心肌梗死PCI术后心肌的保护作用[J].中国临床药理学与治疗学,2018,23(2):184-188.
[3]韩崇明.高龄急性心肌梗死患者PCI治疗效果及安全性评估[J].中国医学创新,2018,15(3):50-53.
[4]徐伟豪,郭文杰.糖尿病对急性心肌梗死患者PCI术后远期生存的影响[J].解放军医药杂志,2017,29(3):57-61.
[5]李明琰,崔永生,何文凯,等.口服曲美他嗪对急性心肌梗死患者急诊PCI近期疗效的影响[J].山东医药,2015,55(36):44-46.
[6]魏立业,夏岳,戚国庆,等.尼可地尔联合曲美他嗪对非ST段抬高心肌梗死冠状动脉介入患者心肌微循环的影响[J].实用医学杂志,2017,33(9):1483-1486.
[7]李婷婷,刘彬,王丽,等.疏肝活血化瘀法对急性心肌梗死PCI术后血清PAPP-A、IL-6及ICAM-1表达的影响[J].中医药信息,2017,34(6):99-101.
[8]金风.延迟经皮冠脉介入在急性心肌梗死患者中的疗效观察及对死亡率的影响[J].中国医学创新,2018,15(18):50-53.
[9]杨亚囡,吴强.替格瑞洛和氯吡格雷对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术中术后冠脉血流影响[J].现代仪器与医疗,2018,24(1):29-31.
[10]胡玉宝,陈伟,伍于斌,等.雷贝拉唑在急性心肌梗死患者经皮冠状动脉介入术后预防消化道出血的效果分析[J].解放军医药杂志,2017,29(8):83-85+96.
[11]徐萍,石月萍.加减枳实薤白桂枝汤对大鼠心肌缺血再灌注过氧化损伤的影响[J].中药药理与临床,2017,33(3):14-18.
[12]邢冬梅,李彬,朱明军,等.中医药预防急性心肌梗死后心力衰竭的新思路[J].中华中医药杂志,2017,32(1):196-198.
[13]王吉元,李树斌,谢相智,等.枳实薤白桂枝汤合桂枝茯苓丸治疗冠心病的疗效及对内皮损伤炎症反应和血小板活化的影响[J].四川中医,2017,35(5):79-81.
[14]王付.枳实薤白桂枝汤方证探索与实践[J].中医杂志,2013,54(13):1160-1162.
[15]王程,张玉峰,赵筱萍.枳实薤白桂枝汤抗心肌细胞损伤活性成分的发现研究[J].中国中药杂志,2013,38(10):1601-1605.
[16]刘阳春,李浪,苏强,等.曲美他嗪影响巴马小型猪冠状动脉微栓塞后心肌细胞凋亡的机制[J].中国动脉硬化杂志,2015,23(7):657-662.