祛瘀化痰宁心汤联合西药治疗急性冠脉综合征经皮冠状动脉介入术后心绞痛45例临床观察
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摘要
目的观察中药祛瘀化痰宁心汤治疗急性冠脉综合征经皮冠状动脉介入术(PCI)后心绞痛的临床疗效。方法将90例急性冠脉综合征PCI术后心绞痛患者随机分为治疗组和对照组各45例;两组患者均给予PCI术后的西医规范治疗,治疗组在规范治疗的基础上给予祛瘀化痰宁心汤口服,每日1剂。两组均治疗8周。观察两组治疗后心绞痛疗效、中医证候疗效、心电图疗效,检测血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、C反应蛋白(CRP)以及肝肾功能、血常规、尿常规等安全性指标。结果治疗8周后,治疗组心绞痛总有效率(91. 1%)、中医证候总有效率(93. 3%)及心电图总有效率(57. 8%)均明显高于对照组(分别为71. 1%、71. 1%及33. 3%)(P <0. 05)。治疗组治疗后血清TC、TG、LDL-C及CRP水平均较本组治疗前及对照组治疗后明显降低(P <0. 05)。结论祛瘀化痰宁心汤配合常规西药可以明显缓解急性冠脉综合征PCI术后心绞痛症状,改善心电图表现及冠状动脉血流,降低血脂和抑制炎症反应可能为其主要作用机制。
Objective To observe the clinical efficacy of Quyu Huatan Ningxin Decoction(祛瘀化痰宁心汤) in treating angina pectoris after percutaneous coronary intervention(PCI) of patients with acute coronary syndrome.Methods A total of 90 acute coronary syndrome patients with angina after PCI were randomly divided into a control group and a treatment group,with 45 cases in each group. Both groups of patients were given standard western medicine treatment after PCI. The treatment group was orally given Quyu Huatan Ningxin Decoction on the basis of standardized treatment,1 dose per day,and both groups were treated for 8 weeks. The efficacy of angina pectoris,traditional Chinese medicine(TCM) syndrome efficacy,electrocardiography(ECG) efficacy were observed. The serum total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C),C-reactive protein(CRP) and safety indexes including liver function,kidney function,blood routine and urine routine were detected before and after the treatment. Results After 8 weeks of treatment,the total effective rate of angina(91. 1%),the total effective rate of TCM syndrome(93. 3%) and the total effective rate of ECG(57. 8%) in the treatment group were significantly higher than those of the control group(respectively71. 1%,71. 1%,and 33. 3%)(P < 0. 05). The levels of serum TC,TG,LDL-C and CRP in the treatment group were decreased more significantly than those before treatment and those of the control group after treatment(P <0. 05). Conclusion Quyu Huatan Ningxin Decoction combined with conventional western medicine treatment can obviously relieve angina symptom of patients with acute coronary syndrome after PCI. Improving ECG performance and coronary blood flow,reducing blood lipids and inhibiting inflammation may be the main mechanism.
Objective To observe the clinical efficacy of Quyu Huatan Ningxin Decoction(祛瘀化痰宁心汤) in treating angina pectoris after percutaneous coronary intervention(PCI) of patients with acute coronary syndrome.Methods A total of 90 acute coronary syndrome patients with angina after PCI were randomly divided into a control group and a treatment group,with 45 cases in each group. Both groups of patients were given standard western medicine treatment after PCI. The treatment group was orally given Quyu Huatan Ningxin Decoction on the basis of standardized treatment,1 dose per day,and both groups were treated for 8 weeks. The efficacy of angina pectoris,traditional Chinese medicine(TCM) syndrome efficacy,electrocardiography(ECG) efficacy were observed. The serum total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C),C-reactive protein(CRP) and safety indexes including liver function,kidney function,blood routine and urine routine were detected before and after the treatment. Results After 8 weeks of treatment,the total effective rate of angina(91. 1%),the total effective rate of TCM syndrome(93. 3%) and the total effective rate of ECG(57. 8%) in the treatment group were significantly higher than those of the control group(respectively71. 1%,71. 1%,and 33. 3%)(P < 0. 05). The levels of serum TC,TG,LDL-C and CRP in the treatment group were decreased more significantly than those before treatment and those of the control group after treatment(P <0. 05). Conclusion Quyu Huatan Ningxin Decoction combined with conventional western medicine treatment can obviously relieve angina symptom of patients with acute coronary syndrome after PCI. Improving ECG performance and coronary blood flow,reducing blood lipids and inhibiting inflammation may be the main mechanism.
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.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.
[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.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,45(5):380-393.
[3]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:171-173.
[4]胡镜清,王传池,段飞,等.冠心病痰瘀互结证宏观诊断标准研究[J].中国中西医结合杂志,2016,36(10):1164-1168.
[5]GIBBONS RJ,ABRAMS J,CHATTERJEE K,et al.ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-summary article[J].JAm Coll Cardiol,2003,41(1):159-168.
[6]中华医学会心血管病学分会介入心脏病学组,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2012,40(4):271-277.
[7]HASDAI D,LERMAN A,GRILL DE et al.Medical therapy after successful percutaneous coronary revascularization[J].Ann Intern Med,1999,130(2):108-115.
[8]陈鹏,王磊,张俭,等.冠脉血运重建术后再发心绞痛的中西医干预策略[J].中国中西医结合杂志,2010,30(12):1237-1240.
[9]中华中医药学会介入心脏病学专家委员会.经皮冠状动脉介入治疗(PCI)术后胸痛中医诊疗专家共识[J].中医杂志,2014,55(13):1167-1170.
[10]郭敏,史冬梅,周玉杰,等.冠状动脉介入术后患者抑郁障碍及其与预后的关系[J].中国介入心脏病学杂志,2010,18(1):28-31.
[11]吴波,曹红,陈思维,等.瓜蒌提取物对缺血缺氧及缺血后再灌注损伤心肌的保护作用[J].沈阳药科大学学报,2000,17(6):450-451.
[12]王冬梅,代世元,芦丽莉,等.栝楼皮提取物对大鼠动脉粥样硬化保护作用的实验研究[J].北华大学学报(自然科学版),2008,9(2):128-131.
[13]XIE X,WANG S,XIAO L,et al.DBZ Blocks LPS-induced monocyte activation and foam cell formation via inhibiting nuclear factor-κB[J].Cell Physiol Biochem,2011,28(4):649-662.
[14]黄筑艳,赵延涛,李焱.葛根药理及临床研究进展[J].光明中医,2007,22(6):63-67.
[15]孙莹莹,刘玥,陈可冀.人参皂苷的心血管药理效应:进展与思考[J].中国科学:生命科学,2016,46(6):771-778.
[16]王征,陈晓光,吴岩.土鳖虫溶栓酶抗凝血及抗血栓作用的实验研究[J].中国实验诊断学,2007,11(9):1143-1145.
[17]李鑫辉,张炳填,喻融.瓜蒌薤白半夏汤对急性心肌缺血大鼠保护作用的研究[J].湖南中医药大学学报,2009,29(1):19-21.
[18]何小丽,顾宁.桂枝甘草龙骨牡蛎汤的临床应用现状[J].江西中医药,2008,39(2):76-78.
[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.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,45(5):380-393.
[3]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:171-173.
[4]胡镜清,王传池,段飞,等.冠心病痰瘀互结证宏观诊断标准研究[J].中国中西医结合杂志,2016,36(10):1164-1168.
[5]GIBBONS RJ,ABRAMS J,CHATTERJEE K,et al.ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-summary article[J].JAm Coll Cardiol,2003,41(1):159-168.
[6]中华医学会心血管病学分会介入心脏病学组,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2012,40(4):271-277.
[7]HASDAI D,LERMAN A,GRILL DE et al.Medical therapy after successful percutaneous coronary revascularization[J].Ann Intern Med,1999,130(2):108-115.
[8]陈鹏,王磊,张俭,等.冠脉血运重建术后再发心绞痛的中西医干预策略[J].中国中西医结合杂志,2010,30(12):1237-1240.
[9]中华中医药学会介入心脏病学专家委员会.经皮冠状动脉介入治疗(PCI)术后胸痛中医诊疗专家共识[J].中医杂志,2014,55(13):1167-1170.
[10]郭敏,史冬梅,周玉杰,等.冠状动脉介入术后患者抑郁障碍及其与预后的关系[J].中国介入心脏病学杂志,2010,18(1):28-31.
[11]吴波,曹红,陈思维,等.瓜蒌提取物对缺血缺氧及缺血后再灌注损伤心肌的保护作用[J].沈阳药科大学学报,2000,17(6):450-451.
[12]王冬梅,代世元,芦丽莉,等.栝楼皮提取物对大鼠动脉粥样硬化保护作用的实验研究[J].北华大学学报(自然科学版),2008,9(2):128-131.
[13]XIE X,WANG S,XIAO L,et al.DBZ Blocks LPS-induced monocyte activation and foam cell formation via inhibiting nuclear factor-κB[J].Cell Physiol Biochem,2011,28(4):649-662.
[14]黄筑艳,赵延涛,李焱.葛根药理及临床研究进展[J].光明中医,2007,22(6):63-67.
[15]孙莹莹,刘玥,陈可冀.人参皂苷的心血管药理效应:进展与思考[J].中国科学:生命科学,2016,46(6):771-778.
[16]王征,陈晓光,吴岩.土鳖虫溶栓酶抗凝血及抗血栓作用的实验研究[J].中国实验诊断学,2007,11(9):1143-1145.
[17]李鑫辉,张炳填,喻融.瓜蒌薤白半夏汤对急性心肌缺血大鼠保护作用的研究[J].湖南中医药大学学报,2009,29(1):19-21.
[18]何小丽,顾宁.桂枝甘草龙骨牡蛎汤的临床应用现状[J].江西中医药,2008,39(2):76-78.