黄芪益参汤加减治疗冠心病心绞痛(气虚血瘀)随机平行对照研究
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摘要
[目的]观察黄芪益参汤加减治疗冠心病心绞痛(气虚血瘀)疗效。[方法]使用随机平行对照方法,将40例门诊患者按信封法随机分为两组。对照组20例硝酸异山梨酯,5～20mg/次,3次/d;普萘洛尔,10～30mg/次,3次/d;硝苯地平,40～80mg/次,3次/d;阿司匹林,100～300mg/次,1次/d。治疗组20例黄芪益参汤(益母草20g,黄芪~炙25g,当归10g,丹参25g,白术15g,甘草~炙20g,莲子心8g,桂枝20g),水煎300mL,1剂/d,早晚分服;气虚血瘀加红花3g,桃仁5g,川芎3g;气滞血瘀加川芎8g,枳壳4g,柴胡3g;痰浊瘀阻加赤芍、半夏、薤白各8g;寒凝血瘀加吴茱萸5g,细辛、附子各3g;心阴亏损加远志、茯苓各15g,酸枣仁35g。连续治疗10d为1疗程。观测临床表现、心绞痛发作次数及持续时间、硝酸甘油用量、心电图、不良反应。连续治疗2疗程(20d),判定疗效。随访3个月,观测心绞痛发作次数及持续时间。[结果]治疗组显效16例,有效3例,无效1例,总有效率95.00%;对照组显效11例,有效3例,无效6例,总有效率70.00%;治疗组疗效优于对照组(P<0.01)。随访3个月,心绞痛发作次数、心绞痛发作时间治疗组均少于对照组(P<0.01)。[结论]黄芪益参汤加减治疗冠心病心绞痛(气虚血瘀),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of Huangqi Yishen decoction on angina pectoris of coronary heart disease(Qi deficiency and blood stasis). [Method] 40 outpatients were randomly divided into two groups by envelope method. The control group consisted of 20 patients with isosorbide nitrate, 5～20 mg/time, 3 times a day; propranolol, 10～30 mg/time, 3 times a day; nifedipine, 40～80 mg/time, 3 times a day; aspirin,100～300 mg/time, 1 time a day. In the treatment group, 20 cases of Huangqi Yishen decoction(Yimucao20 g, Huangqi 25 g, Danggui 10 g, Danshen 25 g, Baizhu 15 g, Zhigancao 20 g, Lianzixin 8 g, Guizhi 20 g) were decocted in water for 300 mL, morning and evening, divided into two groups; Qi deficiency and blood stasis plus Honghua 3 g, Taoren 5 g, Chuanxiong 3 g; Qi stagnation and blood stasis plus Chuanxiong 8 g, Zhihu 4 g,Chaihu 3 g; Phlegm turbid stasis plus Chishao, Banxia, Xibai each 8 g; Cold blood stasis plus Wuzhuyu 5 g;Xinxi, Fuzi each 3 g; Xinyin deficit plus Yuanzhi, Fuling each 15 g, Suanzaoren 35 g. Continuous treatment for10 days is a course of treatment. The clinical manifestations, the frequency and duration of angina pectoris,the dosage of nitroglycerin, electrocardiogram and adverse reactions were observed. Continuous treatment for 2 courses(20 days) to determine the efficacy. The number and duration of angina pectoris attacks were observed after 3 months of follow-up. [Result] In the treatment group, 16 cases were markedly effective, 3 cases were effective and 1 case was ineffective, the total effective rate was 95.00%. In the control group, 11 cases were markedly effective, 3 cases were effective and 6 cases were ineffective, the total effective rate was70.00%. The curative effect of the treatment group was better than that of the control group(P<0.01). After3 months of follow-up, the number of angina attacks and the duration of angina attacks in the treatment group were less than those in the control group(P<0.01). [Conclusion] The modified Huangqi Yishen decoction has satisfactory curative effect on angina pectoris of coronary heart disease(Qi deficiency and blood stasis),and has no serious adverse reactions. It is worth popularizing.
[Objective] To observe the effect of Huangqi Yishen decoction on angina pectoris of coronary heart disease(Qi deficiency and blood stasis). [Method] 40 outpatients were randomly divided into two groups by envelope method. The control group consisted of 20 patients with isosorbide nitrate, 5～20 mg/time, 3 times a day; propranolol, 10～30 mg/time, 3 times a day; nifedipine, 40～80 mg/time, 3 times a day; aspirin,100～300 mg/time, 1 time a day. In the treatment group, 20 cases of Huangqi Yishen decoction(Yimucao20 g, Huangqi 25 g, Danggui 10 g, Danshen 25 g, Baizhu 15 g, Zhigancao 20 g, Lianzixin 8 g, Guizhi 20 g) were decocted in water for 300 mL, morning and evening, divided into two groups; Qi deficiency and blood stasis plus Honghua 3 g, Taoren 5 g, Chuanxiong 3 g; Qi stagnation and blood stasis plus Chuanxiong 8 g, Zhihu 4 g,Chaihu 3 g; Phlegm turbid stasis plus Chishao, Banxia, Xibai each 8 g; Cold blood stasis plus Wuzhuyu 5 g;Xinxi, Fuzi each 3 g; Xinyin deficit plus Yuanzhi, Fuling each 15 g, Suanzaoren 35 g. Continuous treatment for10 days is a course of treatment. The clinical manifestations, the frequency and duration of angina pectoris,the dosage of nitroglycerin, electrocardiogram and adverse reactions were observed. Continuous treatment for 2 courses(20 days) to determine the efficacy. The number and duration of angina pectoris attacks were observed after 3 months of follow-up. [Result] In the treatment group, 16 cases were markedly effective, 3 cases were effective and 1 case was ineffective, the total effective rate was 95.00%. In the control group, 11 cases were markedly effective, 3 cases were effective and 6 cases were ineffective, the total effective rate was70.00%. The curative effect of the treatment group was better than that of the control group(P<0.01). After3 months of follow-up, the number of angina attacks and the duration of angina attacks in the treatment group were less than those in the control group(P<0.01). [Conclusion] The modified Huangqi Yishen decoction has satisfactory curative effect on angina pectoris of coronary heart disease(Qi deficiency and blood stasis),and has no serious adverse reactions. It is worth popularizing.
引文
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[9]张思团.硝苯地平控释片治疗心绞痛的临床观察[J].临床医药实践,2010,19(3b):334-335.
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[11]曾莲.冠心病心绞痛心电图检查及其价值分析[J].陕西医学杂志2017,46(1):49-50.
[12]高学敏.中药学[M].北京:中国中医药出版社,2007.
[13]刘燕.黄芪中有效成分黄芪皂苷甲对压力过载性血管肥厚的作用[D].上海:上海中医药大学,2009.
[14]聂媛媛.对益母草成分及药理活性的研究[J].当代医药论丛,201210(3):57-58.
[15]张萃.丹参酮ⅡA等活血化瘀类中药抗内毒素作用的筛选[J].山西医科大学学报,2010,41(7):621-623.
[2]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2012-03-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[3]中华中医药学会.中医内科常见病诊疗指南(西医疾病部分)冠心病心绞痛[J].中国中医药现代远程教育,2011,9(18):143-145.
[4]周仲瑛.中医内科学[M].7版.北京:中国中医药出版社,2004:142-143.
[5]陈日新,梁春明,吴红勇,等.不稳定型心绞痛与心电图检测的价值研究[J].岭南急诊医学杂志,2004,9(2):91-92.
[6]高润霖.遵循指南规范慢性稳定性心绞痛的诊断和治疗[J].中华心血管病杂志,2007,35(3):193-194.
[7]王吉云.单硝酸异山梨酯速释缓释剂型与心绞痛患者的生活质量[J].国际心血管病杂志,2002,29(5):312-314.
[8]童三强.浅述普萘洛尔的临床药理作用[J].现代保健·医学创新研究,2006,3(6):122.
[9]张思团.硝苯地平控释片治疗心绞痛的临床观察[J].临床医药实践,2010,19(3b):334-335.
[10]温涌,刘改英.拜阿司匹林联合氯吡格雷治疗不稳定型心绞痛45例疗效观察[J].基层医学论坛,2012,16(11):1384-1385.
[11]曾莲.冠心病心绞痛心电图检查及其价值分析[J].陕西医学杂志2017,46(1):49-50.
[12]高学敏.中药学[M].北京:中国中医药出版社,2007.
[13]刘燕.黄芪中有效成分黄芪皂苷甲对压力过载性血管肥厚的作用[D].上海:上海中医药大学,2009.
[14]聂媛媛.对益母草成分及药理活性的研究[J].当代医药论丛,201210(3):57-58.
[15]张萃.丹参酮ⅡA等活血化瘀类中药抗内毒素作用的筛选[J].山西医科大学学报,2010,41(7):621-623.