芪参益气滴丸对冠状动脉旁路移植术后病人心室重构及心功能的影响
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摘要
目的观察芪参益气滴丸对冠状动脉旁路移植术后病人心室重构及心功能的影响。方法选取符合标准的非体外循环冠状动脉旁路移植术病人80例,随机分为对照组和治疗组,各40例。对照组术后接受常规治疗,治疗组在对照组基础上加用芪参益气滴丸治疗,疗程为1年。研究期间观察并比较两组主要心血管不良事件(MACE)发生情况,治疗前后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和N末端B型钠尿肽原(NT-proBNP)变化情况及超声心动图所示心脏结构及功能变化情况。结果研究期间,治疗组MACE中心力衰竭发生率低于对照组(P<0.05)。治疗后,两组TNF-α、IL-6、NT-proBNP较治疗前均降低(P<0.05),且治疗组TNF-α、IL-6、NT-proBNP较对照组显著改善。治疗后,两组左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室重量指数(LVMI)均较治疗前降低,左室射血分数(LVEF)较治疗前升高(P<0.05),且治疗组LVESD、LVEDD、LVEF、LVMI较对照组显著改善(P<0.05)。结论冠状动脉旁路移植术能改善冠心病病人的心室重构及心功能,术后配合芪参益气滴丸效果更佳。
Objective To investigate the Influence of Qishenyiqi pills on ventricular structure and cardiac functions of patients undergoing coronary artery bypass surgery.Methods Eighty patients undergoing coronary artery bypass surgery were divided randomly into the treatment group and the control group.The control group were treated with routine medicine after surgery and the treatment group were treated additionally by Qishenyiqi pills after surgery.After 1 year,main adverse cardiovascular events(MACE), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α),N-terminal b-type natriuretic peptide(NT-proBNP),the cardiac structure,and functional changes of echocardiography were observed and compared between groups.Results During the study, the incidence of heart failure in the treatment group was lower than that in the control group(P<0.05).After treatment, IL-6, TNF-α and NT-proBNP were significantly improved in both groups(P<0.05), and IL-6, TNF-α and NT-proBNP in the treatment group were significantly better than those in the control group(P<0.05).After treatment, left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular ejection fraction(LVEF),and left ventricular mass index(LVMI) were significantly improved after treatment(P<0.05), and LVESD, LVEDD, LVEF, and LVMI in the treatment group were significantly higher than those in the control group(P<0.05).Conclusion Coronary artery bypass grafting can more effectively improve the ventricular remodeling and cardiac function in patients with coronary artery disease,with Qishenyiqi pills.
Objective To investigate the Influence of Qishenyiqi pills on ventricular structure and cardiac functions of patients undergoing coronary artery bypass surgery.Methods Eighty patients undergoing coronary artery bypass surgery were divided randomly into the treatment group and the control group.The control group were treated with routine medicine after surgery and the treatment group were treated additionally by Qishenyiqi pills after surgery.After 1 year,main adverse cardiovascular events(MACE), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α),N-terminal b-type natriuretic peptide(NT-proBNP),the cardiac structure,and functional changes of echocardiography were observed and compared between groups.Results During the study, the incidence of heart failure in the treatment group was lower than that in the control group(P<0.05).After treatment, IL-6, TNF-α and NT-proBNP were significantly improved in both groups(P<0.05), and IL-6, TNF-α and NT-proBNP in the treatment group were significantly better than those in the control group(P<0.05).After treatment, left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular ejection fraction(LVEF),and left ventricular mass index(LVMI) were significantly improved after treatment(P<0.05), and LVESD, LVEDD, LVEF, and LVMI in the treatment group were significantly higher than those in the control group(P<0.05).Conclusion Coronary artery bypass grafting can more effectively improve the ventricular remodeling and cardiac function in patients with coronary artery disease,with Qishenyiqi pills.
引文
[1] 刘盛,胡盛寿,王巍,等.冠状动脉旁路移植术治疗缺血性心功能不全患者的远期疗效[J].中国胸心血管外科临床杂志,2010,17(3):188-191.
[2] 胡建华,陈世健,刘琨,等.芪参益气滴丸对舒张性心力衰竭患者左室舒张功能及血浆脑钠肽的影响[J].中成药,2015,37(5):959-961.
[3] 郑俊华,唐浩然,景丽英,等.芪参益气滴丸联合阿托伐他汀对慢性心力衰竭患者心功能和BNP、TNF-α和IL-6 的影响[J].中华临床医师杂志(电子版),2014,8(16):2972-2975.
[4] 陈图刚,谭维羚,马战清,等.芪参益气滴丸对慢性心力衰竭患者心功能和细胞因子的影响[J].中国老年性杂志,2011,31(5):742-745.
[5] 胡盛寿.心力衰竭外科治疗现状与进展[J].中国循环杂志,2016,31(3):209-213.
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[7] 周明阳,张健群,毛斌,等.冠状动脉旁路移植术患者死亡相关因素分析[J].中国医药,2017,12(3):343-346.
[8] 于欣,杨震,韩学波.慢性心力衰竭中细胞因子的变化及其临床意义[J].检验医学与临床,2009,6(19):1636-1640.
[9] 马立庆,段保湘,张红松,等.急性心力衰竭患者血清TNF-α、CA125的变化[J].社区医学杂志,2015,13(20):82-83.
[10] 林先和,彭佑华.慢性充血性心力衰竭患者IL-6、TNF-α与心功能分级的相关性[J].山东医药,2010,50(9):52-53.
[11] 蔡洪滨,姚朱华,尹浩晔,等.NT-proBNP与急性心肌梗死后左心室功能和重构的关系及对远期心血管事件的预测价值[J].广东医学,2013,34(1):78-80.
[12] 韦丙奇,张健,杨跃进,等.N末端B型利钠肽原在陈旧性心肌梗死患者中诊断心力衰竭的价值[J].中华心血管病杂志,2012,40(1):34-38.
[13] 许正峰,邵坤,陈杰峰.血清NT-proBNP和CRP与舒张性心衰心室重构的关系[J].齐齐哈尔医学院学报,2014,35(17):2501-2502.
[14] 蒋洪强,张金国,谭洪勇,等.黄芪甲苷对慢性心力衰竭大鼠心肌纤维化和结缔组织生长因子表达的影响[J].中国循环杂志,2016,31(2):165-169.
[15] 杨庆有,陆曙,孙慧茹.黄芪对慢性心力衰竭患者心功能与血清肿瘤坏死因子水平的影响[J].中国中西医结合杂志,2010,30(7):699-701.
[16] LI Y,YANG Y,YU D,et al.The effect of tanshinone ⅡA upon the TGF-beta1/Smads signaling pathway in hypertrophic myocardium of hypertensive rats[J].Huazhong Univ Sci Technolog Med Sci,2009,29(4):476-480.
[17] 郭洁文,邓志军,符永恒,等.三七总皂苷对心梗后心室重构大鼠肿瘤坏死因子-α与基质金属蛋白酶表达的影响及其作用机制[J].南方医科大学学报,2009,29(10):2048-2050.
[18] 牟菲,段佳林,边海旭,等.降香水提物和挥发油对心肌缺血/再灌注损伤大鼠预防作用的代谢组学研究[J].中国药理学通报,2016,32(10):1377-1382.
[19] 谢东霞,毛秉豫.芪参益气滴丸对心肌梗死后气虚血瘀证患者心室重构及心功能的影响[J].中国实验方剂学杂志,2011,17(1):192-195.
[20] 郑俊华,唐浩然,景丽英,等.芪参益气滴丸联合阿托伐他汀对慢性心力衰竭患者心功能和 BNP、TNF-α和IL-6 的影响[J].中华临床医师杂志(电子版),2014,8(16):41-44.
[21] 李玉宏,吴存刚.实时三维超声心动图评价AMI患者CABG术后左心室重构[J].辽宁医学院学报,2010,31(1):26-29.
[2] 胡建华,陈世健,刘琨,等.芪参益气滴丸对舒张性心力衰竭患者左室舒张功能及血浆脑钠肽的影响[J].中成药,2015,37(5):959-961.
[3] 郑俊华,唐浩然,景丽英,等.芪参益气滴丸联合阿托伐他汀对慢性心力衰竭患者心功能和BNP、TNF-α和IL-6 的影响[J].中华临床医师杂志(电子版),2014,8(16):2972-2975.
[4] 陈图刚,谭维羚,马战清,等.芪参益气滴丸对慢性心力衰竭患者心功能和细胞因子的影响[J].中国老年性杂志,2011,31(5):742-745.
[5] 胡盛寿.心力衰竭外科治疗现状与进展[J].中国循环杂志,2016,31(3):209-213.
[6] 王欢,谢维泉,韩涛,等.冠状动脉旁路移植术253例[J].中国胸心血管外科临床杂志,2007,14(1):20-22.
[7] 周明阳,张健群,毛斌,等.冠状动脉旁路移植术患者死亡相关因素分析[J].中国医药,2017,12(3):343-346.
[8] 于欣,杨震,韩学波.慢性心力衰竭中细胞因子的变化及其临床意义[J].检验医学与临床,2009,6(19):1636-1640.
[9] 马立庆,段保湘,张红松,等.急性心力衰竭患者血清TNF-α、CA125的变化[J].社区医学杂志,2015,13(20):82-83.
[10] 林先和,彭佑华.慢性充血性心力衰竭患者IL-6、TNF-α与心功能分级的相关性[J].山东医药,2010,50(9):52-53.
[11] 蔡洪滨,姚朱华,尹浩晔,等.NT-proBNP与急性心肌梗死后左心室功能和重构的关系及对远期心血管事件的预测价值[J].广东医学,2013,34(1):78-80.
[12] 韦丙奇,张健,杨跃进,等.N末端B型利钠肽原在陈旧性心肌梗死患者中诊断心力衰竭的价值[J].中华心血管病杂志,2012,40(1):34-38.
[13] 许正峰,邵坤,陈杰峰.血清NT-proBNP和CRP与舒张性心衰心室重构的关系[J].齐齐哈尔医学院学报,2014,35(17):2501-2502.
[14] 蒋洪强,张金国,谭洪勇,等.黄芪甲苷对慢性心力衰竭大鼠心肌纤维化和结缔组织生长因子表达的影响[J].中国循环杂志,2016,31(2):165-169.
[15] 杨庆有,陆曙,孙慧茹.黄芪对慢性心力衰竭患者心功能与血清肿瘤坏死因子水平的影响[J].中国中西医结合杂志,2010,30(7):699-701.
[16] LI Y,YANG Y,YU D,et al.The effect of tanshinone ⅡA upon the TGF-beta1/Smads signaling pathway in hypertrophic myocardium of hypertensive rats[J].Huazhong Univ Sci Technolog Med Sci,2009,29(4):476-480.
[17] 郭洁文,邓志军,符永恒,等.三七总皂苷对心梗后心室重构大鼠肿瘤坏死因子-α与基质金属蛋白酶表达的影响及其作用机制[J].南方医科大学学报,2009,29(10):2048-2050.
[18] 牟菲,段佳林,边海旭,等.降香水提物和挥发油对心肌缺血/再灌注损伤大鼠预防作用的代谢组学研究[J].中国药理学通报,2016,32(10):1377-1382.
[19] 谢东霞,毛秉豫.芪参益气滴丸对心肌梗死后气虚血瘀证患者心室重构及心功能的影响[J].中国实验方剂学杂志,2011,17(1):192-195.
[20] 郑俊华,唐浩然,景丽英,等.芪参益气滴丸联合阿托伐他汀对慢性心力衰竭患者心功能和 BNP、TNF-α和IL-6 的影响[J].中华临床医师杂志(电子版),2014,8(16):41-44.
[21] 李玉宏,吴存刚.实时三维超声心动图评价AMI患者CABG术后左心室重构[J].辽宁医学院学报,2010,31(1):26-29.