芪参益气滴丸联合心脉通贴散对不稳定型心绞痛PCI术后心绞痛的临床研究及对炎症因子的影响

发布时间：2018-06-20 15:58

本文选题：芪参益气滴丸 + 心脉通贴散　；参考：《南京中医药大学》2017年博士论文

【摘要】：冠心病是目前临床上的常见病、多发病,近年来其死亡率不断上升,2014年中国心血管病死亡(粗)率仍位居各病之首,高于肿瘤和其他疾病,严重损害了人民大众的身心健康。冠心病常规的治疗方法有药物治疗和手术治疗,其中经皮冠脉介入术(PCI)作为治疗方法之一,因见效快,疗效明确,受到大家一致的关注。但PCI仍然有很多问题不能解决,如PCI术后再狭窄,术后生活质量未改善,心理状态不平稳,心绞痛的复发等等,这些问题困扰着广大医师和患者。祖国医学中没有冠心病、PCI术后胸痛等名词,根据其临床症状和表现,类似于中医名词"胸痹心痛"所指范畴。中医的内治法和外治法在几千年的使用中挽救了无数人的生命。如今西医在临床上也面临很多棘手甚至不能解决的问题,中医一直倡导辨证论治,始终提倡把人作为一个整体,因此在很多治疗方面可以很好的发挥其优势,和西医学结合起来,取长补短,以减轻患者的病痛。目的一:对160例行PCI术的且中医辨证为气虚痰瘀的不稳定型心绞痛患者进行研究,以观察芪参益气滴丸联合心脉通贴散对冠心病PCI术后气虚痰瘀型患者临床疗效。方法:选择160例行PCI术的冠心病不稳定型心绞痛患者,采用随机数字表法分为对照组和治疗组(A、B、C组),每组40例,四组均采用常规西药治疗,治疗A组在对照组治疗基础上加用心脉通贴散;治疗B组在对照组治疗基础上加用芪参益气滴丸;C组在对照组治疗基础上加用芪参益气滴丸1包3次/日及心脉通贴散穴位贴敷。疗程共4周。观察临床疗效、中医症候积分、凝血功能(PT、APTT、TT、FIB)、Hs-CRP、MPO、血脂(TC、LDL、LPA)和FFA等的变化。结果:1.四组心绞痛疗效和中医证候疗效均有一定的改善,而治疗组的总有效率高于对照组,尤其是显效率更是明显,四组比较有显著性差异(P0.05),治疗C组疗效最佳。2.四组生活质量均有改善,其中四组治疗前后比较心绞痛稳定状态(AS)、心绞痛发作情况(AF)、治疗满意程度(TS)和疾病认知程度(DP)均有不同程度改善(P0.05,P0.01),而治疗组在治疗后AS、AF、TS、DP优于同期对照组(P0.05),且C组优于A组、B组(P0.05)。四组治疗后心电图及动态心电图较治疗前改善,其中治疗组优于对照组。四组治疗后左室大小无明显差异,但治疗组射血分数优于对照组。3.四组凝血功能均有改善,其中四组治疗前后比较凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均有不同程度延长,但治疗前后无明显差异(P0.05);四组治疗前后纤维蛋白原(FIB)均有明显改善,有不同程度下降,而治疗组在治疗后优于同期对照组(P0.05),且C组优于A组、B组(P0.05)。4.四组患者治疗前后血Hs-CRP和MPO水平均有不同程度降低(P0.05)。四组治疗后比较,治疗组血Hs-CRP和MPO水平明显低于对照组(P0.05),且C组优于A组、B组(P0.05)。四组在治疗后比较,中西医联合治疗后胆固醇(TC)、低密度脂蛋白(LDL)、脂蛋白a(LPA)、游离脂肪酸(FFA)的降幅也略优于对照组。结论:心脉通贴散和芪参益气滴丸不但具有改善不稳定型心绞痛患者PCI术后的心绞痛疗效及中医症候的作用,还具有改善凝血功能,降低血脂及不稳定斑块炎症因子水平(Hs-CRP、MPO),提高患者生活质量的作用。提示芪参益气滴丸、心脉通贴散是防治不稳定型心绞痛疾病的有效药物,具有稳定不稳定性斑块及抗炎的作用。其不良反应少,值得临床推广。目的二:探讨芪参益气滴丸联合心脉通贴散对缺血再灌注损伤大鼠的心功能、血流动力学、炎症因子的影响。方法:对大鼠行冠脉结扎,继则松开结扎线,使大鼠形成缺血再灌注损伤,然后分组予芪参益气滴丸联和心脉通贴散以及阿托伐他汀钙治疗4周。最后分别监测各组的心脏彩超、血流动力学、心肌HE染色、NT-proBNP、CKMB、cTnI及炎症因子Hs-CRP、MPO。结果:1.与模型组比较,芪参益气滴丸联合心脉通贴散组和阿托伐他汀组大鼠LVEDD、LVESD不同程度降低(P0.05),EF、FS及SV增加(P0.05)。2.与模型组比较,阿托伐他汀组和芪参益气滴丸联合心脉通贴散组大鼠MAP、LVDP、+dp/dtmax、-dp/dtmax显著升高(P0.05),LVEDP及ST显著降低(P0.05)。3.与假手术组比较,模型组、芪参益气滴丸联合心脉通贴散组和阿托伐他汀组血清NT-proBNP、Hs-CRP、MPO含量均明显升高(P0.01)。与模型组比较,芪参益气滴丸联合心脉通贴散组和阿托伐他汀组血清NT-proBNP及Hs-CRP、MPO含量显著性降低(P0.05)。
[Abstract]:Coronary heart disease (CHD) is a common disease in clinic. The mortality rate is increasing in recent years. In 2014, the death rate of cardiovascular disease in China is still the first in all diseases. It is higher than tumor and other diseases, which seriously damage the people's physical and mental health. The conventional treatment methods of coronary heart disease include drug treatment and surgical treatment, including percutaneous coronary intervention. PCI is one of the treatment methods, because of its quick effect and clear curative effect. But PCI still has many problems that can not be solved, such as restenosis after PCI, the quality of life is not improved after the operation, the mental state is not flat, the recurrence of angina pectoris, and so on. These problems have plagued the general doctors and patients. There is no coronal heart in Chinese medicine. Nouns such as disease and chest pain after PCI, according to their clinical symptoms and manifestations, are similar to the category of the Chinese medicine noun "chest pain and heart pain". The internal treatment and external treatment of traditional Chinese medicine have saved countless lives for thousands of years. Nowadays, western medicine is also faced with many difficult and incapable problems in clinical. Traditional Chinese medicine has always advocated syndrome differentiation and treatment. In the end, we advocate taking people as a whole, so they can give full play to their advantages in a lot of treatment, and combine with western medicine to relieve the pain of the patients. Objective: To study 160 cases of unstable angina pectoris with Qi deficiency and phlegm stasis in 160 cases, and to observe the combination of Qi Shen Yiqi dropping pills and heart pulse. The clinical effect of Tong tie powder on patients with Qi deficiency and phlegm stasis after PCI operation. Methods: 160 patients with unstable angina pectoris with PCI were selected and divided into control group and treatment group (A, B, C group), 40 cases in each group. The four groups were treated with conventional western medicine, and the A group was treated with the treatment of the control group. The treatment group B was treated with Qi Shen Yiqi dripping pill on the basis of the control group; group C was treated with 1 packs of Qi Shen Yiqi dropping pill 3 times / day and Xin Mai Tong pasting Acupoint Application on the basis of the control group. The clinical curative effect, TCM syndrome score, coagulation function (PT, APTT, TT, FIB), Hs-CRP, MPO, lipid (TC, LDL, LPA) and FFA and other changes were observed. Results: 1. The effect of four groups of angina pectoris and TCM syndrome were improved, and the total effective rate of the treatment group was higher than that of the control group, especially in the four groups (P0.05). The best quality of life of.2. four groups in the treatment group C was improved, of which four groups were compared with the stable state of angina pectoris (AS), angina pectoris before and after treatment. Seizures (AF), treatment satisfaction (TS) and disease cognition (DP) were improved (P0.05, P0.01) in different degrees (P0.05, P0.01), while AS, AF, TS, DP in the treatment group were better than those of the same group (P0.05) after treatment, and the C group was better than the A group. The four groups were better than the treatment group before treatment, and the treatment group was superior to the control group. The treatment group was better than the control group. There was no significant difference in the size of left ventricle after treatment, but the ejection fraction of the treatment group was better than that of the control group.3. four. Among the four groups, the prothrombin time (PT), the activated partial thromboplastin time (APTT) and the thrombin time (TT) were prolonged in different degrees, but there was no significant difference before and after treatment (P0.05); the four groups were treated before and after treatment. The fibrinogen (FIB) was obviously improved, and the treatment group was better than the control group (P0.05) after treatment, and the C group was better than the A group. The level of Hs-CRP and MPO in the group of group B (P0.05).4. four were reduced in varying degrees (P0.05). The four groups were compared with the control group. .05), and group C was superior to group A and group B (P0.05). The four groups were compared after treatment, and the decrease of cholesterol (TC), low density lipoprotein (LDL), lipoprotein a (LPA), and free fatty acid (FFA) was slightly better than that of the control group after the combination of Chinese and Western medicine. Conclusion: Xin Mai Tong paste and Qi Shen Yiqi dropping pills not only have angina pectoris after PCI operation in patients with unstable angina pectoris. The effect of curative effect and TCM syndrome also have the effect of improving the function of blood clotting, reducing the level of lipid and unstable plaque inflammatory factors (Hs-CRP, MPO), and improving the quality of life of the patients. It suggests that the Qi Shen Yiqi dropping pill is an effective drug to prevent and cure unstable angina pectoris, and it has the effect of stabilizing unstable plaque and anti inflammation. Objective two: To explore the effect of Qi Shen Yiqi dropping pill combined with Xin Mai Tong paste on the cardiac function, hemodynamics and inflammatory factors in rats with ischemia-reperfusion injury. Methods: the rats were ligated with coronary artery, then the ligation line was released to make the rats form the ischemia reperfusion injury, and then group to the Qi Shen Yiqi dropping pill. The treatment of cardiac color Doppler and atorvastatin calcium for 4 weeks. Finally, the cardiac color Doppler ultrasound, hemodynamics, myocardial HE staining, NT-proBNP, CKMB, cTnI and inflammatory factors Hs-CRP, MPO. results were measured respectively. 1. compared with the model group, Qi Shen Yiqi dropping pills combined with the heart Mai Tong paste group and atorvastatin group LVEDD, LVESD decreased in varying degrees (P0.). 05), EF, FS and SV increase (P0.05).2. compared with the model group, the Atorvastatin group and the Qi Shen Yiqi dropping pill combined with the heart Mai Tong paste group, the MAP, LVDP, +dp/dtmax, -dp/dtmax significantly increased (P0.05), LVEDP and ST significantly decreased, the model group, the Qi Shen Yiqi dropping pill combined with the heart Mai Tong paste group and the Atorvastatin group serum The content of NT-proBNP, Hs-CRP and MPO increased significantly (P0.01). Compared with the model group, the content of NT-proBNP and Hs-CRP in the serum of Qi Shen Yiqi dropping pills and the Atorvastatin group was significantly lower than that of the model group (P0.05).
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R541.4

【相似文献】