冠心汤治疗气虚血瘀型冠心病介入术后残余病变心绞痛的临床疗效研究

发布时间：2018-04-15 14:06

本文选题：介入术后 + 残余病变心绞痛　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:观察冠心汤治疗气虚血瘀型冠心病介入术后残余病变心绞痛的临床疗效及安全性,并初步探讨其作用机制,为临床使用冠心汤治疗气虚血瘀型冠心病介入术后残余病变心绞痛提供可靠的证据,为中医临床治疗冠心病介入术后残余病变心绞痛提供新的治疗思路和方法。方法:选取2016年4月至2017年1月期间在徐州市中医院心血管内科治疗的气虚血瘀型冠心病介入术后残余病变心绞痛患者60例。以随机数字表法对60位患者进行选择分组,其中共有27位患者入对照组进行观察,该组患者在介入术后采用常规西药治疗(如以下药物:阿司匹林、氯吡格雷、阿托伐他汀钙、美托洛尔等)。33位患者入选冠心汤组进行观察,该组患者除予常规西药治疗之外加服用冠心汤。临床观察周期为3个月。疗程结束以后,将两组患者治疗前后心绞痛程度分级、西雅图心绞痛量表(SAQ)(见附录一)、中医证候积分疗效(见附录二)、生活质量评分(SF-36)(见附录三)、高密度脂蛋白、低密度脂蛋白、总胆固醇、超敏C反应蛋白和安全性指标的变化进行比较。使用统计学软件SPSS 20.0进一步分析以上结果。结果:治疗后两组在西雅图心绞痛量表、中医证候积分疗效、生活质量评分等方面较治疗前均有明显改善,且冠心汤组相较对照组以上指标改善尤为显著(P0.05),治疗后冠心汤组的中医证候有效率较对照组更高,且差异显著(P0.05);冠心汤组在心绞痛程度分级改善较为显著(P0.05),对照组在心绞痛程度分级方面未见明显改善(P0.05)。治疗后两组的超敏C反应蛋白、总胆固醇、低密度脂蛋白等指标均降低,高密度脂蛋白相比较治疗前明显上升,统计学上存在差异(P0.05);且两组间的超敏C反应蛋白、总胆固醇、低密度脂蛋白等指标对比,冠心汤组各指标降低更加显著,统计学上有明显区别(P0.05);治疗后两组的高密度脂蛋白相比较,组间无统计学差别(P0.05)。结论:冠心汤联合西药可以显著改善气虚血瘀型冠心病介入术后残余病变心绞痛患者的临床症状,降低心绞痛的发生率,降低炎症反应,改善脂质代谢,改善预后,无不良反应,具有相对良好的临床安全性,因而可以广泛进行临床推广并加以使用。
[Abstract]:Objective: to observe the clinical efficacy and safety of Guanxin decoction in treating residual angina pectoris of coronary heart disease with deficiency of qi and blood stasis, and to explore its mechanism.To provide reliable evidence for clinical application of Guanxin decoction in treating residual angina pectoris of coronary heart disease with deficiency of qi and blood stasis after interventional operation, and to provide a new way of treatment for angina pectoris of residual disease after coronary intervention in TCM.Methods: from April 2016 to January 2017, 60 patients with residual angina pectoris of coronary heart disease with Qi deficiency and blood stasis were treated in Xuzhou Hospital of traditional Chinese Medicine from April 2016 to January 2017.Sixty patients were randomly divided into two groups. A total of 27 patients were observed in the control group. The patients were treated with routine western medicine (aspirin, clopidogrel, Atto vastatin calcium) after interventional surgery.Metoprolol et al. 33 patients were selected for observation in Guanxin decoction group.The clinical observation period was 3 months.After the course of treatment, the patients in the two groups were classified as angina pectoris before and after treatment, the Seattle angina scale (see appendix I), the curative effect of TCM syndromes score (see appendix II), quality of life score (see appendix III), high density lipoprotein (HDL),Changes of low density lipoprotein, total cholesterol, hypersensitive C reactive protein and safety index were compared.Statistical software SPSS 20.0 was used to further analyze the above results.Results: after treatment, the two groups in Seattle angina scale, TCM syndromes integral efficacy, quality of life score were significantly improved compared with before treatment.The improvement of above indexes in Guanxin decoction group was more significant than that in control group, and the effective rate of TCM syndromes in Guanxin decoction group was higher than that in control group after treatment.The difference was significant (P 0.05), and the improvement of angina pectoris grade in Guanxin decoction group was more significant than that in control group (P 0.05), but there was no significant improvement in angina pectoris grade in control group.After treatment, the hypersensitive C-reactive protein, total cholesterol and low density lipoprotein in the two groups were all decreased, the high density lipoprotein increased significantly before treatment, and there was statistical difference between the two groups (P 0.05), and the hypersensitive C-reactive protein between the two groups, total cholesterol,Compared with low density lipoprotein and other indexes, the index of Guanxin decoction group decreased more significantly, there was significant difference in statistics between the two groups, and there was no statistical difference between the two groups in terms of high density lipoprotein after treatment (P 0.05).Conclusion: Guanxin decoction combined with western medicine can significantly improve the clinical symptoms, reduce the incidence of angina pectoris, reduce inflammatory reaction, improve lipid metabolism and improve prognosis in patients with residual angina pectoris after intervention of coronary heart disease with Qi deficiency and blood stasis.No adverse reaction, relatively good clinical safety, so it can be widely used in clinical application.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

【参考文献】