中风醒脑液治疗非ST段抬高型急性心肌梗死的临床疗效观察

发布时间：2018-05-05 09:56

本文选题：脑卒中 + 异病同治　；参考：《成都中医药大学》2015年博士论文

【摘要】：目的：1.从中医学角度探讨心脑异病同治的理论基础,为中风醒脑液治疗心血管疾病提供理论依据；2.通过临床研究,系统评价中风醒脑液对NSTEMI的治疗作用,为中风醒脑液干预治疗心血管疾病提供科学依据。方法：1.理论研究：(1)回顾中医学关于“心痛”“胸痹”等类似疾病的认识和研究,并归纳其与现代医学AMI的联系。(2)探讨中医学关于心脑异病同源及异病同治的理论基础。(3)探讨中风醒脑液治疗NSTEMI的实践基础及理论依据。2.临床研究(1)本研究采用随机、平行、对照方法,将84例符合纳入标准的NSTEMI患者随机分为治疗组和对照组,其中治疗组43例,对照组41例,对两组纳入病例要求基线齐性,具有可比性。(2)两组患者在均予西医常规抢救治疗措施的基础上,治疗组另予中风醒脑液干预治疗,疗程14d。(3)病程中按照拟定的诊疗计划在不同的时间点检测或记录ECG、VLP. CK-MB、cTnI、胸痛发作次数及持续时间、镇痛药物使用剂量、超声心动图(LVEF、 E/A、WMSI)等,并记录不良安全事件。观察结束后对两组检查结果进行统计分析比较。结果：1.古人对“真心痛”等类似AMI的疾病诊治经验丰富,与现代医学观点具有类似之处；中医学理论支持心脑异病同源、异病同治的观点；中风醒脑液治疗NSTEMI符合中医理论。2.临床研究(1)入院时两组患者的基线水平一致,各项基线检测值无统计学差异。(2)中风醒脑液治疗后两组患者的缺血性心电图均成好转趋势,但是治疗组改善趋势更为明显。与同组内入院时相比较,治疗组在24h的结果就显示差异具有统计学意义(P0.05),而对照组则是在72h。两组间结果比较显示在24h、48h时治疗组优于对照组(P0.05)。(3)两组患者在疗程中VLP均成好转趋势,但治疗组更为明显。组间比较显示治疗组的指标在第1周及第2周时均明显优于对照组(P0.05)。(4)两组CTnI和CK-MB在病程初期达峰值后均呈下降趋势,治疗组较对照组的cTnI和CK-MB下降趋势更为明显,两组间结果比较显示差异在第48h、72h时更为突出(P(0.01)。(5)两组患者胸痛发作次数及持续时间均成下降趋势,治疗组更为明显,两组在25-48h时间段内的数据具有显著性差异(P0.05),第7日两组症状已无明显差别。(6)组间比较结果显示治疗组在各时间段内镇痛药剂量均明显低于对照组(P0.05)。(7)两组在各个时间段的LVEF、E/A、WMSI指标均趋于好转,治疗组趋势更明显。在第7d、14d时治疗组的WMSI指标均优于对照组(P0.05),而且在第14d时治疗组LEVF指标也优于对照组(P0.05),整个观察过程中未见两组间E/A具有统计学差异(p0.05)。结论：1.中医学对AMI类似疾病的临床诊治具有丰富的理论和实践基础；中医学理论支持心脑异病同治的观点；2.中风醒脑液的理法方药适合临床治疗心血管急症,其治疗AMI符合中医学异病同治理论；3.中风醒脑液可以显著改善急性期NSTEMI患者的ECG、VLP、CK-MB、cTnI、超声心动图(LVEF、E/A、WMSI),降低胸痛发作次数及持续时间、镇痛药物使用剂量,较单纯西药治疗具有明显优势；4.中风醒脑液治疗NSTEMI临床疗效确切,安全可靠,无不良反应；5.中风醒脑液是治疗NSTEMI的有效方剂。
[Abstract]:Objective: 1. to explore the theoretical basis of treating heart and brain disease with the same treatment from the perspective of traditional Chinese medicine, and to provide the theoretical basis for the treatment of cardiovascular diseases by the stroke Xingnao liquid; 2. through the clinical study, the therapeutic effect of apoplexy Xingnao liquid on NSTEMI is systematically evaluated, and the scientific basis for the intervention and treatment of cardiovascular diseases by the cerebral apoplexy solution is provided. Method: 1. theoretical studies: (1) The understanding and Research on similar diseases such as "heart pain" "chest pain" and other similar diseases in traditional Chinese medicine (TCM). (2) discuss the theoretical basis of traditional Chinese medicine on the homology of different diseases of the heart and brain and the treatment of the same disease. (3) the practical basis and theoretical basis of the treatment of apoplexy in the treatment of AMI (1) clinical study (1) this study was a random, flat study. 84 cases of NSTEMI patients were randomly divided into the treatment group and the control group, including 43 cases in the treatment group and 41 cases in the control group. The two groups were included in the baseline homogeneity and comparable. (2) on the basis of the routine treatment of Western medicine in the two groups, the treatment group was given the intervention therapy of apoplectic wake up solution, and the treatment group was treated with treatment, treatment and treatment of the treatment group. In the course of course 14D. (3), we detected or recorded ECG, VLP. CK-MB, cTnI, the number and duration of chest pain, the dosage of analgesic drugs, LVEF, E/A, WMSI, etc., and recorded the adverse safety events. After the observation, the results of the two groups were statistically analyzed and compared. The results were 1. ancient times. People are rich in the diagnosis and treatment of AMI like diseases, such as "true heart pain" and so on. It is similar to the modern medical viewpoint; the theory of traditional Chinese medicine supports the point of view of the homology of different diseases of heart and brain, and the same treatment with different diseases. The baseline level of the two groups of patients at the admission is consistent with the.2. clinical study of TCM theory (1). Statistical difference. (2) the ischemic electrocardiogram of the two groups of patients after the stroke was improved, but the improvement trend of the treatment group was more obvious. Compared with the same group, the results of the treatment group in 24h showed a statistically significant difference (P0.05), while the results in the group of 72h. were compared to 24h, 48h in the group of two groups. The treatment group was better than the control group (P0.05). (3) the two groups were improved during the course of treatment, but the treatment group was more obvious. The comparison between the group and the treatment group showed that the index of the treatment group was obviously superior to the control group at first and 2 weeks (P0.05). (4) the two groups of CTnI and CK-MB were decreasing in the initial stage of the course of the disease, and the treatment group was cTnI and CK-M compared with the control group. The downward trend of B was more obvious. The results showed that the difference between the two groups was more prominent in 48h and 72h (P (0.01). (5) the number and duration of chest pain in the two groups were decreased, the treatment group was more obvious, the data in the two groups were significantly different (P0.05), and there was no significant difference between the two groups of the two groups on the seventh day. (6) the group of two groups had no significant differences. The comparison results showed that the dosage of the analgesic drug in the treatment group was significantly lower than that of the control group (P0.05). (7) the LVEF, E/A, WMSI indexes of the two groups tended to improve, and the trend of the treatment group was more obvious. The WMSI index in the treatment group was better than that of the control group at 7d and 14d, and the LEVF index in the treatment group was also better than the control group at 14d. Group (P0.05), there was no statistical difference between the two groups in the whole observation process (P0.05). Conclusion: 1. Chinese medicine has a rich theoretical and practical basis for the clinical diagnosis and treatment of similar diseases of AMI; the theory of traditional Chinese medicine supports the viewpoint of the same treatment of heart and brain diseases; 2. the rational prescription of the cerebral apoplexy solution is suitable for the clinical treatment of cardiovascular emergencies, and the treatment of AM I accords with the theory of treatment of different diseases in Chinese medicine; 3. apoplexy Xingnao liquid can significantly improve ECG, VLP, CK-MB, cTnI, echocardiography (LVEF, E/A, WMSI) in acute NSTEMI patients, reduce the number and duration of chest pain, and the dosage of analgesic drugs has obvious advantages compared with that of pure western medicine; the clinical efficacy of the treatment of NSTEMI in the treatment of apoplexy is true. The clinical efficacy of the treatment of NSTEMI is true. Cut, safe and reliable, no adverse reactions; 5. stroke Xingnao liquid is an effective prescription for treating NSTEMI.

【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R542.22

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