祛风稳斑汤治疗寒凝心脉型冠心病不稳定型心绞痛的临床观察

发布时间：2018-05-25 21:08

本文选题：祛风稳斑汤 + 从风论治　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的旨在通过祛风稳斑汤治疗寒凝心脉型不稳定心绞痛患者,观察其临床的治疗效果以及其对患者易损斑块的血清学相关指标变化的作用,从而为冠心病不稳定心绞痛、易损斑块的形成与预防提供进一步的中医理论基础和临床依据。方法选取冠心病不稳定心绞痛患者中符合中医症候诊断为寒凝心脉型者76例,采用随机分组对照的研究方法,将上述患者分为两个组别,治疗组38例,对照组38例。所有受试者均给予抗心绞痛、降脂等基础治疗,对照组在维持基础治疗同时,加用复方丹参滴丸(10丸/次,3次/日,口服);而治疗组在基础治疗上加用祛风稳斑汤,由本院药房统一代煎,每付药分装成两袋,各150ml,于早饭、晚饭后半小时温热后服用。上述76例患者治疗4周后,详细记录每个患者心绞痛发作频率、持续时间长短、严重程度以及治疗前后患者心电图变化等指标;同时,记录患者舌苔、脉象等中医症候改变;此外,还需定期测定患者不稳定斑块状况的血清学指标,例如超敏C反应蛋白(high-sensitivity C-reactiveprotein,hs-CRP)、血浆同型半胱氨酸(homocysteine,Hcy)、氧化性低密度脂蛋白(ox LDL)等。结果⑴实验结束后,治疗组的总有效率(86.84%),对照组总有效率(68.42%),两个组相比较差异有统计学的意义(P0.05);⑵治疗后两组的临床症状与治疗前相比均改善(P0.05),且治疗组的改善优于对照组(P0.05),尤其是在胸痛、气短、神疲乏力、自汗等症状上改善更加明显;⑶治疗前,两组间中医证候总积分相比没有显著差异(P0.05);治疗后,两组证候总积分与治疗前相比都明显下降,有显著差异(P0.05),且治疗后两组间相比也有显著的差异(P0.05);⑷治疗前,两组心电图指标比较均没有差异(P0.05);治疗后,两组心电图指改善与自身治疗前比较有差异(P0.05);两组之间治疗后比较,心电图水平的改善有明显的差异(P0.05);⑸两组治疗前血脂代谢比较没有差异性(P0.05);对照组治疗前后血脂比较无差异(P0.05);治疗组治疗后血脂,与治疗前比较有差异(P0.05);⑹治疗前后,两组相比,hs-CRP均有明显的差异(P0.05);治疗后两个组比较,hs-CRP均有明显差异(P0.05);⑺治疗前,两组ox-LDL指标之间比较差异无显著性(P0.05);治疗后,两组自身与治疗前相比,均有显著差异(P0.05),有统计学意义;两组治疗后比较,有显著性差异(P0.05),有统计学意义。⑻治疗前,两组HCY指标之间比较差异无显著性(P0.05);治疗后,两组自身与治疗前比较,均有显著差异(P0.05),有统计学意义;两组治疗后比较,有显著性差异(P0.05),有统计学意义。⑼治疗组1例患者出现轻微腹痛隐痛症状,但可耐受。未出现其他严重并发症、终末事件,对照组7例患者病情转为加重。结论运用祛风稳斑汤联合常规西药治疗治疗可明显缩短寒凝心脉型冠心病不稳定型心绞痛患者心绞痛持续时间,缓解心绞痛疼痛程度,改善患者心电图表现,不仅可以显著提高治疗的总有效率,降低患者的中医证候总积分,而且改善患者的中医临床症状;此外,祛风稳斑汤可明显改善患者血脂、血浆同型半胱氨酸(HCY)、氧化性低密度脂蛋白(ox LDL)、超敏C反应蛋白(hs-CRP)的水平,与单用西药治疗相比,未出现明显的不良反应、毒副作用,安全性较高,在临床治疗不稳定型心绞痛中值得推广。
[Abstract]:Objective To observe the effect of the treatment of cold coagulant angina pectoris with the treatment of cold coagulant angina pectoris, and its effect on the changes of the serum related indexes of vulnerable plaque, so as to provide further theoretical basis and clinical basis for the development of unstable angina pectoris, the formation and prevention of vulnerable plaque. Methods 76 cases of coronary heart disease patients with unstable angina pectoris were selected and divided into two groups, 38 cases in the treatment group and 38 in the control group. All the subjects were treated with anti angina pectoris, lipid lowering and other basic treatment, while the control group was maintained at the same time in the maintenance of basic treatment. Combined with Compound Danshen Dripping Pills (10 pills / times, 3 times a day, oral), and the treatment group was combined with the decoction of dispelling wind and stabilizing the spot on the basis of the treatment, the medicine room of our hospital was decocted together and divided into two bags, each 150ml, in breakfast, after supper half an hour after supper. After 4 weeks of treatment, the frequency of angina pectoris in each patient was recorded and the duration of each patient was recorded in detail. Length, severity, and electrocardiogram changes in patients before and after treatment; at the same time, TCM syndrome changes such as tongue coating and pulse condition are recorded; in addition, the serological indexes of unstable plaque condition in patients, such as hypersensitive C reactive protein (high-sensitivity C-reactiveprotein, hs-CRP), plasma homocysteine (homocysteine Hcy), oxidative low density lipoprotein (ox LDL) and so on. Results (1) after the experiment, the total effective rate of the treatment group (86.84%), the total effective rate (68.42%) in the control group (68.42%), the difference between the two groups was statistically significant (P0.05); 2. After treatment, the clinical symptoms were improved compared with before treatment (P0.05), and the improvement of the treatment group was better than that of the control group (P0.05). Especially in the chest pain, shortness of breath, fatigue, sweating and other symptoms improved more obviously; (3) before treatment, the total score of TCM syndromes between the two groups was not significantly different (P0.05); after treatment, the total score of the two groups was significantly lower than before treatment (P0.05), and there were significant differences between the two groups after treatment (P0.05); 4 Before treatment, there was no difference in electrocardiogram between the two groups (P0.05). After treatment, the two groups had a difference (P0.05) before the treatment, and the improvement of electrocardiogram level between the two groups was significantly different (P0.05); there was no difference between the two groups before treatment (P0.05), and the blood lipid before and after treatment in the control group. There was no difference (P0.05); the blood lipid in the treatment group was different from that before treatment (P0.05); before and after treatment, there were significant differences between the two groups (P0.05); after the treatment, there was a significant difference between the two groups after treatment (P0.05); before the treatment, there was no significant difference between the two groups of ox-LDL indexes (P0.05); after treatment, the two groups themselves and the two groups were not significantly different (P0.05). Before treatment, there were significant differences (P0.05), statistically significant; there were significant differences between the two groups after treatment (P0.05). Before treatment, there was no significant difference between the two groups of HCY indexes (P0.05); after treatment, the two groups were significantly different from before treatment (P0.05), with statistical significance; the two groups were compared after treatment. There were significant differences (P0.05). There were 1 cases of mild abdominal pain in the treatment group, but they were tolerable. There were no other serious complications, end events and 7 cases in the control group. Conclusion the treatment of coronary heart disease with the combination of dispelling wind and stabilizing the spot soup combined with the conventional western medicine can obviously shorten the unstable angina pectoris type coronary heart disease instability. The duration of angina pectoris in patients with angina pectoris, alleviating angina pectoris and improving patients' electrocardiogram can not only significantly improve the total effective rate of treatment, reduce the total score of TCM syndrome, but also improve the clinical symptoms of Chinese medicine. In addition, it can obviously improve the blood lipid and plasma homocysteine (HC Y), the level of oxidized low density lipoprotein (ox LDL) and hypersensitive C reactive protein (hs-CRP), compared with western medicine alone, has no obvious adverse reactions, toxic side effects and high safety. It is worth popularizing in the clinical treatment of unstable angina pectoris.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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