郭老经验方治疗急性冠脉综合征PCI术后的临床研究

发布时间：2018-01-28 20:36

本文关键词： 急性冠脉综合征 PCI术血小板聚集率 BNP 郭老经验方中医症候积分　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：观察郭老经验方治疗急性冠脉综合征(ACS) PCI术后的临床疗效及安全性。方法：本研究采用单盲、随机的研究方法,选取2015年5月至2016年2月于广东省中医院心血管内科确诊为ACS并于住院期间行PCI术的患者40例,随机分为治疗组(郭老经验方+西医标准化治疗)和对照组(西医标准化治疗)各20例,对照组在PCI术后给予常规西医基础治疗,治疗组在对照组治疗的基础上加用郭老经验方。入组后分别记录两组患者冠心病中医症候积分、血小板聚集率、BNP、肝肾功能等指标,经治疗1月后再次进行上述评分,复查患者血小板聚集率、BNP及肝肾功能,观察治疗期间是否发生心血管不良事件,分析郭老经验方治疗急性冠脉综合征PCI术后的临床疗效及安全性。结果：40例ACS患者中总共有ST段抬高型心肌梗死6例(治疗组3例,对照组3例)非ST段抬高型心肌梗死9例(治疗组5例,对照组4例),不稳定性心绞痛25例(治疗组12例,对照组13例),两组间无统计学意义(P＞0.050)；对治疗组和对照组一般临床资料比较,两组分别在年龄、性别、高血压病史、2型糖尿病病史、血脂代谢异常、吸烟、饮酒、冠脉病变数目、冠脉内支架植入数目等指标差异均无统计学意义(P＞0.050)。 (1)治疗组治疗前中医症候积分为17.40±1.875,治疗后中医症候积分为6.20±2.567；对照组治疗前中医症候积分为16.90±2.553,治疗后中医症候积分为8.90±2.573；治疗后俩组中医症候积分均较前明显下降,组间比较差异具有统计学意义(P＜0.050)。(2)治疗组治疗前血小板聚集率为48.45±10.118,治疗后血小板聚集率为18.45±6.747；对照组治疗前血小板聚集率为50.85±12.737,治疗后血小板聚集率为23.10±6.980；治疗后两组血小板聚集率均较治疗前明显下降,组间比较差异具有统计学意义(P＜0.050)。(3)治疗组治疗前BNP分别为314.70±388.949,治疗后BNP分别为120.05±90.001；对照组治疗前BNP为216.85±226.350,治疗后BNP为77.65±56.498；治疗后两组BNP均较前有所下降,但组间比较差异无统计学意义(P＞0.050)。 (4)治疗组、对照组均无肝肾功能损害等不良反应,均无急性心衰、恶性心律失常、再梗死、心源性猝死等主要心血管不良事件发生。结论：西医标准化治疗联合郭老经验方可以有效降低急性冠脉综合征PCI术后患者的中医症候积分；可以进一步降低急性冠脉综合征PCI术后患者的血小板聚集率；无肝肾功能损害,不增加主要心血管不良事件风险,安全性良好；但其未能有效降低急性冠脉综合征PCI术后患者的血浆BNP值。
[Abstract]:Objective: to observe the clinical efficacy and safety of Guo Lao experience prescription in the treatment of acute coronary syndrome (ACS) after PCI. From May 2015 to February 2016, 40 patients who were diagnosed as ACS in Department of Cardiovascular Medicine, Guangdong Provincial Hospital of traditional Chinese Medicine and underwent PCI operation during hospitalization were selected. They were randomly divided into two groups: the treatment group (20 cases) and the control group (20 cases). The control group was treated with routine western medicine basic therapy after PCI. The treatment group in the control group on the basis of treatment plus Guo Lao experience prescription. After entering the two groups respectively recorded the coronary heart disease TCM symptom score platelet aggregation rate of BNPs liver and kidney function and other indicators. After the treatment of January, the above scores were re-evaluated, and the platelet aggregation rate and liver and kidney function of the patients were re-examined to observe whether cardiovascular adverse events occurred during the treatment. Results there were 6 cases of St segment elevation myocardial infarction (St segment elevation myocardial infarction) in 40 cases of ACS (treatment group 3 cases). There were 9 cases of non-ST-segment elevation myocardial infarction (5 cases in the treatment group, 4 cases in the control group and 25 cases in the unstable angina pectoris) (12 cases in the treatment group and 13 cases in the control group). There was no significant difference between the two groups (P > 0.050). The general clinical data of the treatment group and the control group were compared, the two groups in age, sex, hypertension history of type 2 diabetes history, dyslipidemia, smoking, drinking, coronary artery disease number. There was no significant difference in the number of stents implanted in coronary artery (P > 0.050). The score of TCM symptom before treatment in the treatment group was 17.40 卤1.875. After treatment, the score of TCM symptom was 6.20 卤2.567; In the control group, the score of TCM symptom was 16.90 卤2.553 before treatment and 8.90 卤2.573 after treatment. After treatment, the scores of TCM symptoms in both groups were significantly lower than before. The platelet aggregation rate of the treatment group was 48.45 卤10.118 before treatment. The platelet aggregation rate after treatment was 18.45 卤6.747; In the control group, the platelet aggregation rate was 50.85 卤12.737 before treatment and 23.10 卤6.980 after treatment. After treatment, the platelet aggregation rate in both groups was significantly lower than that before treatment. The BNP of the treatment group was 314.70 卤388.949 before treatment. The BNP after treatment was 120.05 卤90.001; In the control group, BNP was 216.85 卤226.350 before treatment and BNP was 77.65 卤56.498 after treatment. After treatment, the BNP of the two groups was decreased, but there was no significant difference between the two groups (P > 0.050. 4) in the treatment group, there were no adverse reactions such as liver and kidney function damage in the control group. There were no acute heart failure, malignant arrhythmia, and reinfarction. Conclusion: Western medicine standardized treatment combined with Guo Lao experience prescription can effectively reduce the TCM symptom score of patients with acute coronary syndrome after PCI. It can further reduce the platelet aggregation rate of patients with acute coronary syndrome after PCI. No liver and kidney function damage, no increased risk of major cardiovascular adverse events, good safety; However, it can not effectively reduce the plasma BNP of patients with acute coronary syndrome after PCI.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R259

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