益气养阴活血法治疗冠心病心绞痛临床疗效及对HRV时域指标干预的研究

发布时间：2018-05-04 04:23

本文选题：稳定型心绞痛 + 生脉散瘀汤　；参考：《山东中医药大学》2016年硕士论文

【摘要】：目的:冠心病稳定型心绞痛是危害人类健康的常见病,近年来发病率较前增加,且发病呈年轻化趋势。本研究运用中医学理论,遵循中医内科疾病的辨治原则,研究益气养阴活血法对冠状动脉粥样硬化性心脏病稳定型心绞痛中气阴两虚、血脉瘀阻证的疗效及心率变异性的影响。方法:将符合纳入标准的60例冠心病稳定型心绞痛,气阴两虚、血脉瘀阻证患者随机平均分为治疗组和对照组。对照组30例给予常规药物治疗,即口服阿司匹林(拜阿司匹灵)100mg qd、琥珀酸美托洛尔缓释片(倍他乐克)23.75mg qd、立普妥(阿托伐他汀钙片)20mg qn及单硝酸异山梨酯片(欣康)20mg bid;治疗组30例在常规药物治疗基础上给予生脉散瘀汤(党参30g丹参30g茯苓15g白术15g当归15g熟地黄30g五味子12g赤芍30g麦冬30g甘草6g)口服,在治疗4周后分别记录两组受试者治疗前后的动态心电图中所记录之心率变异性指标,同时观察两组治疗前后中医症候积分、中医症候疗效、心绞痛症状积分、心绞痛疗效及安全性指标的差异。所有观察指标之结果均建立数据库,使用“SPSS17.0”统计软件进行统计学分析处理。结果:在经过4周的治疗后,组内对比,两组治疗后的心率变异性指标(SDNN、r MSSD、p NN50)、中医症候积分、心绞痛症状积分明显优于治疗前,差异有统计学意义(P0.05);在治疗后,所统计治疗组和对照组的心率变异性指标(SDNN、r MSSD、p NN50)、中医症候积分、中医症候疗效、心绞痛症状积分进行组间对比,其差异有统计学意义(P0.05);治疗后治疗组与对照组之心绞痛疗效对比,两组差异无统计学意义(P0.05);所统计治疗组和对照组在治疗前的心率变异性指标(SDNN、r MSSD、p NN50),其差异无统计学意义(P0.05)。两组安全性指标治疗前后对比差异无统计学意义(P0.05)。结论:1.生脉散瘀汤能明显改善冠心病稳定型心绞痛,气阴两虚、血脉瘀阻证患者的心绞痛临床症状、中医证候。2.生脉散瘀汤联合琥珀酸美托洛尔缓释片可进一步改善冠心病心绞痛,气阴两虚、血脉瘀阻证患者的心率变异性指标(SDNN、r MSSD、p NN50),改善患者的心脏自主神经功能。3.冠心病心绞痛,证属气阴两虚、血脉瘀阻证的患者在常规药物治疗的基础上加用生脉散瘀汤可进一步增加疗效,生脉散瘀汤可起到较好的辅助作用,且安全性良好,亦印证了中西医结合治疗本病的优势。
[Abstract]:Objective: stable angina pectoris of coronary heart disease (CHD) is a common disease harmful to human health. Using the theory of traditional Chinese medicine (TCM) and following the principle of differentiation and treatment of internal diseases of traditional Chinese medicine, this study studied the effect of the method of supplementing qi and nourishing yin and activating blood circulation on the curative effect and heart rate variability in stable angina pectoris of coronary atherosclerotic heart disease. Methods: sixty patients with stable angina pectoris, deficiency of qi and yin, and blood stasis syndrome were randomly divided into treatment group and control group. The control group (30 cases) was treated with routine medicine. Oral aspirin (Beispirin 100mg QD, metoprolol succinate 23.75mg QD, Atto vastatin calcium 20mg QN and isosorbide mononitrate 20mg bid; treatment group: 30 patients) On the basis of treatment, Shengmai Sanyu decoction was given orally (Codonopsis 30g Salvia miltiorrhiza 30g Fuling 15g Danggui 15g Radix angelicae Sinensis 30g Radix Schisandrae 30g Radix Schisandrae 30g Rhizoma Ophiopogonis 30g Licorice 30g). After 4 weeks of treatment, the indexes of heart rate variability were recorded in the dynamic electrocardiogram of the two groups before and after treatment, and the scores of TCM symptoms, TCM symptoms and angina pectoris were observed before and after treatment. The difference of curative effect and safety index of angina pectoris. The results of all the observed indexes were analyzed by SPSS17.0 software. Results: after 4 weeks of treatment, the indexes of heart rate variability (HRV) of the two groups were compared. The scores of symptoms of TCM and angina pectoris were significantly better than those before treatment (P 0.05), and after treatment, the indexes of heart rate variability (HRV) of the two groups were significantly higher than that of before treatment (P 0.05), and the scores of symptoms of TCM and angina pectoris were significantly better than those before treatment. The indexes of heart rate variability (HRV) of the treatment group and the control group were compared between the two groups, including the score of TCM symptom, the curative effect of TCM symptom and the symptom score of angina pectoris. The difference was statistically significant (P 0.05); there was no significant difference between the treatment group and the control group in the effect of angina pectoris (P 0.05); the heart rate variability (HRV) of the treatment group and the control group before treatment was not significantly different from that of the control group (P 0.05). There was no significant difference in safety indexes between the two groups before and after treatment (P 0.05). Conclusion 1. Shengmai Sanyu decoction can obviously improve the clinical symptoms of angina pectoris in patients with stable angina pectoris of coronary heart disease, deficiency of qi and yin, and blood stasis syndrome. Shengmai Sanyu decoction combined with metoprolol succinate sustained release tablet can further improve the heart rate variability index of patients with angina pectoris, deficiency of qi and yin, blood vessel stasis syndrome, and improve cardiac autonomic nervous function. Coronary heart disease angina pectoris, syndrome of deficiency of qi and yin, blood vessel stasis syndrome patients can add Shengmai Sanyu decoction on the basis of routine drug treatment to further increase the curative effect, Shengmai Sanyu decoction can play a better auxiliary role, and the safety is good. Also confirmed the combination of traditional Chinese and Western medicine treatment of the advantages of this disease.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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