清热活血法联合益气养阴法对AMI患者PCI术后心功能的影响及随访研究

发布时间：2018-07-05 08:18

本文选题：清热活血法联合益气养阴法 + AMI　；参考：《广州中医药大学》2016年硕士论文

【摘要】：研究目的：通过前瞻性观察方法,观察清热活血法联合益气养阴法对急性心肌梗死患者PCI术后心功能的影响,为急性心肌梗死PCI术后的中医药防治提供参考依据。研究方法：选择广州中医药大学第一附属医院2015年6月至2016年3月符合纳入标准的患者100例,随机分为单纯西药组(对照组),西药+清热活血汤组(试验1组),西药+清热活血汤+益心活血丸组(试验2组)。疗程1月,重点观察治疗前后中医证候积分、心功能评级、抽血指标(BNP、ALT、AST、UREA、CREA)和超声心动图(EF、LA、LVESD、LVEDD、E、A、E/A)的变化。研究结果：(1)严格遵循西医的药物治疗方案能显著改善急性心梗患者的的胸闷、胸痛、气促等中医证候,在此基础上联用清热活血类中药效果更佳,在西药治疗上,应用清热活血法联合益气养阴法,能进一步降低中医证候积分。(2)AMI患者PCI术后严格坚持冠心病二级预防用药方案能显著提高急性心梗患者的早期的心功能分级,改善患者预后；短期内使用清热活血法或清热活血法联合益气养阴法,于心功能无进一步改善作用。(3)急性心肌梗死患者接受血运重建后及接受西医的药物治疗方案能降低血清BNP,可能与及时恢复血供,减少坏死心肌面积和抑制早期心室重构有关。在此基础上合用清热活血中药,血清BNP进一步降低,再联合益气养阴法则效果进一步增强。(4)本研究观察以EF作为评价收缩功能的指标,以E、A、EA比作为评价心脏舒张功能的指标,研究结果提示,经过1个月的规范西医药物治疗,三组EF、E、E/A较治疗前改善。但是E/A受流体力学影响较大,可能出现“假性正常化”现象,并不能完全反映AMI患者心脏的舒张功能,需要联合S/D,TDI,Tei指数等才能较好的用于心脏舒张功能的评价。在接收规范西药治疗的基础上,联合清热活血中药则对心脏舒缩功能的改善更明显；中医使用清热活血法联合益气养阴法干预则可以进一步增强AMI患者PCI术后的心脏舒张功能。(5)本研究以LA和LVED作为评估心室重构的指标,研究结果初步提示,AMI患者术后LA短期内未见明显变化,但总体呈现上升趋势。术后患者的LVESD及LVEDD均有不同程度的增加,提示心肌发生急性梗死后出现心室重构,且心室重构的发生不受血运重建(溶栓、PCI、CABG)的影响。使用指南推荐药物只能延缓其进展的速度,极少能完全抑制甚至逆转心室重构的进程。西药联合清热活血中药的疗效与单纯使用西药相仿,但是在此基础上再加用益心活血丸可以明显抑制心室重构,提示急性心梗后心室重构可能与心气亏损,心肾阴精耗损有关。(6) ALT、UREA、CREA较治疗前均无明显上升,提示短时间内接受冠心病二级预防的药物、清热活血中药汤剂及益心活血丸的治疗,不会对患者的肝肾功能造成影响,使用以上药物治疗AMI患者具有安全性。其中,益心活血丸成分包括何首乌,本实验侧面证明短期内按规定剂量服用何首乌制剂是安全的。AST较治疗前明显下降(p0.01)。AST是心肌酶学标志物之一,本研究纳入病例以12h之内为多,大部分病例的AST已经超过正常值甚至超过3倍以上,经过治疗,心梗病情经已稳定,故AST恢复到正常水平。(7)治疗期间所有病例未出现任何不良反应。结论：短期内应用清热活血法联合益气养阴法能在西医治疗的疗效基础上进一步降低血清BNP水平、促进急性心肌梗死PCI术后患者心功能的恢复,而且不损害肝、肾功能,服药期间无明显不良反应。
[Abstract]:Objective: To observe the effect of clearing heat and activating blood method combined with Supplementing Qi and nourishing yin method on the cardiac function of patients with acute myocardial infarction after PCI, and to provide reference for the prevention and treatment of traditional Chinese medicine after PCI operation in acute myocardial infarction. The standard 100 patients were randomly divided into simple western medicine group (control group), western medicine + clearing heat Huoxue Decoction group (test 1 groups), western medicine + clearing heat Huoxue Soup + yigxin Huoxue pill group (test 2 groups). In January, the TCM syndrome score, cardiac function rating, blood pumping index (BNP, ALT, AST, UREA, CREA) and echocardiography (EF, LA, LVESD, LVED) were observed before and after treatment. D, E, A, E/A) changes. (1) strict compliance with western medicine treatment scheme can significantly improve the symptoms of acute myocardial infarction in patients with chest distress, chest pain, and shortness of breath. On this basis, the effect of combination of clearing heat and activating blood type Chinese medicine is better. In the treatment of Western medicine, the combination of clearing blood and blood activating and nourishing yin and nourishing Yin can further reduce TCM syndrome. (2) strict adherence to the two grade prevention of coronary heart disease after AMI patients can significantly improve the early cardiac function classification and improve the prognosis of patients with acute myocardial infarction. In the short term, the method of clearing heat and activating blood or clearing heat and activating blood and supplementing qi and nourishing Yin is used in the short term. (3) patients with acute myocardial infarction receive blood. The drug treatment program after reconstruction and receiving Western medicine can reduce the serum BNP, which may be related to the timely recovery of blood supply, reducing the area of necrotic myocardium and inhibiting the early ventricular remodeling. On the basis of this, the combination of traditional Chinese medicine of clearing heat and blood circulation, the decrease of serum BNP, and the effect of combined supplementing qi and nourishing Yin are further enhanced. (4) this study was evaluated with EF as the evaluation. The index of valence contraction function, using E, A, EA ratio as the index of evaluating cardiac diastolic function. The results suggest that after 1 months of standard western medicine treatment, the three groups of EF, E, E/A are better than before treatment. But E/A is affected by fluid mechanics, may appear "pseudonormalization" phenomenon, and can not completely reflect the heart diastolic function of AMI patients. The combination of S/D, TDI, Tei index and so on can be used to evaluate the cardiac diastolic function better. On the basis of receiving standard western medicine treatment, the combination of clearing heat and promoting blood circulation can improve the cardiac contractile and contraction function more obviously; the use of clearing heat and activating blood and nourishing yin and nourishing Yin can further enhance the heart comfort of AMI patients after PCI operation. (5) (5) this study uses LA and LVED as an indicator of ventricular remodeling. The results of the study suggest that there is no obvious change in LA in the short term after operation in AMI patients, but the overall increase trend. The postoperative LVESD and LVEDD have increased in varying degrees, suggesting ventricular remodeling after acute myocardial infarction and the occurrence of ventricular remodeling. It is not affected by blood revascularization (thrombolytic, PCI, CABG). The guide recommends that drugs can only slow down the speed of its progress and rarely completely inhibit or even reverse the process of ventricular remodeling. The curative effect of Western medicine combined with clearing heat and activating blood medicine is similar to that of Western medicine alone, but on this basis, the combined use of yyxin Huoxue pill can obviously inhibit ventricular remodeling. It is suggested that the ventricular remodeling after acute myocardial infarction may be related to the loss of heart gas and the loss of heart and kidney essence. (6) ALT, UREA, and CREA have no obvious increase compared with those before the treatment. It suggests that the treatment of two grade prevention of coronary heart disease in a short time, the treatment of traditional Chinese medicine decoction and Yixin Huoxue pill, can not affect the liver and kidney function of the patients, and use the treatment of the above drugs. AMI patients are safe. Among them, the ingredients of Yixin Huoxue pill include Polygonum multiflorum. The experimental side shows that the dosage of Polygonum multiflorum is a safe.AST in a short period of time compared with before treatment (P0.01).AST is one of the markers of myocardial enzyme. This study included more than 12h in the case, and the AST in most cases was more than normal. The value is even more than 3 times. After treatment, the condition of myocardial infarction is stable, so AST is restored to normal level. (7) there is no adverse reaction in all cases during the treatment. Conclusion: in the short term, the combination of clearing heat and activating blood and nourishing Yin can further reduce the level of serum BNP on the basis of the curative effect of Western medicine and promote the P of acute myocardial infarction. After CI, the cardiac function of the patients recovered, and the liver and kidney function were not damaged. No obvious adverse reactions were observed during the medication.
【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】：R259

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