“宣痹通瘀方”治疗冠心病心绞痛（气滞血瘀证）的临床观察

发布时间：2018-08-22 07:54

【摘要】：目的:通过检测试验组与对照组冠心病心绞痛(气滞血瘀证)患者的相关指标,评定宣痹通瘀方的有效性及安全性。方法:根据纳入标准,将试验组与对照组以相等的数量随机分为两组,各36例患者,进行试验。对照组参照指南,采用规范疗法。心绞痛发作时:即刻舌下含服硝酸甘油1/2-1片(规格为0.5mg),根据缓解情况,选择5分钟之后继续服用。长期服用:阿司匹林肠溶片(Bayer S.p.A)0.1g日1次口服,阿托伐他汀钙片(Pfizer Ireland Pharmaceuticals)20mg日1次口服。根据病情选择使用:钙拮抗剂(如拜新同30mg,日1次口服),β受体阻滞剂(如酒石酸美托洛尔片25mg,日2次口服),血管紧张素转换酶抑制剂(如马来酸依那普利10mg,日1次口服)。治疗组给予西药常规治疗加宣痹通瘀方,本方由长春中医药大学附属医院免煎药房提供。每天1剂,早晚温开水冲服,观察4周。结果:1、中医症状疗效评定方面:加服宣痹通瘀方组的患者总有效率83.33%,单纯西药治疗患者中总有效率74.29%,差异显著(p0.05);2、心绞痛症状方面:加服宣痹通瘀方组的患者总有效率88.57%,单纯西药治疗患者中总有效率68.57%,差异显著(p0.05);3、心电图疗效评定:加服宣痹通瘀方组的患者总有效率45.71%,单纯西药治疗患者中总有效率40.00%;两组治疗方案均可改善心电图,组间差异不明显(p0.05);4、硝酸甘油减停率,加服宣痹通瘀方组的患者总有效率91.43%,单纯西药治疗患者中总有效率68.57%,存在显著差异(p0.05),有统计学意义,5,两组方案均可改善患者血脂情况,对于降低低密度脂蛋白方面,加服用宣痹通瘀方组明显优于单纯西药治疗组,6,两组患者治疗前后血常规、尿常规、肝功能、肾功能均无明显改变。结论:宣痹通瘀方针对胸痹心痛(气滞血瘀证)的患者,关于改善中医症状、改善心绞痛及降低硝酸甘油使用率有较好的疗效,对改善心电图有较好疗效,但与常规西药治疗无显著差异;宣痹通瘀方对肝肾功能无损伤,可广泛推广。
[Abstract]:Objective: to evaluate the efficacy and safety of Xuanbi Tongyu decoction by detecting the related indexes of angina pectoris (Qi stagnation and blood stasis syndrome) in the experimental group and the control group. Methods: according to the inclusion criteria, the experimental group and the control group were randomly divided into two groups, 36 patients in each group. The control group was treated with standard therapy according to the guidelines. Angina pectoris attack: immediately sublingual 1 / 2-1 tablet nitroglycerin (specification is 0.5mg), according to remission, choose 5 minutes to continue taking. Long-term administration: aspirin enteric-coated tablets (Bayer S.p.A) 0.1 g / d, Atto vastatin calcium tablets (Pfizer Ireland Pharmaceuticals) 20mg once a day. Calcium antagonists (30 mg / d), 尾 -blockers (such as metoprolol tartrate 25 mg, twice a day) and angiotensin converting enzyme inhibitors (such as enalapril maleate 10 mg, once a day) were used according to their condition. The treatment group was treated with routine western medicine plus Xuan Bi Tong Yu Fang, which was provided by Changchun University of traditional Chinese Medicine affiliated Hospital. Take 1 dose a day, warm water in the morning and evening, and observe for 4 weeks. Results: in the aspect of evaluating the curative effect of traditional Chinese medicine, the total effective rate was 83.33 in Xuanbi Tongyu prescription group, 74.29 in western medicine treatment group, and the difference was significant (p0.05). In angina pectoris symptom, the patients in Xuan Bi Tongyu prescription group had total effective rate of 83.33, and the total effective rate in western medicine group was 74.29, the difference was significant (p0.05). The total effective rate of western medicine alone was 68.57 and the difference was significant (p0.05). The evaluation of electrocardiogram efficacy: the total effective rate was 45.71 in the group treated with Xuan Bi Tong Yu decoction, and 40.00th in the patients treated with western medicine alone, and the electrocardiogram was improved in both groups. There was no significant difference between the two groups (p0.05) (p0.05). The total effective rate was 91.43 in addition to Xuanbi Tongyu prescription group, and the total effective rate was 68.57 in the patients treated with western medicine alone (p0.05). There was significant difference between the two groups (p0.05), there was significant difference between the two groups (p0.05). The two groups could improve the blood lipid status of the patients. For the reduction of low density lipoprotein, the combination of Xuanbi Tongyu prescription group was significantly better than the western medicine treatment group, the two groups of patients before and after treatment blood routine, urine routine, liver function, renal function have no significant change. Conclusion: Xuanbi Tongyu prescription has better curative effect on improving TCM symptoms, improving angina pectoris and reducing the utilization rate of nitroglycerin for patients with chest arthralgia and heart pain (Qi stagnation and blood stasis syndrome), and has better effect on improving electrocardiogram. However, there is no significant difference between Xuan Bi Tong Yu recipe and conventional western medicine, and Xuan Bi Tong Yu recipe has no damage to liver and kidney function and can be widely popularized.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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