炙甘草汤对气阴两虚型胸痹（ACS）PCI术后并发低血压的防治作用及中医理论探讨

发布时间：2019-01-17 11:57

【摘要】：目的：通过对研究气阴两虚型胸痹(ACS)行PCI的患者,评价炙甘草汤在对气阴两虚型胸痹(ACS) PCI术后并发低血压的防治作用,并初步探讨其发生机制,为今后能临床早期干预提供参考和依据。方法：将在无锡市中医医院2015年01月-2016年3月住院确诊为急性冠脉综合征且为气阴两虚型病例60例,且均行PCI,随机分为实验组及对照组各30例。实验组加用炙甘草汤口服,统计两组病人PCI术前一般情况,危险因素,手术前后的中医证候积分、低血压发生率、TNF-α、hs-CRP、BNP、左室射血分数(LVEF)数据的变化。结果：1.两组病例在性别,年龄统计学上无统计学差别,比较两组病例的危险因素：高血压、吸烟、糖尿病,两组的危险因素在统计学上无差异。2.统计比较治疗前后证候积分,显示治疗前差异无统计学意义,而治疗后即积分比较差异有统计学意义,其中实验组显效率优于对照组。3.术前两组TNF-α的比较,提示两组术前TNF-α的比较无统计学差异,通过实验组前后的比较、对照组前后的比较、两组术后比较,提示两组TNF-α在治疗后均上升,但是实验组更有优势。4.术前两组的NBP比较,提示两组术前NBP的比较无统计学差异,通过实验组前后比较、对照组前后比较、两组术后比较,提示两组的BNP均明显下降,实验组BNP下降更明显,提示增加使用炙甘草汤对于改善心衰更有优势。5.术前两组的LVEF比较,提示两组术前LVEF的比较无统计学差异,实验组PCI前后比较、对照组PCI前后比较、两组术后比较,提示在PCI术后两组的LVEF均明显改善,但实验组对于LVEF的改善优于对照组。6.术前两组hs-CRP的比较,提示两组术前hs-CRP的比较无统计学差异,实验组前后比较、治疗后对照组前后比较、两组术后比较,提示两组在治疗后CRP均明显上升,治疗后两组比较统计学无差异。7.术前两组的血压基线比较,两组统计学上无差异,提示术前两组血压基线平衡。术后两组血压使用四格表资料的确切概率法,提示使用炙甘草汤,降低了PCI术后低血压的发生。结论：1.在西医规范化治疗PCI术后基础上加用炙甘草汤,其临床中医症候疗效较单纯西药治疗有所提高。2.炙甘草汤可以明显降低气阴两虚型胸痹患者PCI术后低血压发生率,机制可能和炙甘草汤改善心肌再灌注损伤的作用有关。
[Abstract]:Objective: to evaluate the effect of Zhigancao decoction on the prevention and treatment of hypotension after (ACS) PCI of Qi and Yin deficiency type chest arthralgia (ACS) with Qi and Yin deficiency, and to explore the mechanism of its occurrence. To provide reference and basis for early clinical intervention in the future. Methods: from January 2015 to March 2016, 60 cases of acute coronary syndrome with deficiency of qi and yin were diagnosed in Wuxi traditional Chinese Medicine Hospital. All patients were randomly divided into experimental group and control group with PCI,. The patients in the experimental group were treated with Zhigancao decoction. The changes of general condition, risk factors, TCM syndromes, incidence of hypotension, TNF- 伪, hs-CRP,BNP, left ventricular ejection fraction (LVEF) before and after operation were analyzed. Results: 1. There was no statistical difference in sex and age between the two groups. There was no statistical difference in risk factors between the two groups: hypertension, smoking, diabetes. Statistical comparison of syndrome score before and after treatment showed that there was no significant difference before and after treatment, but the difference was statistically significant after treatment, and the significant efficiency of the experimental group was better than that of the control group. The comparison of TNF- 伪 between the two groups before operation showed that there was no significant difference in TNF- 伪 between the two groups before and after treatment. Through the comparison between the experimental group and the control group, the comparison before and after the operation between the two groups, it was suggested that the TNF- 伪 of the two groups increased after treatment. But the experimental group had an advantage. 4. The comparison of NBP between the two groups before operation showed that there was no statistical difference between the two groups in preoperative NBP. Through the comparison between the experimental group and the control group before and after operation, the BNP of the two groups was obviously decreased, and the BNP in the experimental group was more obvious. It is suggested that it is more advantageous to increase the use of Zhigancao decoction for improving heart failure. 5. The comparison of LVEF between the two groups before operation showed that there was no significant difference in preoperative LVEF between the two groups. The comparison between the experimental group and the control group before and after PCI and the comparison between the control group and the control group showed that the LVEF of the two groups was significantly improved after PCI. But the improvement of LVEF in the experimental group was better than that in the control group. 6. 6. The comparison of hs-CRP between the two groups before operation showed that there was no statistical difference between the two groups before and after treatment. The comparison between the experimental group and the control group after treatment and the comparison between the two groups after operation indicated that the CRP of the two groups was obviously increased after treatment. There was no statistical difference between the two groups after treatment. There was no statistical difference in blood pressure baseline between the two groups before operation, suggesting that the blood pressure baseline balance between the two groups before operation. The exact probability method of four grid table data was used in the two groups, suggesting that the use of Zhigancao decoction could reduce the incidence of hypotension after PCI. Conclusion: 1. On the basis of western standard treatment of PCI, the clinical curative effect of traditional Chinese medicine is better than that of western medicine alone. 2. Zhigancao decoction can obviously reduce the incidence of hypotension after PCI in patients with chest obstruction with deficiency of Qi and Yin, and the mechanism may be related to the effect of Zhigancao decoction on myocardial reperfusion injury.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.22

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