益气解毒化浊通痹汤治疗糖尿病性冠心病的临床研究

发布时间：2019-07-08 15:39

【摘要】：目的：通过观察比较自拟方药益气解毒化浊通痹汤与阿托伐他汀钙片配合阿司匹林肠溶片治疗糖尿病性冠心病的临床疗效,探讨采用益气解毒化浊通痹汤治疗糖尿病性冠心病的有效性。方法：选择就诊于延边大学附属医院和长春中医药大学附属医院(于2014年10月-2016年2月期间)被确诊为糖尿病性冠心病的60例门诊患者,被随机分为自拟方组与对照组。患者均给予同样的饮食控制方法和糖尿病教育,给予富含维生素、优质蛋白饮食,并根据患者日常劳动体力消耗情况的不同制定不同的主食量,选择制定合适的运动方案；同时充分考虑每位患者空腹、餐后血糖水平给予适宜每个个体的胰岛素治疗。自拟方组给予基础治疗加益气解毒化浊通痹汤(由人参、生黄芪、草果仁、川黄连、连翘、姜半夏、桂枝、枸杞子、金银花、厚朴、瓜蒌、紫丹参、甘草、川芎、香附子、麦门冬等组成)加减治疗,肝阳上亢者西洋参易人参、加钩藤、天麻；心痛甚者加乳香、没药；血瘀者加红花、当归、三七。水煎取汁300ml,每日早饭前(若服药后大便稀者早餐后10分钟再服药)、晚饭后1小时,温服。对照组则给予基础治疗加阿托伐他汀钙片l0mg(晚餐后)配以阿司匹林肠溶片100mg(早餐后10分钟),均日1次,口服；两组同时观察2个疗程,每个疗程为1个月。自拟方组与对照组患者用药前后主要观察比较的指标有：(1)中医症状、舌苔、脉象的变化；(2)心绞痛的疗效；(3)心电图的疗效；(4)空腹血糖、餐后两小时血糖；(5)糖化血红蛋白；(6)血脂(TC、TG、HDL)；(7)血液流变学(高切、低切及纤维蛋白原)变化；(8)尿常规、血常规；(9)肾功能、肝功能。结果：1.用药后自拟方药组与对照组中医证候疗效的总有效率分别为83.3%、63.3%；心电图总有效率为分别为70%、43.3%。自拟方药组与对照组比较中医证候及心电图的疗效,均有统计学差异(P0.05)。2.用药后自拟方组患者FBG、2hPG、HbAlc明显下降(P0.01)。用药后自拟方益气解毒化浊通痹汤组与对照组比较,具有明显差异(P0.05,P0.01),说明益气解毒化浊通痹汤在调节患者血糖代谢方面优于阿托伐他汀片配合阿司匹林肠溶片组。3.用药后两组患者的TC、TG、HDL均有变化,但两组比较不存在显著性差异(P0.05),说明益气解毒化浊通痹汤在调节患者血脂含量的方面与对照组具有相同的疗效。4.用药后两组患者高切黏度、低切黏度、纤维蛋白原值均较用药前明显降低(P0.01),自拟方组与对照组用药后的结果比较可见服用益气解毒化浊通痹汤的患者血液流变学各指标值改变程度更大(P0.05)。说明益气解毒化浊通痹汤在改善血液流变学方面的疗效优于对照组。结论：益气解毒化浊通痹汤能够有效的增加心肌血供、改善临床症状,调节血糖、增强保护心血管功能的作用,降低血液黏度,促进血液循环流速,增加缺血心肌供血、供氧量,且能够有效降低因用药而出现的不良反应及毒副反应的发生率。
[Abstract]:Objective: To study the clinical effect of the treatment of diabetic coronary heart disease with the combination of the self-formula, the Yiqi Jiedu Decoction and the Atorvastatin calcium tablet in the treatment of diabetic coronary heart disease. Methods:60 out-patients who were diagnosed as diabetic coronary heart disease from the affiliated hospital of Yanbian University and the Affiliated Hospital of Changchun University of Traditional Chinese Medicine (October,2014 to February,2016) were randomly divided into the self-planning group and the control group. The patient is given the same diet control method and the diabetes education, and is provided with a vitamin-rich and high-quality protein diet, Postprandial blood glucose levels are given to the insulin treatment appropriate for each individual. A Chinese medicinal preparation is prepared from Radix Ginseng, Rhizoma Pinelliae, Semen Ginkgo, Rhizoma Coptidis, Fructus Forsythiae, Rhizoma Pinelliae, Ramulus Cinnamomi, Fructus Lycii, Flos Lonicerae, Cortex Magnolia Officinalis, Radix Polygalae, Radix Salviae Miltiorrhizae, Radix Glycyrrhizae, Radix Dipsaci, Radix Aconiti Lateralis Preparata, and Radix Ophiopogonis. Radix Panacis Quinquefolii, Radix Panacis Quinquefolii, Ramulus Uncariae cum Uncariae cum Uncariae, and Rhizoma Gastrodiae are prepared from Radix Panacis Quinquefolii, and Radix Panacis Quinquefolii, Olibanum and Myrrha; and Carthami Flos, Radix Angelicae Sinensis, and The decoction is decocted with water for 300ml, and before breakfast (after taking the medicine for 10 minutes after taking the medicine after taking the medicine), the decoction is heated for 1 hour after supper. The control group was given the basic treatment plus atorvastatin calcium tablet l0mg (after dinner) with aspirin enteric-coated tablets 100 mg (10 minutes after the breakfast), both day and day, and the two groups also observed 2 courses of treatment, each treatment course was 1 month. The main observation of the comparison between the self-proposed group and the control group were as follows: (1) the change of the symptoms of TCM, the tongue and the tongue and the pulse condition, (2) the curative effect of the angina, (3) the curative effect of the electrocardiogram, (4) the fasting blood sugar, the two-hour postprandial blood sugar, and (5) the glycosylated hemoglobin; (6) Blood lipid (TC, TG, HDL); (7) hemorheology (high-cut, low-cut and fibrinogen) changes; (8) routine urine and blood routine; (9) renal function and liver function. Results:1. The total effective rate was 83.3% and 63.3%, respectively, and the total effective rate was 70% and 43.3%, respectively. The curative effect of the traditional Chinese medicine and the electrocardiogram was compared with that of the control group (P0.05). The FBG, 2hPG and HbAlc in the self-proposed group were significantly lower after administration (P0.01). Compared with the control group, the self-prepared and Jiedu Huoxue Tongbi decoction group had a significant difference (P0.05, P0.01). It was indicated that the Yiqi Jiedu Tongbi Decoction was better than that of atorvastatin tablet in regulating the blood sugar metabolism of the patient. The TC, TG and HDL of the two groups were changed, but there was no significant difference between the two groups (P0.05). The results showed that the changes of hemorrheology of the two groups were significantly lower than that of the control group (P0.05). It is indicated that the effect of Yiqi Jiedu Tongbi Decoction in improving hemorheology is superior to that of the control group. Conclusion: Yiqi Jiedu Tongbi Decoction can effectively increase the blood supply of the myocardium, improve the clinical symptoms, regulate the blood sugar, enhance the function of protecting the cardiovascular function, reduce the blood viscosity, promote the blood circulation flow rate, increase the blood supply of the ischemic myocardium and supply the oxygen, And can effectively reduce the adverse reaction and the occurrence rate of the toxic side reaction due to the use of the medicine.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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