通脉开痹汤联合复方丹参滴丸与西药治疗冠心病稳定型心绞痛临床研究
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R541.4;R259

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Clinical Study on Tongmai Kaibi Decoction Combined with Compound Danshen Dropping Pills and Western Medicine for Stable Angina Pectoris of Coronary Heart Disease
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    摘要:

    目的:观察通脉开痹汤联合复方丹参滴丸与西药治疗气滞血瘀型冠心病稳定型心绞痛的临床效 果。方法:纳入94 例气滞血瘀型冠心病稳定型心绞痛患者,随机分为对照组、联合组各47 例。2 组均给予抗 血小板、调脂等常规西药与复方丹参滴丸治疗,联合组加予通脉开痹汤治疗。2 组均连续治疗2 个月。治疗前 后评定中医证候评分,记录患者的心绞痛发作次数、心绞痛持续时间、心率、血压、心电图相关指标情况,应 用彩色多普勒超声系统检测左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、左心 室射血分数(LVEF),并检测可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素-18(IL-18)、白细胞介素- 6 (IL-6)、谷胱甘肽过氧化物酶(GSH-Px)、髓过氧化物酶(MPO)、高迁移率族蛋白B1 (HMGB1)、丙二 醛(MDA)、超氧化物歧化酶(SOD) 水平。结果:治疗后,联合组临床疗效总有效率与心电图疗效总有效率 均高于对照组(P<0.05)。2 组胸痛胸闷、心悸气短、神倦乏力评分均较治疗前下降(P<0.05)。联合组胸痛 胸闷、心悸气短、神倦乏力评分均低于对照组(P<0.05)。2 组心绞痛发作次数均较治疗前减少,心绞痛持续 时间均较治疗前缩短,LVESVI、LVEDVI 值均较治疗前下降,LVEF 值均较治疗前升高,差异均有统计学意 义(P<0.05)。联合组心绞痛发作次数少于对照组,心绞痛持续时间较对照组缩短,LVEF 值高于对照组, LVESVI、LVEDVI 值均低于对照组,差异均有统计学意义(P<0.05)。2 组收缩压、舒张压均较治疗前下降, 心率均较治疗前减少,ST 段上升幅度、T 波改变幅度均较治疗前增加,差异均有统计学意义(P<0.05)。联合 组收缩压、舒张压均低于对照组,心率少于对照组,ST 段上升幅度、T 波改变幅度均大于对照组,差异均有 统计学意义(P<0.05)。2 组sICAM-1、IL-18、IL-6 水平均较治疗前降低(P<0.05)。联合组sICAM-1、 IL-18、IL-6 水平均低于对照组(P<0.05)。2 组MDA 水平均较治疗前降低,SOD、GSH-Px 水平均较治疗前升 高,差异均有统计学意义(P<0.05)。联合组MDA 水平低于对照组,SOD、GSH-Px 水平均高于对照组,差异均 有统计学意义(P<0.05)。2 组MPO、HMGB1 水平均较治疗前降低(P<0.05)。联合组MPO、HMGB1 水平均 低于对照组(P<0.05)。结论:在常规西药与复方丹参滴丸治疗的基础上加用通脉开痹汤治疗气滞血瘀型冠心 病稳定型心绞痛患者,能有效改善心功能,减轻炎症反应,抑制氧化应激状态,缓解临床症状。

    Abstract:

    Abstract: Objective: To observe the clinical effect of Tongmai Kaibi Decoction combined with Compound Danshen Dropping Pills and western medicine for stable angina pectoris of coronary heart disease of qi stagnation and blood stasis type. Methods:A total of 94 cases of patients with stable angina pectoris of coronary heart disease of qi stagnation and blood stasis type were randomly divided into the control group and the combination group,with 47 patients in each group. Both groups were treated with routine western medicines for antiplatelet and regulating lipid and Compound Danshen Dropping Pills,and the combination group was additionally treated with Tongmai Kaibi Decoction. Both groups were treated for 2 months. Before and after treatment,traditional Chinese medicine syndrome scores were assessed;angina pectoris attack frequency, angina pectoris duration, heart rates, blood pressure and ECG- related indexes of patients were recorded;left ventricular end-systolic volume index (LVESVI),left ventricular end-diastolic volume index (LVEDVI) and left ventricular ejection fraction (LVEF) were detected by Color Doppler Ultrasound System ; the levels of soluble intercellular adhesion molecule- 1 (sICAM-1) , interleukin- 18 (IL- 18) , interleukin- 6 (IL- 6) , glutathione peroxidase (GSH- Px) , myeloperoxidase (MPO) , high mobility group protein B1 (HMGB1), malondialdehyde (MDA), and superoxide dismutase (SOD) were detected. Results: After treatment, the total effective rate and the total clinical effective rate of electrocardiogram in the combination group were higher than those in the control group (P<0.05). The scores of chest pain,chest tightness,palpitation,shortness of breath,fatigue and lack of strength in the two groups were decreased when compared with those before treatment (P<0.05), and the scores of chest pain, chest tightness, palpitation, shortness of breath, fatigue and lack of strength in the combination group were lower than those in the control group (P<0.05). When compared with those before treatment, the frequency of angina pectoris attack in the two groups was decreased, the duration of angina pectoris was shortened, and the values of LVESVI and LVEDVI were decreased, and the LVEF values were increased,differences being significant (P<0.05). The frequency of angina pectoris attack in the combination group was lower than that in the control group,the duration of angina pectoris was shorter than that in the control group,the LVEF value was higher than that in the control group,and the values of LVESVI and LVEDVI were lower than those in the control group, differences being significant (P<0.05). Systolic blood pressure and diastolic blood pressure in the two groups were decreased when compared with those before treatment, heart rates were decreased when compared with those before treatment, the rise of ST segment and the change amplitude range of T-wave were increased when compared with those before treatment, differences being significant (P<0.05). The systolic blood pressure and diastolic blood pressure in the combination group were lower than those in the control group,the heart rate was less than that in the control group,and the rise of ST segment and the change of T-wave were more significant than those in the control group, differences being significant (P<0.05). The levels of sICAM-1, IL-18, and IL-6 in the two groups were decreased when compared with those before treatment (P<0.05), and the levels of sICAM-1,IL-18,and IL-6 in the combination group were lower than those in the control group (P<0.05). MDA levels in the two groups were decreased when compared with those before treatment, and the levels of SOD and GSH- Px were increased when compared with those before treatment, differences being significant (P<0.05). The MDA level in the combination group was lower than that in the control group,and the levels of SOD and GSH-Px were higher than those in the control group,differences being significant (P<0.05). The levels of MPO and HMGB1 in the two groups were decreased when compared with those before treatment (P<0.05),and the levels of MPO and HMGB1 in the combination group were lower than those in the control group (P<0.05). Conclusion:On the basis of routine western medicine and Compound Danshen Dropping Pills,the additional application of Tongmai Kaibi Decoction for patients with stable angina pectoris of coronary heart disease of qi stagnation and blood stasis type can effectively improve heart function, reduce inflammatory responses, inhibit oxidative stress and relieve clinical symptoms.

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周依娜,吴玄珠,李菲.通脉开痹汤联合复方丹参滴丸与西药治疗冠心病稳定型心绞痛临床研究[J].新中医,2023,55(23):41-48

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  • 在线发布日期: 2023-12-13
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