自拟活血舒痹汤治疗急性心肌梗死PCI术后缺血再灌注损伤的临床研究

郑祥; 王审

doi:10.16766/j.cnki.issn.1674-4152.003026

自拟活血舒痹汤治疗急性心肌梗死PCI术后缺血再灌注损伤的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003026

郑祥^1, ,,
王审²

1.
温州市中西医结合医院心血管内科，浙江温州 325000
2.
浙江绿城心血管病医院心内科，浙江杭州 310000

基金项目:

浙江省中医药科技计划项目 2022ZB149

详细信息

通讯作者:
郑祥，E-mail: kinddoctorky@126.com

中图分类号: R542.22
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- 被引次数: 0
出版历程
- 收稿日期: 2023-02-13
- 网络出版日期: 2023-08-26

Clinical study of self-made Huoxue Shubi Decoction on the treatment of ischemia reperfusion injury after PCI in acute myocardial infarction

ZHENG Xiang^{1
, ,},
WANG Shen²

1.
Department of Cardiovascular Medicine, Wenzhou Integrated Hospital of Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨自拟活血舒痹汤对急性心肌梗死经皮冠状动脉介入术(PCI)后缺血再灌注损伤(IRI)的临床疗效、心室重塑、心血管不良事件的影响。方法选取2019年1月—2021年12月温州市中西医结合医院心血管内科急性心肌梗死PCI术后患者96例，根据随机数字表法，分为对照组(48例)和观察组(48例)。对照组给予阿司匹林和替格瑞洛治疗，观察组加服自拟活血舒痹汤治疗。比较2组临床疗效、中医证候积分、血小板聚集、心绞痛、心功能指标、心血管不良事件等。结果治疗2个月后，观察组有效率为95.83%(46/48)，对照组为79.17%(38/48)，2组比较差异有统计学意义(χ²=6.095, P=0.014)。治疗2个月后，观察组胸痛、心悸气短、乏力、自汗、舌质暗紫、脉虚无力等评分均低于对照组(均P＜0.05)。治疗2个月后，2组血小板聚集率、心绞痛均改善，观察组均优于对照组(均P＞0.05)；2组左室射血分数(LVEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)均改善，观察组均优于对照组(均P＜0.05)；2组心血管不良事件发生率比较差异无统计学意义(P＞0.05)。结论在西医治疗基础上，加用自拟活血舒痹汤治疗急性心肌梗死PCI术后IRI效果显著，能促进症状改善，减少血小板聚集，缓解心肌重塑，且安全性高。
- 急性心肌梗死 /
- 经皮冠状动脉介入术 /
- 缺血再灌注损伤 /
- 联合治疗 /
- 气虚血瘀证
Abstract: Objective To explore the clinical efficacy, ventricular remodeling, and cardiovascular adverse events of self-made Huoxue Shubi Decoction on patients with ischemia-reperfusion injury (IRI) after percutaneous coronary intervention (PCI) in acute myocardial infarction. Methods A total of 96 patients with acute myocardial infarction after PCI surgery in the Department of Cardiovascular Medicine of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2019 to December 2021 were selected. According to the random number table method, they were randomly divided into a control group and an observation group, with 48 cases each group. The control group was treated with aspirin and ticagrelor, while the observation group was treated with self-made Huoxue Shubi Decoction on the basis of the control group. The clinical efficacy, traditional Chinese medicine syndromes, platelet aggregation, angina pectoris, cardiac function indicators, and cardiovascular adverse events were compared between the two groups. Results After 2 months of treatment, the effective rate of the observation group was 95.83% (46/48), while the control group was 79.17% (38/48), with statistically significant (χ²=6.095, P=0.014). After two months of treatment, the scores of chest pain, palpitations, shortness of breath, fatigue, spontaneous sweating, dark purple tongue, and weak pulse in the observation group were lower than those in the control group (all P < 0.05). After 2 months of treatment, the platelet aggregation rate and angina in the two groups were improved and the observation group were better than the control group (all P > 0.05), the left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) in the two groups were improved and the observation group were better than the control group (all P < 0.05), and there was no statistically significant difference in the incidence of cardiovascular adverse events between the two groups (P > 0.05). Conclusion On the basis of Western medicine treatment, the addition of self-made Huoxue Shubi Decoction has a significant therapeutic effect on IRI after PCI in acute myocardial infarction. It can promote the improvement of symptoms, reduce platelet aggregation, relieve myocardial remodeling, and has high safety.
- Acute myocardial infarction /
- Percutaneous coronary intervention /
- Ischemia-reperfusion injury /
- Combination therapy /
- Qi deficiency and blood stasis syndrome

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表 1 2组急性心肌梗死PCI术后患者一般资料比较

Table 1. Comparison of general data of patients with acute myocardial infarction after PCI in 2 groups

组别	例数	性别(例)		年龄(x±s，岁)	就诊时间[M(P₂₅, P₇₅)，h]	Killip分级(例)			基础疾病(例)
组别	例数	男性	女性	年龄(x±s，岁)	就诊时间[M(P₂₅, P₇₅)，h]	Ⅰ	Ⅱ	Ⅲ	高血压	高血脂	糖尿病
对照组	48	25	23	65.53±11.30	2.90(2.51，3.73)	13	28	7	36	19	15
观察组	48	28	20	64.91±12.66	3.02(2.65，3.59)	10	25	13	35	22	17
统计量		0.379^a		0.253^b	0.404^c	1.356^c			0.054^a	0.383^a	0.188^a
P值		0.538		0.801	0.688	0.175			0.816	0.536	0.665
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组急性心肌梗死PCI术后患者临床疗效比较[例(%)]

Table 2. Comparison of clinical efficacy between two groups of patients with acute myocardial infarction after PCI [cases (%)]

组别	例数	显效	缓解	无效	总有效
对照组	48	28(58.33)	10(20.83)	10(20.83)	38(79.17)
观察组	48	36(75.00)	10(20.83)	2(4.17)	46(95.83)
注：2组总有效率比较，χ²=6.095, P=0.014。

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表 3 2组急性心肌梗死PCI术后患者中医临床症状量表积分比较(x±s，分)

Table 3. Comparison of TCM clinical symptom scale scores between the two groups of patients with acute myocardial infarction after PCI

组别	例数	胸痛		气短心悸		乏力
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	48	2.52±0.25	1.65±0.22^a	2.34±0.31	1.38±0.21^a	2.02±0.31	1.51±0.36^a
观察组	48	2.59±0.31	0.73±0.13^a	2.28±0.33	0.82±0.10^a	2.11±0.35	1.01±0.22^a
t值		1.218	24.943	0.918	16.681	1.334	8.211
P值		0.226	＜0.001	0.361	＜0.001	0.185	＜0.001

组别	例数	自汗		舌质暗紫		脉虚无力
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	48	2.22±0.45	1.65±0.32^a	2.50±0.40	1.40±0.22^a	2.31±0.30	1.21±0.25^a
观察组	48	2.17±0.33	1.01±0.28^a	2.44±0.38	0.72±0.09^a	2.20±0.28	0.07±0.15^a
t值		0.621	10.428	0.753	19.820	1.857	27.090
P值		0.536	＜0.001	0.453	＜0.001	0.066	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组急性心肌梗死PCI术后患者血小板聚集率及心绞痛程度比较(x±s)

Table 4. The platelet aggregation rate and the degree of angina in patients with acute myocardial infarction after PCI were compared between the two groups (x±s)

组别	例数	血小板聚集率(%)		t值	P值	SAQ评分(分)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	48	72.64±9.27	43.35±5.29	19.013	＜0.001	272.32±51.68	387.46±58.71	10.199	＜0.001
观察组	48	71.33±9.36	32.19±4.87	25.701	＜0.001	283.51±53.79	415.60±65.32	10.815	＜0.001
t值		0.689	10.753			1.039	2.220
P值		0.493	＜0.001			0.301	0.029

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表 5 2组急性心肌梗死PCI术后患者心功能指标比较(x±s)

Table 5. Comparison of cardiac function indexes between the two groups of patients with acute myocardial infarction after PCI (x±s)

组别	例数	LVEF(%)		LVEDV(mL)		LVESV(mL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	48	48.62±5.33	52.15±6.27^a	135.32±15.21	120.39±10.35^a	85.24±5.37	65.39±5.20^a
观察组	48	47.69±4.49	56.33±6.79^a	135.68±13.76	115.95±9.21^a	84.69±5.10	60.81±4.68^a
t值		0.925	3.133	0.122	2.220	0.515	4.536
P值		0.358	0.002	0.904	0.029	0.608	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 6 2组急性心肌梗死PCI术后患者心血管不良事件比较[例(%)]

Table 6. Comparison of cardiovascular adverse events between the two groups of patients with acute myocardial infarction after PCI [cases (%)]

组别	例数	严重心律失常	出血	再次心肌梗死	心力衰竭	死亡	合计
对照组	48	4(8.33)	2(4.17)	1(2.08)	1(2.08)	2(4.17)	10(20.83)
观察组	48	2(4.17)	2(4.17)	0	2(4.17)	1(2.08)	7(14.58)
注：2组不良事件总发生率比较，χ²=0.643，P=0.423。

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