中药涂擦法对急性冠脉综合征患者PCI后负性情绪及疼痛的影响

金丽; 唐杏

doi:10.16766/j.cnki.issn.1674-4152.003647

中药涂擦法对急性冠脉综合征患者PCI后负性情绪及疼痛的影响

doi: 10.16766/j.cnki.issn.1674-4152.003647

金丽,
唐杏^,

浙江中医药大学附属第三医院急诊科，浙江杭州 310000

基金项目:

浙江省中医药科技计划项目 2024ZL534

详细信息

通讯作者:
唐杏，E-mail：txokw@126.com

中图分类号: R543.3 R289.6
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出版历程
- 收稿日期: 2023-12-18

The effect of traditional Chinese medicine inunction on negative emotions and pain in patients with acute coronary syndrome after PCI

JIN Li,
TANG Xing^,

Department of Emergency, the Third Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的负性情绪和疼痛是影响急性冠脉综合征患者预后的重要因素之一，本研究旨在探讨中药涂擦法在接受经皮冠状动脉介入治疗(PCI)的急性冠脉综合征患者中的价值，为改善急性冠脉综合征患者负性情绪及降低疼痛水平提供参考。方法回顾性收集2020年1月—2022年12月浙江中医药大学附属第三医院急诊科收治的急性冠脉综合征患者200例，根据患者是否接受中药涂擦法治疗，将其分为中药涂擦法组(90例)和对照组(110例)，所有患者均急诊接受PCI及常规治疗，同时中药涂擦法组术后给予中药涂擦治疗，比较2组患者负性情绪、疼痛和预后情况。结果 2组患者治疗前左心室射血分数、N末端B型利钠肽原(NT-proBNP)、疼痛视觉模拟评分、焦虑自我评分和抑郁自我评分等差异无统计学意义(P>0.05)。治疗后与对照组比较，中药涂擦法组左心室射血分数增高(P=0.001)；NT-proBNP降低(P < 0.001)；疼痛视觉模拟评分降低(P < 0.001)；焦虑自我评分降低(P < 0.001)；抑郁自我评分降低(P < 0.001)。与对照组比较，中药涂擦法组重大不良心血管事件发生率降低[1.11%(1/90) vs.9.09%(10/110), P=0.031]。结论中药涂擦法可改善急性冠脉综合征患者PCI术后负性情绪、降低疼痛水平，降低短期重大不良心血管事件的发生率。
- 中药涂擦法 /
- 急性冠脉综合征 /
- 负性情绪 /
- 疼痛 /
- 重大不良心血管事件
Abstract: Objective Negative emotions and pain are among the most important factors affecting the prognosis of patients with acute coronary syndrome. The aim of this study was to explore the value of traditional Chinese medicine (TCM) in the treatment of patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI), and to provide a reference for improving negative emotions and reducing pain levels in patients with acute coronary syndrome. Methods From January 2020 to December 2022, 200 patients with acute coronary syndrome who were treated at the Third Affiliated Hospital of Zhejiang Chinese Medicine University were retrospectively collected. Patients were divided into two groups according to whether they received TCM or not: the TCM inunction group (n=90) and the control group (n=110). All patients received emergency percutaneous coronary intervention (PCI) and conventional therapy, while the TCM treatment group received TCM inunction. The negative emotions, pain and prognosis of the two groups of patients were compared. Results There was no statistically significant difference in left ventricular ejection fraction, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), pre-treatment visual analogue scale, self-rating anxiety scale and self-rating depression scale between the two groups of patients before treatment (P>0.05). After treatment, compared with the control group, the left ventricular ejection fraction in the TCM inunction group was increased (P=0.001), NT-proBNP was decreased (P < 0.001), the visual analogue scale was reduced (P < 0.001), the self-rating anxiety scale was significantly decreased (P < 0.001), and the self-rating depression scale was also decreased (P < 0.001). Compared with the control group, the incidence of major adverse cardiovascular events was significantly reduced in the TCM inunction method group [1.11% (1/90) vs. 9.09% (10/110), P=0.031]. Conclusion TCM can improve negative emotions, reduce pain levels, and reduce the incidence of short-term major adverse cardiovascular events in patients with acute coronary syndrome after PCI.
- Traditional Chinese medicine inunction /
- Acute coronary syndrome /
- Negative emotions /
- Pain /
- Major adverse cardiovascular events
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表 1 2组急性冠脉综合征患者一般临床资料、合并症和病变特征比较

Table 1. Comparison of general clinical data, comorbidities, and lesion characteristics between the two groups of patients with acute coronary syndrome

变量	中药涂擦法组(n=90)	对照组(n=110)	统计量	P值
年龄(x±s，岁)	55.82±6.63	56.34±6.72	0.548^a	0.585
性别[例(%)]			0.253^b	0.615
男性	50(55.56)	65(59.09)
女性	40(44.44)	45(40.91)
BMI(x±s)	23.66±4.18	24.42±4.26	1.266^a	0.207
吸烟史[例(%)]	18(20.00)	23(20.91)	0.025^b	0.874
嗜酒史[例(%)]	16(17.78)	28(25.45)	1.700^b	0.192
家族史[例(%)]	3(3.33)	6(5.45)	0.142^b	0.706
高血压病[例(%)]	65(72.22)	88(80.00)	1.666^b	0.197
糖尿病[例(%)]	25(31.25)	33(30.00)	0.034^b	0.853
高脂血症[例(%)]	72(80.00)	90(81.82)	0.106^b	0.744
急性冠脉综合征类型[例(%)]			2.802^b	0.246
ST段抬高型心肌梗死	43(47.78)	40(36.36)
非ST段抬高型心肌梗死	32(35.56)	50(45.45)
不稳定型心绞痛	15(16.67)	20(18.18)
冠状动脉支架植入数目(x±s, 个)	3.03±0.90	2.86±0.82	1.396^a	0.164
注：^a为t值，^b为χ²值。

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表 2 2组急性冠脉综合征患者其他主要治疗措施比较[例(%)]

Table 2. Comparison of other major treatment measures between the two groups of patients with acute coronary syndrome [cases (%)]

治疗措施	中药涂擦法组(n=90)	对照组(n=110)	χ²值	P值
降压药物			2.385	0.303
未用	25(27.78)	22(20.00)
单一药物	40(44.44)	60(54.55)
联合用药	25(27.78)	28(25.45)
降糖药物			0.351	0.839
未用	65(72.22)	77(70.00)
单纯药物	20(22.22)	28(25.45)
药物联合胰岛素	5(5.56)	5(4.55)
降脂药物			0.106	0.744
未用	18(20.00)	20(18.18)
降脂药物	72(80.00)	90(81.82)
抗血小板治疗方案			1.941	0.164
双联抗血小板治疗	80(88.89)	90(81.82)
三联抗血小板治疗	10(11.11)	20(18.18)

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表 3 2组急性冠脉综合征患者治疗前后左心室射血分数、NT-proBNP比较(x±s)

Table 3. Comparison of left ventricular ejection fraction and NT-proBNP between the two groups of patients with acute coronary syndrome before and after treatment (x±s)

组别	例数	左心室射血分数(%)		NT-proBNP(pg/mL)
组别	例数	治疗前	治疗后7 d	治疗前	治疗后7 d
中药涂擦法组	90	53.37±5.62	58.92±4.91^b	1245.34±358.84	287.48±98.77^b
对照组	110	52.64±5.71	56.43±5.05^b	1274.47±403.82	385.34±89.67^b
统计量		0.906^a	3.895^c	0.533^a	8.985^c
P值		0.366	< 0.001	0.594	< 0.001
注：^a为t值，^c为F值。与同组治疗前比较，^bP < 0.05。

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表 4 2组急性冠脉综合征患者疼痛水平和负性情绪比较(x±s, 分)

Table 4. Comparison of pain levels and negative emotions between the two groups of patients with acute coronary syndrome (x±s, points)

组别	例数	疼痛视觉模拟评分		焦虑自我评分		抑郁自我评分
组别	例数	治疗前	治疗后7 d	治疗前	治疗后7 d	治疗前	治疗后7 d
中药涂擦法组	90	4.62±1.45	1.23±0.55^b	54.55±10.43	35.45±8.54^b	48.59±9.34	36.49±6.75^b
对照组	110	4.70±1.42	1.84±0.60^b	53.89±9.84	42.55±8.09^b	49.05±8.82	40.83±7.12^b
统计量		0.392^a	8.653^c	0.472^a	7.262^c	0.362^a	5.261^c
P值		0.694	< 0.001	0.624	< 0.001	0.749	< 0.001
注：^a为t值，^c为F值。与同组治疗前比较，^bP < 0.05。

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表 5 2组急性冠脉综合征患者重大不良心血管事件和院内死亡率比较[例(%)]

Table 5. Comparison of major adverse cardiovascular events and in-hospital mortality rates between the two groups of patients with acute coronary syndrome [cases (%)]

组别	例数	重大不良心血管事件	院内死亡
中药涂擦法组	90	1(1.11)	1(1.11)
对照组	110	10(9.09)	3(2.73)
χ²值		4.626	0.093
P值		0.031	0.761

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参考文献(24)

[1]	RALAPANAWA U, SIVAKANESAN R. Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: a narrative review[J]. J Epidemiol Glob Health, 2021, 11(2): 169-177. doi: 10.2991/jegh.k.201217.001
[2]	GHAZALI H, GAMMOUDI M, YAHMADI A, et al. Acute coronary syndrome without persistent st segment elevation in the emergency department: epidemiology, clinical features and prognosis[J]. Tunis Med, 2017, 95(12): 229-235.
[3]	WEN J, HE L, DU X, et al. Body mass index enhances the associations between plasma glucose and mortality in patients with acute coronary syndrome[J]. Diabetes Metab Syndr Obes, 2022, 15(10): 2675-2682.
[4]	蒋南, 包炳蔚, 丁丝雨, 等. 皖北地区高血压合并急性冠脉综合征患者临床特征、危险分层及临床预后相关性分析[J]. 中华全科医学, 2023, 21(8): 1287-1290, 1350. doi: 10.16766/j.cnki.issn.1674-4152.003104 JIANG N, BAO B W, DING S Y, et al. Risk stratification of clinical characteristics and correlation analysis of clinical prognosis in patients with hypertension complicated by acute coronary syndrome in northern Anhui[J]. Chinese Journal of General Practice, 2023, 21(8): 1287-1290, 1350. doi: 10.16766/j.cnki.issn.1674-4152.003104
[5]	LIN Z, CARDELLI P, MARINO R, et al. Advantage of using of high-sensitivity troponin I compared to conventional troponin I in shortening time to rule out/in acute coronary syndrome in chest pain patients presenting to the emergency department[J]. Medicina (Kaunas), 2022, 58(10): 1223-1231.
[6]	NORUM I B, OTTERSTAD J E, RUDDOX V, et al. Novel regional longitudinal strain by speckle tracking to detect significant coronary artery disease in patients admitted to the emergency department for chest pain suggestive of acute coronary syndrome[J]. J Echocardiogr, 2022, 20(3): 166-177. doi: 10.1007/s12574-022-00568-7
[7]	MA C P, LIU X L, FENG J S, et al. Development and validation of a risk score for chest pain with suspected non-st-segment elevation acute coronary syndrome[J]. Ann Noninvasive Electrocardiol, 2022, 27(3): e12929-e12937. doi: 10.1111/anec.12929
[8]	倪小坤. 中药涂擦、烫熨加贴敷疗法对女性早中期KOA患者血清Leptin、MMP-13的影响[D]. 南宁: 广西中医药大学, 2020. NI X K. Effects of Chinese medicine application, ironing and application on serum Leptin and MMP-13 in female patients with early and middle stage KOA[D]. Nanning: Guangxi University of Traditional Chinese Medicine, 2020.
[9]	周苏梅. 中药涂擦联合推拿在湿热证寻常型银屑病患者中的应用研究[D]. 成都: 成都中医药大学, 2020. ZHOU S M. Study on the application of traditional Chinese medicine smearing combined with massage in patients with psoriasis vulgaris with damp-heat syndrome[D]. Chengdu: Chengdu University of Traditional Chinese Medicine, 2020.
[10]	赵煜. 中药涂擦法治疗头皮银屑病(血燥证)临床观察[D]. 石家庄: 河北中医学院, 2020. ZHAO Y. Clinical observation on the treatment of scalp psoriasis (blood dryness syndrome) by external use of traditional Chinese medicine[D]. Shijiazhuang: Hebei University of Traditional Chinese Medicine, 2020.
[11]	邹旨龙. 中药烫熨加贴敷联合涂擦疗法治疗KOA的临床疗效观察[D]. 南宁: 广西中医药大学, 2019. ZOU Z L. Clinical observation on treatment of KOA by traditional Chinese medicine ironing and applying combined with smearing therapy[D]. Nanning: Guangxi University of Traditional Chinese Medicine, 2019.
[12]	THOMPSON D R. Which females have the highest rates of depression and anxiety following acute coronary syndrome?[J]. Cardiology, 2023, 148(1): 20-22. doi: 10.1159/000528624
[13]	ALHURANI A S, HAMDAN-MANSOUR A M, AHMAD M M, et al. The association of persistent symptoms of depression and anxiety with recurrent acute coronary syndrome events: a prospective observational study[J]. Healthcare (Basel), 2022, 10(2): 1290-1299.
[14]	PLAUT A G, GORBACH S L, NAHAS L, et al. studies of intestinal microflora. 3. the microbial flora of human small intestinal mucosa and fluids[J]. Gastroenterology, 1967, 53(6): 868-873. doi: 10.1016/S0016-5085(19)34123-X
[15]	KLAINER A S, GORBACH S, WEINSTEIN L. Studies of intestinal microflora. Ⅶ. effect of diet and fecal microbial flora on survival of animals exposed to x irradiation[J]. J Bacteriol, 1967, 94(2): 383-387. doi: 10.1128/jb.94.2.383-387.1967
[16]	GORBACH S L, PLAUT A G, NAHAS L, et al. Studies of intestinal microflora. Ⅱ. microorganisms of the small intestine and their relations to oral and fecal flora[J]. Gastroenterology, 1967, 53(6): 856-867. doi: 10.1016/S0016-5085(19)34122-8
[17]	王莹. 小陷胸汤合桃仁红花煎治疗冠脉PCI术后稳定型心绞痛(痰瘀互结证)的临床观察[D]. 济南: 山东中医药大学, 2023. WANG Y. The clinical observation of Xiaoxianxiong Decoction combined with Taoren Honghua Decoction in the treatment of stable angina pectoris after coronary artery PCI (phlegm and blood stasis)[D]. Jinan: Shandong University of Traditional Chinese Medicine, 2023.
[18]	董雯佳, 游志鹏, 余晓, 等. 红花黄色素注射液联合抗VEGF药物治疗非缺血性视网膜中央静脉阻塞[J]. 国际眼科杂志, 2023, 23(12): 1954-1960. doi: 10.3980/j.issn.1672-5123.2023.12.04 DONG W J, YOU Z P, YU X, et al. Saffloryellow injection combined with anti-vascular endothelial growth factor drugs in the treatment of non-ischemic central retinal vein occlusion[J]. International Eye Science, 2023, 23(12): 1954-1960. doi: 10.3980/j.issn.1672-5123.2023.12.04
[19]	卫克昭. 肉桂及其主要药效成分对糖尿病性心脏病的保护作用和机制研究[D]. 上海: 上海中医药大学, 2019. WEI K Z. Protective effects and mechanism of Cinnamon and its main effective components on diabetic cardiopathy[D]. Shanghai: Shanghai University of Traditional Chinese Medicine, 2019.
[20]	刘文频, 熊向晖, 毛湘屏. 吴茱萸碱介导miR-223-3p对心肌微血管内皮细胞增殖、迁移和血管生成的影响[J]. 中国细胞生物学学报, 2022, 44(6): 982-990. LIU W P, XIONG X H, MAO X P. Evodiamine-mediated effects of miR-223-3p on the proliferation, migration and angiogenesis of myocardial microvascular endothelial cells[J]. Chinese Journal of Cell Biology, 2022, 44(6): 982-990.
[21]	马丽梅, 杨军丽. 羌活药材的化学成分和药理活性研究进展[J]. 中草药, 2021, 52(19): 6111-6120. doi: 10.7501/j.issn.0253-2670.2021.19.034 MA L M, YANG J L. Research progress on chemical constituents and pharmacological activities of Notopterygii Rhizoma et Radix[J]. Chinese Traditional and Herbal Drugs, 2021, 52(19): 6111-6120. doi: 10.7501/j.issn.0253-2670.2021.19.034
[22]	蔡群杰. 基于态靶辨证理论探讨桂枝茯苓丸合四妙勇安汤治疗PCI术后心绞痛患者的临床疗效[D]. 福州: 福建中医药大学, 2023. CAI Q J. Discussion on the clinical efficacy of Guizhi Fuling Pill and Simiao Yong ' an Decoction in treating angina after PCI based on the theory of state target syndrome differentiation[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2023.
[23]	刘赫昆. 中药联合外治法干预慢性心力衰竭的Meta分析及回顾性分析[D]. 哈尔滨: 黑龙江中医药大学, 2022. LIU H K. Meta-analysis and retrospective analysis of traditional chinese medicine combined with external treatment in the intervention of chronic heart failure[D]. Haerbin: Heilongjiang University of Traditional Chinese Medicine, 2022.
[24]	岳凤莲. 中药联合外治法治疗不稳定型心绞痛的Meta分析及临床特点的回顾性分析[D]. 哈尔滨: 黑龙江中医药大学, 2022. YUE F L. Meta-analysis and retrospective analysis of clinical characteristics of traditional chinese medicine combined with external therapy in the treatment of unstable angina pectoris[D]. Haerbin: Heilongjiang University of Traditional Chinese Medicine, 2022.