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目的:探讨益心通脉颗粒对冠心病经皮冠状动脉介入治疗(PCI)术后(气虚血瘀证)患者不良心血管事件、生活质量、心室重构等方面的影响,并从炎症反应方面探讨了其作用机制。方法:将160例PCI术后患者随机分为对照组和观察组。两组均采用拜阿司匹林肠溶片,100 mg/次,1次/d;硫酸氢氯吡格雷片,75 mg/次,1次/d;阿托伐他汀钙片,20 mg/次,1次/d;酒石酸美托洛尔缓释片,200 mg/次,2次/d,并进行术后运动康复训练。观察组服用益心通脉颗粒,10 mg/次,3次/d,温开水冲服。两组疗程均为6个月。记录术后再狭窄(ISR),灌注不良(NR)的发生情况;行超声心动图检测,记录治疗前后左室射血分数(LVEF),每搏输出量(SV),左室舒张末容积指数(LVEDVI)和收缩末内径(LVEVI);进行治疗前后西雅图心绞痛量表(SAQ),气虚血瘀证,6 min步行试验(6 MWT),踝臂指数(ABI)评价;检测治疗前后血清肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),N末端B型利钠肽原(NT-pro BNP)和基质金属蛋白酶-9(MMP-9)水平。结果:在6个月内,观察组ISR的发生率为6.58%,低于对照组的19.44%(χ~2=5.051,P<0.05),观察组NR的发生率为9.59%,低于对照组的22.22%(χ~2=4.334,P<0.05);治疗后观察组患者LVEF和SV均高于对照组(P<0.01),LVEDVI均和LVEVI低于对照组(P<0.01);治疗后观察组SAQ量表活动受限程度、心绞痛稳定状态、心绞痛发作情况和治疗满意程度4个维度评分均高于对照组(P<0.01);治疗后观察组血清TNF-α,IL-6,NT-pro BNP和MMP-9水平均低于对照组(P<0.01);治疗后观察组6 min步行距离多于对照组(P<0.01),观察组气虚血瘀证评分低于对照组(P<0.01),观察组ABI高于对照组(P<0.01)。结论:益心通脉颗粒在PCI术后综合康复治疗中能起到降低ISR,NR等不良心血事件发生,抑制心室重构和炎症反应,减轻临床症状,改善心室功能,提高患者的活动能力和生活质量作用,从而促进PCI术后患者的康复。
Objective: To investigate the effects of Yixintongmai Granules on adverse cardiovascular events, quality of life and ventricular remodeling after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD) The mechanism of action is discussed. Methods: 160 patients after PCI were randomly divided into control group and observation group. Both groups were treated with aspirin enteric-coated tablets 100 mg once daily, clopidogrel bisulfate tablets 75 mg once daily, atorvastatin calcium tablets 20 mg once daily, Times / d; metoprolol tartrate extended release tablets, 200 mg / time, 2 times / d, and postoperative exercise rehabilitation training. Observation group taking Yixintongmai particles, 10 mg / time, 3 times / d, warm boiled water. Two courses of treatment are 6 months. The incidences of postoperative restenosis (ISR) and perfusion (NR) were recorded. Echocardiography was performed to measure the left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular end-diastolic volume index (LVEDVI) and end-systolic diameter (LVEVI). Before and after treatment, SAQ, Qi-deficiency and blood-stasis syndrome, 6-MWT and ABI were measured before and after treatment. Serum tumor necrosis (TNF-α), interleukin-6 (IL-6), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and matrix metalloproteinase-9 (MMP- Results: Within 6 months, the incidence of ISR was 6.58% in the observation group, which was lower than 19.44% in the control group (χ ~ 2 = 5.051, P <0.05). The incidence of NR in the observation group was 9.59% LVEF and SV in the observation group were higher than those in the control group (P <0.01), LVEDVI and LVEVI were lower than those in the control group (χ ~ 2 = 4.334, P <0.05) After the treatment, the levels of TNF-α, IL-6 and TNF-α in the observation group were significantly lower than those in the control group (P <0.01), and the degree of activity limitation, the steady state of angina pectoris, the onset of angina pectoris, NT-pro BNP and MMP-9 levels in the observation group were significantly lower than those in the control group (P <0.01) P <0.01). The ABI in observation group was higher than that in control group (P <0.01). Conclusion: Yixintongmai Granule can reduce the occurrence of adverse cardiovascular events such as ISR, NR and so on during the comprehensive rehabilitation treatment after PCI, inhibit ventricular remodeling and inflammatory reaction, relieve clinical symptoms, improve ventricular function and improve the activity of patients and Quality of life, thus promoting the rehabilitation of patients after PCI.