血府逐瘀汤加味治疗冠状动脉支架植入术后心绞痛的临床观察

A clinical observation on Xuefu Zhuyu decoction （血府逐瘀汤） with additives for treatment of post-operative patients of coronary artery stent implantation with angina pectoris

目的 观察血府逐瘀汤加味对冠状动脉（冠脉）支架植入术（CASI）后心绞痛患者的临床疗效.方法 将75例CASI后心绞痛患者随机分为治疗组（45例）和对照组（30例）.对照组给予波立维、阿司匹林、缬沙坦、倍他乐克、阿托伐他汀等常规药物;治疗组在对照组西医治疗基础上,加用血府逐瘀汤加味.治疗180 d后观察患者治疗前后心率、血压、心绞痛、心电图、血浆超敏C-反应蛋白（hs-CRP）、D-二聚体等的变化.结果 两组治疗前心率、血压比较无明显差异,治疗后均明显下降（均P〈0.05）,但两组间无明显差异.两组治疗前心绞痛发作频率、心绞痛持续时间、心电图缺血情况比较差异无统计学意义（均P〉0.05）;两组治疗后各指标较对照组明显改善,且治疗组心绞痛发作频率、持续时间均较对照组明显缩短.治疗组心电图缺血性ST段改善显效率（26.23%）和总有效率（67.36%）明显高于对照组（7.31%、43.01%）,差异均有统计学意义（均P〈0.05）.两组治疗前血浆D-二聚体、hs-CRP比较差异无统计学意义（均P〉0.05）,治疗后D-二聚体、hs-CRP均显著降低,且治疗组较对照组显著下降（均P〈0.05）.结论 血府逐瘀汤加味治疗CASI后心绞痛的机制可能与其对防治术后再狭窄和对心肌、血管内皮的保护以及改善抗凝、抗血小板聚集和心肌微循环作用有关.

Objective To observe the clinical efficiency of Xuefu Zhuyu decoction （血府逐瘀汤） with additives in patients with angina pectoris after the operation of coronary artery stent implantation （CASI）. Methods Seventy-five patients with angina pectoris after the operation of CASI were randomly divided into two groups： treatment group （n=45） and control group （n=30）. The patients in the two groups were given clopidogrel, aspirin, valsartan, metoprolol, atorvastatin and other conventional western drugs. Xuefu Zhuyu decoction with additives was added to the therapy of the treatment group. The changes of heart rate, blood pressure, angina peetoris, electrocardiogram （ECG）, high-sensitive C-reactive protein （hs-CRP）, plasma D-dimer were observed before and after 180 days of treatment. Results Before treatment, there were no significant differences in heart rate and blood pressure between the two groups, and they were significantly decreased after treatment （all P〈0.05）, but no significant differences were seen between the groups. And there were no significant differences in angina frequency, angina duration, isehemia shown in ECG between the two groups before treatment （all P〉0. 05）. After treatment, the indexes were markedly improved, and the episode frequency and duration of angina in the treatment group were significantly lower and shorter than those in the control group. In the treatment group, the improvement efficacy of ischemic ST segment in ECG was 26.23% and the total effective rate 67.36%, significantly higher than those of control group 7.31% and 43.01%, respectively （both P〈0. 05）. There was no significant difference in plasma D-dimer and hs-CRP between the two groups before treatment （both P〉0.05）; after treatment, D-dimer and hs-CRP were significantly lower in the two groups, and they were obviously lower in the treatment group than those in the control group （all P〈 0.05）. Conclusion The mechanisms of Xuefu Zhuyu decoction with additives for treatment of angina pectoris after CASI may be related to the prevention of re-occurrence of coronary artery narrowness, protection of cardiac muscle and vascular endothelium, and improvement of anti-blood coagulation, anti-blood platelet aggregation and myocardial microcirculation.