通冠复脉汤治疗冠心病室性早搏38例

Tongguan Fumai Decoction to Treat Ventricular Premature Beat in Coronary Heart Disease of 38 Cases

目的:探讨通冠复脉汤治疗冠心病(CHD)室性早搏的临床疗效及对血管内皮功能的影响。方法:将77例CHD室性早搏急患者按住院先后随机分为对照组39和观察组38例。两组均给予常规西医治疗,对照组,美托洛尔缓释片,50 mg/次,1次/d。观察组在对照组的基础上加服通冠复脉汤,1剂/d,常规水煎分2次服用。两组疗程均为12周。记录治疗前后心悸、胸痛、神疲乏力、气短及唇色紫暗等主要症状评分;采用24 h动态心电图记录治疗前后室性早搏的次数;记录每周心绞痛发作次数及每次持续时间;检测治疗前后血清一氧化氮(NO),内皮素1(ET-1),血栓素(TXB2)及6-酮-前列腺素F_(1a)(6-Keto-PGF-1a)水平。结果:观察组心律失常总有效率为92.11%,优于对照组的74.36%(P<0.05);经Ridit分析,观察组心电图疗效优于对照组(P<0.05);治疗后观察组心绞痛发作次数及持续时间均少于对照组(P<0.05或P<0.01);观察组心悸、胸痛、神疲乏力、气短及唇色紫暗等症状评分低于对照组(P<0.01);观察组NO和6-Keto-PGF-1a高于对照组,ET-1和TXB2低于对照组(P<0.01)。结论:通冠复脉汤能治冠心病(CHD)室性早搏患者临床症状、心电图缺血改变、室性早搏均有显著改善作用,临床疗效显著,其作用机制可能与改善患者血管内皮功能,增加心肌血供有关。

Objective： The purpose is to discuss the clinical effects of Tongguan Fumai decoction on ventricular premature beat in coronary heart disease （CHD） and the influence of vascular endothelial function. Method： Seventy-seven cases of patients with were randomly divided into control group （39 cases） and observation group （38 cases） according to the oder of being in hospital.Both groups were treated with regular western medicine treatment.In control group,patients took metoprolol sustained-release tablets,50 mg/time,1 does/day.For patients in observation group took Tongguan Fumai decoction based on control group,1 does/day, conventional water decoction,taken orally.The treatment course was 12 weeks for both groups.Record symptom score of palpitation,chest pain,spirit fatigue,breathe hard and dark purple color on lip before and after treatment. Keep a record of the number of ventricular premature beat by 24 hours dynamic electrocardiogram.Besides,record number of angina pectoris attack times and duration time within a week.Detect serum nitric oxide（NO）,endothelin-1（ET-1）, thromboxane （TXB2） and 6-ketone-prostaglandin F_（1a） （6-Keto-PGF_1a） before and after treatment. Result： After the treatment,total effective rate of arrhythmia in observation group was 92.11%,which was better than 74.36% in control group（P〈0.05）.Electrocardiograph curative effect in observation group was superior to control group（P〈0.01） by analysis of Ridit.The number of angina pectoris attack times and duration time in observation group were both lower than control group（P〈0.05 or P〈0.01） after treated.Symptom score of palpitation,chest pain,spirit fatigue,breathe hard and dark purple color on lip in observation group were inferior to control group（P〈0.01）.For observation group, the level of NO and 6-Keto-PGF_1a were higher than control group,but ET-1 and TXB2were lower （P〈0.01）. Conclusion： Through the treatment of Tongguan Fumai decoction. It can improve patients with CHD ventricular premature beat in clinical symptoms,electrocardiograph ischemia change and ventricular premature beat.As for the effective clinical effects, its mechanism of action may be because it improve patients＇ vascular endothelial function and increase myocardial blood supply.