银杏达莫注射液治疗急性冠脉综合征合并高脂血症的临床观察

Clinical observation of ginkgo-dipyridamole injection for treatment of patients with acute coronary syndrome combined with hyperlipidemia

目的观察银杏达莫注射液治疗急性冠脉综合征（ACS）合并高脂血症的临床疗效。方法选择2015年2月至12月荆门市第一人民医院心内科收住的80例ACS合并高脂血症患者，按随机数字表法分为观察组和对照组，每组40例。所有患者均每日1次口眼氯吡格雷75m趴阿托伐他汀20mg、单硝酸异山梨酯40mg等常规治疗，观察组在常规治疗基础上每日1次静脉滴注（静滴）银杏达莫注射液30mL，连续治疗14d。观察两组患者治疗前后血脂水平[包括总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]，心绞痛发作情况（包括心绞痛发作频率、持续时间、发作间隔时间）、心电图ST段下移、血液流变学指标[包括血浆黏度、血小板聚集率、D-二聚体、纤维蛋白原（Fib）]、临床疗效及药物不良反应发生．隋况。结果两组治疗后TC、TG、LDL-C、血浆黏度、D-二聚体、血小板聚集率、Fib均较治疗前明显降低，HDL-C较治疗前明显升高，但观察组和对照组治疗后TC、TG、LDL-C、HDL-C水平比较差异均无统计学意义[TC（mmol／L）：2．48±1．13比3．63±1．17，TG（mmol／L）：1．69±0．37比2．62±0．35，LDL-C（mmol／L）：1．35±0．47比1．25±0．35，HDL-C（mmol／L）：4．03±1．03比3．67±1．07，均P〉O．05]，而观察组血液流变学指标的降低程度较对照组更显著[血浆黏度（mPa·s）：0．32±0．05比0．73±0．68，D-二聚体（mg／L）：0．25±0．06比0．67±0．33，血小板聚集率：（35．45±10．21）％比（46．73±10．19）％，Fib（g／L）：1．18±0．69比3．38±1．23，均P〈O．05]。两组治疗后心绞痛发作频率均较治疗前明显降低（次，d：1．46±1．21比3．61±1．07），心绞痛发作持续时间较治疗前明显缩短（min／次：6．56±2．28比10．57±2．16），心绞痛发作间隔时间较治疗前明显延长（d：6．15±1．35比3．15±0．41），ST段下移较治疗前降低（mV：0．23±0．09比0．72±0．71），且以观察组的变化较对照组更显著（均P〈0．05）。观察组总有效率明显高于对照组[95．0％（38／80）比77．5％（31／80），P〈0．05]。结论在常规治疗的基础上加用银杏达莫注射液能有效降低ACS合并高脂血症患者心绞痛持续时间和发作次数，延长发作间隔时间，减少sT段下移，并可降低血脂，改善心肌缺血。

Objective To observe the clinical efficacy of ginkgo-dipyridamole injection （GDI） for treatment of patients with acute coronary syndrome （ACS） combined with hyperlipidemia. Methods Eighty patients with ACS combined with hyperlipidemia admitted to Department of Cardiology in Jingmen No. 1 People＇s Hospital from February to December 2015 were enrolled, and they were divided into observation group and control group by random number table, each 40 cases. All patients were orally given clopidogrel 75 rag, atorvastatin 20 mg, isosorbide mononitrate sustained release tablets 40 mg and other routine treatment once a day; based on conventional treatment, the observation group was additionally treated with intravenous drip of GDI 30 mL, once a day for consecutive 14 days, forming a treatment course. Before and after treatment, the blood lipid levels [including total cholesterol （TC）, triglyeeride fiG）, high-density lipoprotein-eholesterol （HDL-C）, low-density lipoprotein-cholesterol （LDL-C）], occurrence of angina peetoris （including frequency, duration, interval time of angina）, ST segment downward displacement in electrocardiogram （ECG）, changes of hemorheology index levels [including plasma viscosity, platelet aggregation rate, plasma D-dimer, fibrinogen （Fib）] of the two groups were observed, and the clinical efficacy and adverse reactions were recorded. Results After treatment, the TC, TG, LDL-C, plasma viscosity, D-dimer, platelet aggregation rate and Fib in the two groups were all significantly lower than those before treatment, while HDL-C was obviously higher than that before treatment; there were no statistically significant differences in TC, TG, LDL-C, and HDL-C levels after treatment between observation and control groups [TC （retool/L）： 2.48 ± 1.13 vs. 3.63 ± 1.17, TG （retool/L）： 1.69 ± 0.37 vs. 2.62 ± 0.35, LDL-C （retool/L）： 1.35±＋ 0.47 vs. 1.25 ± 0.35, HDL-C （mmol/L）： 4.03 ± 1.03 vs. 3.67 ± 1.07, all P 〉 0.05]. The degrees of descent in hemorheological indexes of observation group were more significant compared with those of control group [plasma viseosity （mPa · s）： 0.32 ± 0.05 vs. 0.73 ± 0.68, D-dimer （rag/l,）： 0.25 ± 0.06 vs. 0.67 ± 0.33. plalelet aggregali,n rate： （35.45 ± 10.21）% vs. （46.73 ± 10.19）%, Fib （g/L）： 1.18 ± 0.69 vs. 3.38± 1.23, all P 〈 0.05J. Afler lrealmenI, in the two groups, the angina frequency was significantly lowered than Ihal before Irealment （number/d： 1.46± 1.21 vs. 3.61± 1.07）, angina duralion was markedly shorter than thai before treatment （min/frequen（.y： 6.56 ± 2.28 vs. 10.57 ±2.16）, and lhe interval between attacks was longer l han thal bef, re treatment （days： 6.15± 1.35 vs. 3.15 ±0.41）. Ihe ST segment downward displacement was decrease（I than that befcn＇e treatment （mV： 0.23 ± 0.09 vs. 0.72± 0.71）, and lhe degrees of change in observation group was more obvious lhan that in control group （all P 〈 0.05）. The total effective rate of ,bservation group was higher than thai in c.ontro[ group [95.0% （38/80） vs. 77.5% （31/80）, P 〈 0.05}. Conclusion Based on the rouline trealmenl, addition of GDI can effectively reduce the persisting time of angina, attack freqaeney, prolong the interval time between attacks and decrease the ST segment downward displacement of ECG, reduce the lipid levels and improve myocardial isehemia in patients with ACS combined with hyperlipidemia.