中西医结合方法治疗急性心肌梗死的临床疗效

Clinical Therapeutic Effects of Integrated Chinese and Western Medicine on Acute Myocardial Infarction

目的探讨中药联合西医常规处理急性心肌梗死(AMI)的临床疗效。方法将105例确诊为AMI患者分为对照组(51例)与观察组(54例),对照组患者入院后给予AMI常规处理,如绝对卧床、吸氧、心电监护等,患者根据病情及症状选择应用扩张冠状动脉药物、血管紧张素转换酶抑制剂(ACEI)、β-受体阻滞剂,纠正心律失常、抗休克、抗心力衰竭,适合溶栓者予以溶栓治疗。观察组在对照组基础上根据中医辨证不同分型采用不同方剂加减治疗,痰浊闭塞型常用瓜蒌薤白半夏汤加减,气阴两虚型常用生脉散加减,气滞血瘀型常用血府逐瘀汤加减,寒凝心脉型常用当归四逆汤加减。观察两组患者治疗后临床疗效及血管再通率、4周后病死率、出血发生率情况,通过心脏超声检查患者左室各功能指标[左室射血分数(LVEF)、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)]和心排血量情况。结果两组患者治疗后观察组总有效率、血管现通率、出血发生率分别为94.4%、87.0%、55.6%,明显优于对照组的82.3%、68.6%、21.6%,两组比较差异有统计学意义(P<0.05)。两组治疗4周后病死率情况比较,差异无统计学意义(P>0.05)。两组患者治疗后左室各功能指标情况比较,观察组均明显优于对照组,差异有统计学意义(P<0.01)。结论常规西医同时灵活配合辨证中药方法治疗AMI疗效显著,且大大降低了出血发生率,对提高血管再通也有显著效果,同时对改善左室心功能各项指标也有明显效果,值得临床推广。

Objective To discuss the clinical therapeutic effects on acute myocardial infarction（AMI）treated with Chinese herbal medicine and convention measures of Western medicine.Methods One hundred and five patients of AMI were divided into a control group（51 cases）and an observation group（54 cases）.In the control group,after admission,the convention management was given,such as strict bed rest,oxygen uptake and ECG monitoring.According to the conditions and symptoms,the drug for dilating coronary artery,ACEI,β-receptor resistance preparation,rectifying arrhythmia,anti-shock,anti-heart failure and thrombolysis for the patient available.In the observation group,on the basis of the treatment as the control group,the different formulas were modified according to TCM differentiation.For the case of blockage by phlegm,guolouxiebaibanxia tang was modified;for qi and yin deficiency,shengmai san was modified;for qi and blood stagnation,xuefuzhuyu tang was modified;for cold stagnation in heart meridian,dangguisini tang was modified.The clinical therapeutic effects,the vessel repass rate,the mortality in 4 weeks and bleeding incidence were observed in the two groups after treatment.Through the heart ultrasonic B test,the left ventricular function indicators（LVEF,LVEDV and LVESV）and cardiac output were determined.Results The total effective rate,the vessel repass rate and bleeding incidence were 94.4%,87.0% and 55.6% in the observation group separately,which were apparently better than 82.3%,68.6% and 21.6%,indicating the significant differences（P〈0.05）.The mortality in 4 weeks was not different significantly between the two groups（P〉0.05）.The left ventricular function indicators in the observation group were apparently better than those in the control group,but without statistical significance in comparison（P〈0.01）.Conclusion The conventionalwestern medicinecombined flexibly with herbal medication according to TCM differentiation achieves the significant therapeutic effects on AMI.The combined therapy reduces greatly bleeding incidence,improves significantly vessel repass as and the left ventricular function indicators.Hence,this therapy deserves to be promoted in clinic.