温胆汤合四君子汤加味治疗冠心病稳定型心绞痛气虚痰瘀证临床观察

Clinical Observation of Modified Wendan Tang and Sijunzi Tang for Coronary Stable Angina Cordis with Qi Deficiency and Phlegm Stasis Syndrome

目的:观察温胆汤合四君子汤加味治疗冠心病稳定型心绞痛气虚痰瘀证的临床疗效。方法:选取本院收治的80例冠心病稳定型心绞痛气虚痰瘀证患者,随机分为治疗组和对照组各40例。对照组口服常规药物治疗,治疗组在对照组的用药基础上服用温胆汤合四君子汤加味。2组均治疗4周,观察患者的治疗效果,及治疗前后血液流变学指标和24 h动态心电图指标的变化。结果:对照组总有效率67.5%,治疗组总有效率90.0%,2组比较,差异有统计学意义(P<0.05)。治疗前,2组全血黏度高切、全血黏度低切、血浆黏度、红细胞比积和纤维蛋白原水平比较,差异均无统计学意义(P>0.05)。治疗后,治疗组5项血液流变学指标及对照组的全血黏度低切和红细胞比积均较治疗前改善(P<0.01,P<0.05);治疗组全血黏度低切、血浆黏度、红细胞比积和纤维蛋白原水平的改善情况均优于对照组(P<0.01)。治疗后,2组ST段压低次数及ST段压低持续总时间均较治疗前减少(P<0.01),心肌缺血总负荷均较治疗前降低(P<0.01);治疗组ST段压低次数及ST段压低持续总时间均少于对照组(P<0.01),心肌缺血总负荷低于对照组(P<0.01)。结论:在常规药物治疗的基础上服用温胆汤合四君子汤加味治疗冠心病稳定型心绞痛气虚痰瘀证,可提高治疗效果。

Objective：To observe the clinical effect of modified Wendan tang and Sijunzi tang for coronary stable angina cordis with qi deficiency and phlegm stasis syndrome. Methods ：Selected 80 cases of patients with coronary stable angina cordis with qi deficiency and phlegm stasis syndrome, and divided them into the treatment group and the control group randomly,40 cases in each group. Both groups received conventional medicine orally,while the treatment group additionally received modified Wendan tang and Sijunzi tang. Both groups received treatment for four weeks. Observed the curative effect as well as changes of hemorheology indexes and 24-hour dynamic electrocardiogram in both groups before and after treatment. Results ：The total effective rate was 67.5% in the control group and 90.0% in the treatment group,the difference being significant（P〈0.05）. After treatment,compared levels of whole blood viscosity in high shear rate,whole blood viscosity in low shear rate,plasma viscosity,hemotarit and fibrinogen in both groups,there was no significance in the comparisons（P〈0.05）. After treatment, five hemorheology indexes in the treatment group as well as the whole blood viscosity in low shear rate and hemotarit in the control group were all improved when compared with those before treatment（P〈0.01,P〈0.05）. Improvements of whole blood viscosity in low shear rate,plasma viscosity,hemotarit and fibrinogen in the treatment group were all superior to those in the control group（P〈0.01）. Comparing with those before treatment,the frequency of ST segment depression and total duration of ST segment depression in both groups after treatment were decrease（P〈0.01）,and the total ischemia burdens in both groups after treatment were declined（P〈0.01）. In the treatment group,the frequency of ST segment depression and total duration of ST segment depression were both less than those in the control group（P〈0.01）,and the total ischemia burden was lower than that in the control group（P〈0.01）. Conclusion：The therapy of modified Wendan tang and Sijunzi tang based on conventional medicine for coronary stable angina cordis with qi deficiency and phlegm stasis syndrome can enhance the curative effect.