益心通脉颗粒对冠心病介入术后气虚血瘀证的影响

Effect of Yixin Tongmai Grains on Qi and Blood Stasis After Intervention Therapy for Coronary Heart Disease

目的:探讨益心通脉颗粒对冠心病经皮冠状动脉介入治疗(PCI)术后(气虚血瘀证)患者不良心血管事件、生活质量、心室重构等方面的影响,并从炎症反应方面探讨了其作用机制。方法:将160例PCI术后患者随机分为对照组和观察组。两组均采用拜阿司匹林肠溶片,100 mg/次,1次/d;硫酸氢氯吡格雷片,75 mg/次,1次/d;阿托伐他汀钙片,20 mg/次,1次/d;酒石酸美托洛尔缓释片,200 mg/次,2次/d,并进行术后运动康复训练。观察组服用益心通脉颗粒,10 mg/次,3次/d,温开水冲服。两组疗程均为6个月。记录术后再狭窄(ISR),灌注不良(NR)的发生情况;行超声心动图检测,记录治疗前后左室射血分数(LVEF),每搏输出量(SV),左室舒张末容积指数(LVEDVI)和收缩末内径(LVEVI);进行治疗前后西雅图心绞痛量表(SAQ),气虚血瘀证,6 min步行试验(6 MWT),踝臂指数(ABI)评价;检测治疗前后血清肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),N末端B型利钠肽原(NT-pro BNP)和基质金属蛋白酶-9(MMP-9)水平。结果:在6个月内,观察组ISR的发生率为6.58%,低于对照组的19.44%(χ~2=5.051,P<0.05),观察组NR的发生率为9.59%,低于对照组的22.22%(χ~2=4.334,P<0.05);治疗后观察组患者LVEF和SV均高于对照组(P<0.01),LVEDVI均和LVEVI低于对照组(P<0.01);治疗后观察组SAQ量表活动受限程度、心绞痛稳定状态、心绞痛发作情况和治疗满意程度4个维度评分均高于对照组(P<0.01);治疗后观察组血清TNF-α,IL-6,NT-pro BNP和MMP-9水平均低于对照组(P<0.01);治疗后观察组6 min步行距离多于对照组(P<0.01),观察组气虚血瘀证评分低于对照组(P<0.01),观察组ABI高于对照组(P<0.01)。结论:益心通脉颗粒在PCI术后综合康复治疗中能起到降低ISR,NR等不良心血事件发生,抑制心室重构和炎症反应,减轻临床症状,改善心室功能,提高患者的活动能力和生活质量作用,从而促进PCI术后患者的康复。

Objective： To discuss the effect of Yixin Tongmai grains on adverse cardiovascular events,quality of life and ventricular remodeling of patients with Qi and blood stasis after percutaneous coronary intervention therapy for coronary heart disease,and the mechanism for inflammation. Method： One hundred and sixty patients with PCI were randomly divided into control group and observation group by random number table. The two groups were adopted got aspirin enteric-coated tablets,100 mg/time,1 time/day,clopidogrel hydrogen sulfate tablets,75 mg/time,1 time/day,atorvastatin calcium tablets,20 mg/time,1 time/day, metoprolol tartrate sustained-release tablets,200 mg/time,2 times/day,and sports rehabilitation training. Patients in observation group got Yixin Tongmai grains,10 mg/time,3 times/day. The course of treatment was 6 months. Post-surgery restenosis（ ISR） and improper perfusion（ NR） were recorded. Echocardiography was performed, and left ventricular ejection fraction（ LVEF）,stroke volume（ SV）,left ventricular end-diastolic volume index（ LVEDVI）and end-systolic diameter（ LVEVI） were recorded before and after treatment. Seattle angina Rating scale（ SAQ）,Qi and blood stasis,six-minute walk test（ 6 MWT）,ankle brachial index（ ABI） were scored before and after treatment. And levels of tumor necrosis factor-α（ TNF-α）,interleukin-6（ IL-6） and N-terminal pro-B-type natriuretic peptide（ NT-pro BNP） and matrix metalloproteinase-9（ MMP-9） were detected before and after treatment. Result： During the 6 months,incidence of ISR in observation group was 6. 58%,which was lower than19. 44% in control group（ χ~2= 5. 051,P〈0. 05）,incidence of NR in observation group was 9. 59%,which was lower than 22. 22% in control group（ χ~2= 4. 334,P〈0. 05）. After treatment,LVEF and SV were higher than those in control group（ P〈0. 01）,LVEDVI and LVEVI were lower than those in control group（ P〈0. 01）. After treatment,scores of degree of motion limitation,angina stability,angina attack and treatment satisfaction were all higher than those in control group（ P〈0. 01）. Levels of TNF-α,IL-6,NT-pro BNP and MMP-9 were lower than those control group（ P〈0. 01）. The 6-minute walking distance in observation group were longer than that in control group（ P〈0. 01）,score of Qi and blood stasis in observation group was lower than that of control group（ P〈0. 01）,and ABI was higher than that in control group（ P〈0. 01）. Conclusion： After PCI,Yixin Tongmai grains can reduce ISR and NR, inhibit ventricular remodeling and inflammatory response, relieve clinical symptoms,improve ventricular function,and enhance patients＇ motion ability and quality of life,so as to promote recovery of patients.