中医序贯疗法对急性心肌梗死患者PCI术后的康复作用

Rehabilitation effect of sequential therapy of traditional Chinese medicine in patients with acute myocardial infarction after PCI

目的观察中医序贯疗法对急性心肌梗死(AMI)患者冠状动脉介入治疗(PCI)术后的康复作用。方法入选2015年10月~2016年10月于北京中医药大学东直门医院东区心血管病科明确诊断为AMI并行PCI的住院患者100例,男性66例,女性34例。随机分为康复组和常规组,各50例。常规组患者PCI术后标准化药物治疗;康复组在常规组的基础上,应用中医序贯疗法(服用中药茶饮+"中医导引操"),持续3个月。术后第6d、术后3个月测定6min步行试验(6MWT)距离。术后24 h内及术后3个月超声心动图检测左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF);测定冠心病中医症候量表、焦虑自评量表(SAS)及健康调查简表(SF-36)。术后即刻及术后3个月检测脑钠肽(BNP)以及血脂、肌酐等。结果与术后即刻比较,术后3个月两组心率、血脂、谷丙转氨酶以及BNP均降低,差异有统计学意义(P均<0.05)。两组术后3个月较术后24h内LVEDD、LVESD均降低,差异有统计学意义(P均<0.05)。与术后24 h内比较,两组术后3个月LVEF提高,而康复组提高更明显[(61.07±6.31)%vs.(63.74±6.47)%];与术后第6d比较,术后3个月两组6MWT距离均增加,康复组增加更明显[(434.69±127.46)m vs.(503.26±84.97)m],差异有统计学意义(P均<0.05)。两组术后3个月测定的中医症候量表评分、SAS评分以及SF-36评分较术后24 h内测定的评分显著改善,而康复组改善更明显,[(10.17±3.94)分vs.(6.85±2.91)分]、[(34.31±5.37)分vs(31.11+3.76)分]、[(658.31±40.34)分vs.(694.09±33.48)分],差异有统计学意义(P均<0.05)。结论在标准治疗基础上辅以中医序贯疗法,能更有效改善PCI术后AMI患者心率、心功能以及焦虑症状、中医症候及生存质量。

Objective To observe the rehabilitation effect of sequential therapy of traditional Chinese medicine(TCM)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods The patients with diagnosed AMI undergone PCI(n=100,male66and female34)were chosen from the Department of Cardiology in the East Branch of Dongzhimen Hospital of Beijing University of Chinese Medicine from Oct.2015to Oct2016,and randomly divided into rehabilitation group and routine group(each n=50).The routine group was given standardized drug treatment after PCI,and rehabilitation group was additionally given TCM sequential therapy(TCM herbal tea+conduction exercise)for3months.After PCI for6d and3months,6-minute walk distance(6MWD)was detected.After PCI within24h and for3months,left ventricular enddiastolic inner diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were detected by using echocardiogram.The scores of TCM Symptoms and Signs Scale(TCMSSS)for Coronary Heart Disease(CHD),Self-Rating Anxiety Scale(SAS)and the MOS36-Item Short Form Health Survey(SF-36)were detected.The levels of brain natriuretic peptide(BNP),blood fat and serum creatinine(SCr)were detected immediately after PCI and3months after PCI.Results The indexes of heart rate,blood fat,alanine aminotransferase(ALT)and BNP decreased3months after PCI compared with those immediately after PCI(all P<0.05).LVEDD and LVESD decreased3months after PCI compared with those within24h after PCI(all P<0.05).LVEF increased in2groups3months after PCI compared with that within24h after PCI[(61.07±6.31)%vs.(63.74±6.47)%],which was more significant in rehabilitation group,and6MWD increased in2groups3months after PCI compared with that on the6th d after PCI[(434.69±127.46)m vs.(503.26±84.97)m],which was more significant in rehabilitation group(all P<0.05).The scores of TCM-SSS for CHD,SAS and SF-36were improved in2groups3months after PCI compared with those within24h after PCI[(10.17±3.94)vs.(6.85±2.91)],[(34.31±5.37)vs.(31.11±3.76)]and[(658.31±40.34)vs.(694.09±33.48),all P<0.05].Conclusion On the base of standardized treatment,TCM sequential therapy can effectively improve heart rate,heart function and life quality,and relieve anxiety symptoms and TCM symptoms and signs in AMI patients after PCI.