血脉通Ⅱ号颗粒防治冠状动脉介入手术围术期心肌损伤及心功能保护的临床研究

The Clinical Study of XuemaitongⅡGranule in the Prevention and Treatment of Perioperative Myocardial Injury and Cardiac Function in Patients with Percutaneous Coronary Intervention

目的观察血脉通Ⅱ号颗粒在防治冠脉介入手术(percutaneous coronary intervention,PCI)患者围术期心肌损伤及心功能保护中的作用,以评定该治疗方案的有效性和科学性,为临床应用提供依据。方法选取2016年6月—2017年12月在常州市中医医院心内科择期完成PCI的冠心病(coronary artery disease,CAD)患者共186例,采用随机排列法分组,分为对照组、治疗组,其中对照组94例,脱落14例;治疗组92例,脱落12例。统计两组间基本临床资料和PCI相关资料是否具有可比性。对照组采用基础治疗:包括抗血小板(拜阿司匹林+氯吡格雷或替格瑞洛)、调脂、控制心率、控制血压、控制血糖等;治疗组:基础治疗+血脉通Ⅱ号颗粒。在治疗前后分别完善心肌标志物、NT-pro-BNP、血小板聚集率等检查,同时评估不良心脑血管事件的发生,并比较疗效,得出结论。结果对照组和治疗组患者基本临床资料及PCI相关资料均无统计学差异(P>0.05)。①心肌标志物比较:治疗组术后心肌标志物升高程度明显低于对照组,差异有统计学意义(P<0.01);②NT-pro-BNP比较:治疗组术后NT-pro-BNP升高程度明显低于对照组,差异有统计学意义(P<0.01);③治疗组术中无复流慢血流发生率、心绞痛和恶性心律失常发生次数均明显低于对照组(P<0.01);术后即刻冠脉血流TIMI 3级病例数明显多于对照组(P<0.01);术后治疗组心功能分级明显优于对照组(P<0.01);④血小板聚集率比较:治疗组术后5 d血小板聚集率明显低于对照组,差异有统计学意义(P<0.01);⑤术后不良心脑血管事件比较:治疗组术后不良心脑血管事件发现率明显低于对照组,差异有统计学意义(P<0.05)。结论血脉通Ⅱ号颗粒可以有效防治PCI患者围术期心肌损伤及起到心功能保护的作用。

Objective To evaluate the efficacy of XuemaitongⅡGranule in the prevention and treatment of perioperative myocardial injury and cardiac function in patients with percutaneous coronary intervention(PCI),and to provide evidence for clinical application.Methods A total of 186 patients with coronary artery disease(CAD)who completed PCI at the Department of Cardiology,Changzhou Traditional Chinese Medicine Hospital from June 2016 to December 2017 were selected and divided into control group and treatment group by random arrangement method Among them,there were 94 cases in the control group and 14 cases of shedding;92 cases in the treatment group and 12 cases of shedding.The statistics of basic clinical data and PCI-related data are comparable between the two groups.The control group received basic treatment:including antiplatelet(byaspirin+clopidogrel or ticagrelor),lipid regulation,heart rate control,blood pressure control,blood sugar control,etc.;treatment group:basic treatment+XuemaitongⅡparticles.Before and after treatment,the examinations of myocardial markers,NT-pro-BNP,platelet aggregation rate,etc.were perfected,and the occurrence of adverse cardiovascular and cerebrovascular events was evaluated at the same time,and the curative effects were compared to draw conclusions.Results There was no significant difference in clinical data and PCI-related data between the control group and the treatment group(P>0.05).①Comparison of myocardial markers:the level of myocardial marker in the treatment group was significantly lower than in the control group,the difference was statistically significance(P<0.01).②Comparison of NT-pro-BNP:The increase of NT-pro-BNP in the treatment group was significantly lower than that in the control group,and the difference was statistically significant(P<0.01).③In the treatment group,the incidence of non-recurrent slow blood flow,angina pectoris and malignant arrhythmia were significantly lower than those in the control group(P<0.01);Immediately after the operation,TIMI level 3 of coronary blood flow was significantly higher than that in the control group(P<0.01);The cardiac function classification of postoperative treatment group was significantly better than that of the control group(P<0.01).④Comparison of platelet aggregation rate:The platelet aggregation rate in the treatment group was significantly lower than that in the control group 5 days after surgery,and the difference was statistically significant(P<0.01).⑤Comparison of postoperative adverse cardiovascular and cerebrovascular events:The incidence of adverse cardio-cerebrovascular events in the treatment group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion XuemaitongⅡGranule can effectively prevent perioperative myocardial injury and protect cardiac function in patients with PCI.