丹红注射液治疗心血瘀阻证急性心肌梗死经皮冠状动脉介入术后病人的疗效观察

Effect of Danhong Injection on Acute Myocardial Infarction with Heart Blood Stasis after Percutaneous Coronary Intervention

目的观察丹红注射液治疗心血瘀阻证急性心肌梗死经皮冠状动脉介入术(PCI)后病人的临床疗效。方法选取上海中医药大学附属曙光医院2017年1月—2019年1月因急性心肌梗死入院并行急诊PCI术、中医辨证属心血瘀阻证的住院病人66例,随机分为对照组和治疗组,每组33例。对照组采用西药标准治疗,治疗组在西医标准治疗基础上加用丹红注射液治疗,治疗疗程为7 d,并随访1个月。观察治疗前后中医临床症状和血瘀证积分的变化,检测治疗后0 h、8 h、16 h、24 h、72 h、7 d时血浆心肌肌钙蛋白(cTnI)水平及治疗后72 h、7 d血浆脑钠肽水平,观察治疗前后血常规、肝肾功能变化、有无重大并发症等安全性指标。结果经治疗后,两组临床症状积分和血瘀证积分均有下降,治疗组下降更为明显,两组比较差异具有统计学意义(P<0.05或P<0.01)。治疗组血浆cTnI水平在PCI术后8 h较对照组上升缓慢,但差异无统计学意义(P>0.05);两组血浆cTnI水平均在PCI术后16 h开始下降,治疗组在PCI术后16 h下降更为明显,两组比较差异具有统计学意义(P<0.01),而PCI术后24 h、48 h、72 h、7 d虽较对照组有下降趋势,但差异均无统计学意义(P>0.05)。两组血浆脑钠肽在PCI术后72 h均较治疗前有上升,但两组间比较差异无统计学意义(P>0.05);治疗7 d,两组病人脑钠肽水平均有下降,治疗组较对照组下降更为明显,差异有统计学意义(P<0.05)。两组在治疗期间和治疗后随访1个月,均无明显不良反应。结论在西医标准治疗基础上加用丹红注射液可以改善心血瘀阻证急性心肌梗死PCI术后病人的中医临床症状和血瘀证积分,加速PCI术后病人心肌损伤物峰值下降的速度,减少心肌损伤标志物和心力衰竭标志物的表达,并具有良好的临床安全性。

Objective To observe the effect of Danhong Injection on acute myocardial infarction with heart blood stasis after percutaneous coronary intervention(PCI).Methods Sixty-six patients with acute myocardial infarction and heart blood stasis after PCI were randomly divided into control group and treatment group,with 33 cases in each group.The control group was treated with standardized western medicines and treatment group was treated with Danhong Injection combined with standardized western treatment.The patients in two groups were treated for 7 days and followed up for 1 month.The clinical symptoms and blood stasis syndrome score of traditional Chinese medicine were observed before treatment and after treatment.The dynamic changes of plasmacardiac troponin I(cTnI)after PCI(0 h,8 h,16 h,24 h,48 h,72 h,7 d)were compared.The changes of plasma B type natriuretic peptide(BNP)ware observed before PCI and after PCI 3 days and 7 days,and clinical safety indexes were evaluated.Results After treatment,the clinical symptoms and Blood Stasis Syndrome scores of traditional Chinese medicine improved in both groups,but therapeutic effect of the treatment group was better than that of the control group(P<0.05 or P<0.01).The level of cTnI in the treatment group increased slowly at 8 h after PCI compared with that in the control group,but there was no statistically significant difference(P>0.05).The level of cTnI in both groups began to decrease at 16 h after PCI,and the decrease was more obvious in the treatment group 16 h after PCI,with statistical significance(P<0.05).Compared with the control group,the level of cTnI at 24 h,48 h,72 h and 7 d after PCI showed a downward trend,but there was no statistically significant difference(P>0.05).There was no statistical difference between two groups in BNP at 3 d after treatment(P>0.05).At 7 days after treatment,the level of BNP in both groups were decreased,and the decrease in the treatment group was more obvious than that in the control group(P<0.05).There were no obvious adverse reactions in both groups during treatment and after 1 month follow-up.Conclusion Danhong injection could improve the traditional Chinese medicine clinical symptoms and blood stasis syndrome scores of patients with acute myocardial infarction after PCI,accelerate the decline rate of peak value with myocardial injury after PCI,reduce the expressions of myocardial injury markers and heart failure markers,and it was safety.