调脉合剂治疗气阴两虚兼血脉瘀热型冠心病室性期前收缩的临床疗效分析

Clinical Effect of Tiaomai Mixture on Premature Ventricular Contraction in Coronary Heart Disease Due to Qi-Yin Deficiency and Stagnated Heat in Blood Vessel

目的:探讨调脉合剂联合酒石酸美托洛尔治疗气阴两虚兼血脉瘀热型冠心病室性期前收缩的临床效果。方法:纳入冠心病合并室性期前收缩患者共95例,采用随机数字表法分为治疗组和对照组,脱落4例,完成随访91例,治疗组45例和对照组46例,对照组在冠心病常规治疗基础上应用酒石酸美托洛尔治疗,治疗组在对照组基础上联合调脉合剂治疗,观察两组治疗前后中医证候疗效和心电图,24 h动态心电图等疗效性指标及安全性指标,疗程4周。结果:治疗后,治疗组心律失常疗效优于对照组(P<0.05);治疗后,治疗组室性期前收缩次数减少情况优于对照组(P<0.05),治疗组Lown分级改善较对照组具有显著性差异(P<0.01),治疗组心率变异性指标升高较对照组具有显著性差异(P<0.05),治疗组心电图QT离散度值改善较对照组具有明显差异(P<0.05),治疗组超敏C反应蛋白及同型半胱氨酸改善与对照组比较具有明显差异(P<0.05);同治疗前比较,两组均能改善中医证候,治疗组疗效显著优于对照组(P<0.01),其中治疗组气短、乏力、口干喜饮、舌象、脉象单项积分改善情况显著优于对照组(P<0.01)。结论:调脉合剂不仅可以提高冠心病心律失常临床疗效,在调节心律失常患者心率变异性指标、抑制炎症细胞因子、降低同型半胱氨酸及改善患者临床症状方面也表现出明显优势,值得临床推广应用。

Objective: To investigate the clinical effect of Tiaomai mixture combined with metoprolol tartrate on premature ventricular contraction in coronary heart disease(CHD)due to Qi-Yin deficiency and stagnated heat in blood vessel. Method:A total of 95 patients with CHD complicated with premature ventricular contraction were randomized into a treatment group and a control group. Four cases dropped out,leaving 91 cases(45 in the treatment group and 46 in the control group)included in the follow-up. On the basis of routine treatments for CHD,patients in the control group were further treated with metoprolol tartrate,while those in the treatment group received metoprolol tartrate plus Tiaomai mixture. Such curative effect and safety indexes as traditional Chinese medicine(TCM)syndrome score,electrocardiogram(ECG),and 24 h dynamic ECG were observed before and after four-week treatment. Result:After treatment,the therapeutic effect on arrhythmia in the treatment group was better than that in the control group(P<0.05). The treatment group was superior to the control group in reducing the frequency of premature ventricular contraction(P<0.05),improving the Lown grade(P<0.01),increasing the heart rate variability index(P<0.05),and ameliorating the QT dispersion in ECG(P<0.05),hypersensitive C-reactive protein,and homocysteine(P<0.05). As revealed by comparison with those before treatment,both interventions improved TCM syndrome,with better outcomes observed in the treatment group(P<0.01),manifested as the alleviation of shortness of breath,fatigue,dry mouth with desire to drink,and tongue and pulse manifestations(P<0.01). Conclusion: Tiaomai mixture improves the clinical efficacy against arrhythmia in CHD patients by regulating the heart rate variability index, inhibiting inflammatory cytokines,lowering homocysteine,and relieving clinical symptoms,which is worthy of clinical promotion and application.