益心通络利水方对急性心肌梗死PCI术后心衰患者心肌重构的影响

Effect of Yixin Tongluo Lishui prescription on myocardial remodeling in patients with heart failure after percutaneous coronary intervention for acute myocardial infarction

目的:观察益心通络利水方对急性ST段抬高型心肌梗死(STEMI)PCI术后心衰患者心肌重构的影响。方法:选取STEMI PCI术后心衰患者140例,按照随机数字表法将其分为2组,每组各70例。对照组采用西医常规治疗方案,治疗组在对照组基础上加用益心通络利水方治疗,2组均连续治疗4周。比较治疗后2组患者中医证候疗效,测量并比较治疗前后2组患者左房内径、左室内径、左室射血分数(LVEF),并利用三维斑点追踪成像(3D-STI)技术观察左室整体纵向应变(GLS)、径向应变(GRS)及圆周应变(GCS)。结果:总有效率治疗组为92.8%(65/70),对照组为74.3%(52/70),组间比较,差异有统计学意义(P<0.05);治疗后治疗组左房内径、左室内径、LVEF较治疗前均有改善,且较对照组改善明显,差异均有统计学意义(P<0.05);2组GLS、GRS、GCS值治疗前后组内比较及治疗后组间比较,差异均有统计学意义(P<0.05或P<0.01)。结论:益心通络利水方能够改善STEMI PCI术后患者临床症状及心肌重构,提高心功能,3D-STI能够更早期、敏感、准确地评价介入术后心衰患者的心脏收缩功能。

Objective:To investigate the effect of Yixin Tongluo Lishui prescription on myocardial remodeling in patients with heart failure after percutaneous coronary intervention(PCI)for ST-elevation myocardial infarction(STEMI).Methods:A total of 140 patients with heart failure after PCI for STEMI were divided into treatment group and control group using a random number table,with 70 patients in each group.The patients in the control group were given conventional Western medicine treatment,and those in the treatment group were given Yixin Tongluo Lishui prescription in addition to the treatment in the control group;the course of treatment was 4 consecutive weeks for both groups.The treatment outcome of traditional Chinese medicine(TCM)syndrome was compared between the two groups,and left atrial diameter,left ventricular diameter,and left ventricular ejection fraction(LVEF)were measured and compared between the two groups.Three-dimensional speckle-tracking imaging(3 D-STI)was used to observe global longitudinal strain(GLS),global radial strain(GRS),and global circumferential strain(GCS)of the left ventricle.Results:There was a significant difference in overall response rate between the treatment group and the control group[92.8%(65/70)vs 74.3%(52/70),P<0.05].After treatment,the treatment group had significant improvements in left atrial diameter,left ventricular diameter,and LVEF,with significantly greater improvements than the control group(P<0.05).Both groups had significant changes in GLS,GRS,and GCS after treatment,and there were significant differences in these values between the two groups(P<0.05 or P<0.01).Conclusion:Yixin Tongluo Lishui prescription can improve clinical symptoms,myocardial remodeling,and cardiac function in patients after PCI for STEMI,and 3 D-STI can sensitively and accurately evaluate the cardiac systolic function of patients with heart failure after PCI at an earlier stage.