活血通络方联合问诊辨证施治对冠状动脉微循环障碍冠心病患者心肌微循环及血液流变学的影响

Effect of Huoxue Tongluo Formula combined with consultation and evidence-based treatment on myocardial microcirculation and blood rheology in coronary heart disease patients with coronary microvascular dysfunction

目的探究活血通络方联合问诊辨证施治对冠心病患者心肌微循环及血液流变学的影响。方法112例冠状动脉微循环障碍冠心病患者,按照随机数字表法分为对照组和观察组,每组56例。对照组给予西药治疗,观察组在对照组治疗基础上给予活血通络方联合问诊辨证施治。比较两组患者治疗效果,治疗前后心肌微循环[心肌微循环阻力指数(IMR)、冠状动脉血流速度储备(CFVR)]、血液流变学改变情况及中医证候积分。结果观察组治疗总有效率为98.21%,高于对照组的83.93%,差异有统计学意义(P<0.05)。治疗后,观察组IMR(15.62±1.42)U明显低于对照组的(23.25±1.33)U,CFVR(4.29±1.52)明显高于对照组的(3.63±1.38),差异有统计学意义(P<0.05)。治疗后,观察组全血高切粘度、全血低切粘度、血浆粘度及红细胞聚集指数分别为(4.01±0.54)mPa·s、(8.18±1.04)mPa·s、(1.07±0.35)mPa·s、(2.14±0.21),对照组分别为(4.76±0.87)mPa·s、(9.63±1.26)mPa·s、(1.63±0.41)mPa·s、(2.72±0.32)。两组患者全血高切粘度、全血低切粘度、血浆粘度及红细胞聚集指数均低于本组治疗前,且观察组全血高切粘度、全血低切粘度、血浆粘度及红细胞聚集指数均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组胸闷、心悸、胸痛、气短、神疲乏力及面色白评分分别为(0.42±0.04)、(0.35±0.02)、(0.38±0.04)、(0.39±0.03)、(0.24±0.02)、(0.27±0.01)分,对照组分别为(0.93±0.15)、(0.91±0.13)、(0.94±0.05)、(0.96±0.07)、(0.76±0.03)、(0.79±0.02)分。两组患者胸闷、心悸、胸痛、气短、神疲乏力及面色白评分均显著低于本组治疗前,且观察组胸闷、心悸、胸痛、气短、神疲乏力及面色白评分均显著低于对照组,差异有统计学意义(P<0.05)。结论活血通络方联合问诊辨证施治可有效改善冠状动脉微循环障碍冠心病患者心肌微循环及血流变学情况,临床治疗效果显著,且患者中医证候积分下降幅度显著,值得推广应用。

Objective To investigate the effect of Huoxue Tongluo Formula combined with consultation and evidence-based treatment on myocardial microcirculation and blood rheology in coronary heart disease patients with coronary microvascular dysfunction.Methods A total of 112 coronary heart disease patients with coronary microvascular dysfunction were divided into a control group and an observation group according to the random numerical table,with 56 cases in each group.The control group was treated with western medicine,and the observation group was treated with Huoxue Tongluo Formula,consultation and evidence-based treatment on the basis of the treatment of the control group.The therapeutic effects,as well as myocardial microcirculation[index of microcirculatory resistance(IMR),coronary flow velocity reserve(CFVR)],blood rheology changes and traditional Chinese medicine syndrome score before and after treatment were compared between the two groups.Results The total effective rate of treatment in the observation group was 98.21%,which was higher than 83.93%in the control group,and the difference was statistically significant(P<0.05).After treatment,the IMR of the observation group was(15.62±1.42)U,which was significantly lower than(23.25±1.33)U of the control group,and the CFVR(4.29±1.52)was significantly higher than(3.63±1.38)of the control group.The differences were statistically significant(P<0.05).After treatment,the whole blood high-shear viscosity,whole blood lowshear viscosity,plasma viscosity,erythrocyte aggregation index were(4.01±0.54)mPa·s,(8.18±1.04)mPa·s,(1.07±0.35)mPa·s,(2.14±0.21)in the observation group,and(4.76±0.87)mPa·s,(9.63±1.26)mPa·s,(1.63±0.41)mPa·s,(2.72±0.32)in the control group.The whole blood high-shear viscosity,whole blood low-shear viscosity,plasma viscosity and erythrocyte aggregation index in both groups were lower than those before treatment in this group,and the observation group was lower than the control group.The differences were statistically significant(P<0.05).After treatment,the scores of chest tightness,palpitations,chest pain,shortness of breath,fatigue and pale complexion in the observation group were(0.42±0.04),(0.35±0.02),(0.38±0.04),(0.39±0.03),(0.24±0.02)and(0.27±0.01)points,which were(0.93±0.15),(0.91±0.13),(0.94±0.05),(0.96±0.07),(0.76±0.03),and(0.79±0.02)points in the control group.The scores of chest tightness,palpitations,chest pain,shortness of breath,fatigue and pale complexion in both groups were significantly lower than thoes before treatment in this group,and the observation group was significantly lower than the control group.The differences were statistically significant(P<0.05).Conclusion The combination of Huoxue Tongluo Formula with consultation and evidence-based treatment can effectively improve myocardial microcirculation and blood rheology in coronary heart disease patients with coronary microvascular dysfunction,and the clinical effect is significant,and the patients’traditional Chinese medicine syndrome score decreases significantly,which is worthy of promotion and application.