调理脾胃法治疗稳定型劳力性心绞痛58例临床观察

Clinical Observation on 58 Cases of Stable Exertional Angina Pectoris Treated by Regulating Spleen and Stomach

目的观察国医大师路志正教授调理脾胃法用于稳定型劳力性心绞痛患者心肌缺血的临床疗效。方法病例来源于2004年9月—2005年9月期间在中国中医科学院望京医院心内科门诊就诊的稳定型劳力性心绞痛的58例患者,采用体现国医大师路志正教授调理脾胃法辨证治疗胸痹的固定中药处方(调脾益心方),汤剂连续口服用药8周,观察治疗前后患者临床症状、心电图及心电图运动负荷试验中“诱发阳性时间”“运动终止时间”“最大ST下降时间”“最大ST下降幅度”“ST恢复时间”等多角度全方位评价心肌缺血指标的变化。结果反映稳定型劳力性心绞痛主要临床表现的“胸痛程度”“胸痛发作持续时间”“胸痛发作频次”及胸闷、心悸、气短等症状,在治疗后积分均较治疗前降低,差异均有统计学意义(P<0.01);反映患者全身伴随症状主要表现的头晕乏力、失眠健忘、大便异常、腰膝酸软,在治疗后积分均较治疗前降低;多方位反映心缺血的主要指标是心电图运动负荷试验,包括“诱发阳性时间”“运动终止时间”“最大ST下降时间”“最大ST下降幅度”“ST恢复时间”,在治疗后均较治疗前得到改善,差异均有统计学意义(P<0.01)。结论国医大师路志正教授调理脾胃法用于稳定型劳力性心绞痛患者,明显改善了患者心肌缺血主要症状和全身伴随症状,明显改善了心肌缺血各项指标,为冠心病心绞痛的中医治疗提供了新思路新方法,有深入研究的意义和指导临床应用的价值。

Objective To observe the clinical efficacy of regulating the spleen and stomach proposed by Lu Zhizheng,a master of traditional Chinese medicine(TCM),for treating the patients with stable exertional angina pectoris.Methods Fifty-eight patients with stable exertional angina pectoris treated in the outpatient department of cardiology of Wangjing Hospital,China Academy of Chinese Medical Sciences from September 2004 to September 2005 were selected.The patients were treated with Tiaopi Yixin Prescription,a fixed TCM prescription that embodies Lu′s method of regulating the spleen and stomach,for 8 consecutive weeks.The clinical symptoms,electrocardiogram(ECG),and myocardial ischemi⁃a indexes such as the time to positive appearance,time to exercise termination,time of maximum ST decline,maximum ST decline,and time to ST recovery in the exercise ECG before and after treatment were determined.Results The degree of chest pain,duration of chest pain attack,frequency of chest pain attacks,chest tightness,palpitations,and shortness of breath representing the main clinical manifestations of stable exertional angina pectoris all decreased after treatment(P<0.01).The scores of main accompanying symptoms including dizziness,fatigue,insomnia,forgetfulness,abnormal stool,and soreness of waist and knees all reduced after treatment.The main indicators reflecting myocardial ischemia in the exercise ECG including the time to positive appearance,time to exercise termination,time of maximum ST decline,maximum ST de⁃cline,and time to ST recovery were all recovered after treatment(P<0.01).Conclusion The TCM master Lu Zhizheng adopts the method of regulating the spleen and stomach for treating the patients with stable exertional angina pectoris.The method significantly alleviated the main symptoms and systemic accompanying symptoms of myocardial ischemia and recov⁃ered the indicators of myocardial ischemia.It provides a new idea for the TCM treatment of angina pectoris of coronary heart disease and has the significance of in-depth research and the value of guiding clinical practice.