加味大补心汤联合西药治疗冠心病合并室性早搏临床研究

Clinical Study on Modified Dabuxin Decoction Combined with Western Medicine for Coronary Heart Disease Complicated with Ventricular Premature Beat

目的:观察加味大补心汤联合西药治疗冠心病合并室性早搏的临床疗效。方法:采用随机数字表法将90例冠心病合并室性早搏患者分为对照组与试验组各45例。对照组给予西药治疗,试验组在对照组治疗基础上联用加味大补心汤治疗,2组均连续治疗4周。比较2组治疗前后中医证候评分及血清血管紧张素Ⅱ(AngⅡ)、肌酸激酶同工酶(CK-MB)、N-末端B型利钠肽原(NT-proBNP)水平;比较2组治疗前后室性早搏次数、短阵室速次数、室性早搏二联律数目及震荡斜率(TS)、震荡起始(TO)值;比较2组治疗前后左室舒张期平均能量损耗(EL-ave)、左室收缩末期容积(LVESV)、左室心肌质量指数(LVMI)、冠状动脉血流储备(CFR)、循环抵抗指数(IMR)、周围阻力(Rp-V)、平均血流量(Qmean),评估2组临床疗效及不良反应发生情况。结果:试验组总有效率97.78%,高于对照组82.22%(P<0.05)。治疗后,2组血清AngⅡ、CK-MB、NT-proBNP水平及TO值、室性早搏次数、短阵室速次数、室性早搏二联律数目、LVMI、LVESV、Rp-V、中医证候评分均较治疗前降低(P<0.05),且试验组治疗后上述指标低于对照组(P<0.05);2组治疗后TS值及EL-ave、Qmean、CFR、IMR水平均较治疗前升高(P<0.05),试验组治疗后TS值及EL-ave、Qmean、CFR、IMR水平均高于对照组(P<0.05)。2组均无不良反应发生。结论:加味大补心汤联合西药治疗冠心病合并室性早搏疗效确切,能够减少患者室性早搏发作次数,改善心率震荡及左室结构重构,调节冠脉微循环,安全性较高。

Objective:To observe the clinical effect of Modified Dabuxin Decoction combined with western medicine for coronary heart disease complicated with ventricular premature beat.Methods:A total of 90 patients with coronary heart disease complicated with ventricular premature beat were divided into the control group and the trial group according to the random number table method,with 45 cases in each group.The control group was given western medicine treatment,and the trial group was additionally treated with Modified Dabuxin Decoction based on the treatment of the control group.Both groups were treated continuously for 4 weeks.Traditional Chinese medicine(TCM)syndrome scores and levels of angiotensinⅡ(AngⅡ),creatine kinase-MB(CK-MB),and N-terminal pro-brain natriuretic peptide(NTproBNP)in serum were compared before and after treatment between the two groups.The numbers of ventricular premature beats,nonsustained ventricular tachycardia and bigeminy of ventricular prematurebeat,and the values of turbulence slope(TS)and turbulence onset(TO)were compared before and after treatment between the two groups.The average energy loss(EL-ave),left ventricular end systolic volume(LVESV),left ventricular myocardial mass index(LVMI),coronary flow reserve(CFR),index of microvascular resistance(IMR),resistance peripheral-V(Rp-V),and mean blood flow(Qmean)were compared before and after treatment between two groups.The clinical effects and incidence of adverse reactions were evaluated in the two groups.Results:The total effective rate was 97.78%in the trial group,higher than that of 82.22%in the control group(P<0.05).After treatment,Ang II,CK-MB and NT-proBNP in serum,TO values,the number of ventricular premature beats,nonsustained ventricular tachycardia and bigeminy of ventricular prematurebeat,LVMI,LVESV,Rp-V,and TCM syndrome scores in the two groups were decreased when compared with those before treatment(P<0.05),and the above indexes in the trial group were lower than those in the control group(P<0.05).After treatment,the TS values and levels of EL-ave,Qmean,CFR and IMR in the two groups were increased when compared with those before treatment(P<0.05),and the TS value and levels of EL-ave,Qmean,CFR and IMR in the trial group were higher than those in the control group(P<0.05).No adverse reaction occurred in the two groups.Conclusion:Modified Dabuxin Decoction combined with western medicine has a definite therapeutic effect on coronary heart disease complicated with ventricular premature beat,which can reduce the number of ventricular premature beats in patients,improve heart rate turbulence and left ventricular structural remodeling,regulate coronary microcirculation,and have high safety.