补阳还五汤联合坐位八段锦治疗冠心病搭桥术患者的临床疗效及对其心功能、炎症因子、应激指标的影响

Clinical Efficacy of Buyang Huanwu Decoction Combined with Sitting Ba-Duan-Jin in Treating Coronary Heart Disease Patients Undergoing Coronary Artery Bypass Grafting and Its Effects on Their Cardiac Function,Inflammatory Factors,and Stress Indexes

目的 观察补阳还五汤联合坐位八段锦治疗冠心病搭桥术患者的临床疗效及对其心功能、炎症因子、应激指标的影响。方法 选取2020年6月—2023年6月期间江苏省苏北人民医院心脏大血管外科收治的300例冠状动脉搭桥手术患者,采用随机数字表法分为对照组和试验组,每组各150例。对照组按常规处理,试验组在常规治疗方法基础上,予补阳还五汤联合坐位八段锦治疗,均治疗3周。观察比较两组患者临床疗效,治疗前后中医证候积分、心肌损伤标志物[氨基末端脑利钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)、心肌肌钙蛋白I(Cardiac troponin I,cTnI)、肌酸激酶同工酶(Creatine kinase isoenzymes,CK-MB)、肌红蛋白(Myoglobin,Mb)],心脏超声检查指标[左心室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)、左室射血分数(Left ventricular ejection fraction,LVEF)、心脏指数(Cardiac index,CI)]、炎性指标[超敏C反应蛋白(hypersensitive C-reactive proteinhs,CRP)、肿瘤坏死因子α(Tumour necrosis factor-α,TNF-α)]及应激指标[皮质醇(Cortisol,COR)、胱抑素C(Cystatin C,Cys C)]。结果 治疗后试验组临床总有效率92.00%(138/150)明显高于对照组81.33%(122/150),差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心肌损伤标志物NT-proBNP、cTnI及CK-MB含量均较治疗前明显降低,差异有统计学意义(P<0.05);且试验组心肌损伤标志物NT-proBNP、cTnI及CK-MB含量均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者LVEDD和LVEDV指标均较治疗前降低,LVEF和CI指标均较治疗前升高,差异有统计学意义(P<0.05);且试验组LVEDD和LVEDV指标均明显低于对照组,LVEF和CI指标均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者炎性指标hs-CRP、TNF-α含量均较治疗前降低,差异有统计学意义(P<0.05);且试验组炎性指标hs-CRP、TNF-α含量均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者应激指标COR、 CysC水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组应激指标COR、 CysC水平均明显低于对照组,差异有统计学意义(P<0.05)。结论 在常规西药治疗的基础上给予补阳还五汤联合坐位八段锦,可明显改善冠心病搭桥术患者心功能,减轻炎症及应激反应。

Objective Observation of the clinical efficacy of Buyang Huanwu decoction combined with Sitting Ba-Duan-Jin in treating patients undergoing coronary artery bypass grafting for coronary heart disease,and its effects on cardiac function,inflammatory factors,and stress indicators.Methods During the period from June 2020 to June 2023,300 patients undergoing coronary artery bypass grafting(CABG)admitted to the Cardiovascular Center Surgery at Northern Jiangsu People′s Hospital were selected as the research objects.They were divided into a control group and an experimental group using a random number table,with 150 cases in each group.The control group received conventional treatment,and the experimental group received Buyang Huanwu decoction combined with Sitting Ba-Duan-Jin based on conventional treatment,both treated for 3 weeks.The clinical efficacy of the two groups was observed and compared,as well as the following indicators were observed and compared before and after treatment:traditional Chinese medicine(TCM)syndrome scores,and myocardial injury markers[N-terminal pro-B-type natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),creatine kinase isoenzymes(CK-MB),myoglobin(Mb)],echocardiographic indicators[left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),cardiac index(CI)],Stress indicators[cortisol(COR),Cystatin C(Cys C)],inflammatory indexes[high-sensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)],and stress indicators[Cortisol(COR),Cystatin C(Cys C)].Results After the treatment,the total clinical effective rate in the experimental group was 92.00%(138/150),significantly higher than 81.33%(122/150)in the control group,with a statistically significant difference(P<0.05).After treatment,the TCM syndrome scores of patients in both groups decreased compared to before treatment,with a statistically significant difference(P<0.05);and the TCM syndrome scores in the experimental group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).After treatment,the levels of myocardial injury markers NT pro-BNP,cTnI,and CK-MB in both groups decreased significantly compared to before treatment,with a statistically significant difference(P<0.05);and the levels of NT pro-BNP,cTnI,and CK-MB in the experimental group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).After treatment,the levels of indicators LVEDD and LVEDV in both groups decreased compared to before treatment,while the levels of indicators LVEF and CI increased compared to before treatment,with a statistically significant difference(P<0.05);and the levels of LVEDD and LVEDV in the experimental group were significantly lower than those in the control group,while the levels of LVEF and CI were significantly higher than those in the control group,with a statistically significant difference(P<0.05).After treatment,the levels of inflammatory markers hs-CRP and TNF-α in both groups decreased compared to before treatment,with a statistically significant difference(P<0.05);the levels of hs-CRP and TNF-α in the experimental group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).After treatment,the levels of stress indicators COR and CysC in both groups decreased compared to before treatment,with a statistically significant difference(P<0.05);and the levels of COR and CysC in the experimental group were significantly lower than those in the control group(P<0.05),with a statistically significant difference(P<0.05).Conclusion Based on conventional Western medicine treatment,administering Buyang Huanwu decoction combined with Sitting Ba-Duan-Jin can significantly improve the cardiac function in coronary heart disease patients undergoing coronary artery bypass grafting,and alleviate inflammation and stress reaction.