益气养阴化瘀汤对冠心病经皮冠状动脉介入治疗术后患者心功能和血管内皮功能的影响

Effects of self-made Yiqi Yangyin Huayu Decoction on postoperative cardiac function and vascular endothelial function in patients with coronary heart disease underwent percutaneous coronary intervention

目的观察益气养阴化瘀汤对冠心病经皮冠状动脉介入治疗(PCI)术后患者心功能及血管内皮功能的影响。方法将62例冠心病PCI术后患者按照随机数字表法分为2组。对照组31例予常规抗血小板聚集、稳定斑块等药物治疗,治疗组31例在对照组治疗基础上加用益气养阴化瘀汤治疗,均治疗4周。比较2组治疗前后中医症状评分、血管内皮功能[血清一氧化氮(NO)、血管内皮生长因子(VEGF)、内皮素-1(ET-1)]、心功能[心脏每搏输出量(SV)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室收缩末期容积(LVESV)]、血液流变学指标[全血黏度(CP)、血浆黏度(PV)、红细胞比容(Hct)及红细胞聚集指数(AI)]变化,并比较2组心绞痛疗效和不良事件发生率。结果治疗后,2组中医症状胸闷疼痛、心悸盗汗、五心烦热及失眠多梦评分及总分均较本组治疗前下降(P<0.05),且治疗组均低于对照组(P<0.05)。治疗后,2组NO及VEGF水平均较本组治疗前上升(P<0.05),且治疗组高于对照组(P<0.05);治疗后,2组ET-1水平均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组LVEF及SV均较本组治疗前上升(P<0.05),且治疗组高于对照组(P<0.05);治疗后,2组LVEDD、LVESD及LVESV均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组CP、PV、Hct及AI水平均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗组心绞痛疗效总有效率为87.10%(27/31),不良事件发生率6.45%(2/31),对照组分别为64.52%(20/31)、16.13%(5/31),治疗组心绞痛疗效总有效率高于对照组(P<0.05),2组不良事件发生率比较差异无统计学意义(P>0.05)。结论益气养阴化瘀汤可有效改善冠心病PCI术后患者心功能和血管内皮功能,且未增加不良事件发生。

Objective To observe the effects of self-made Yiqi Yangyin Huayu Decoction on postoperative cardiac function and vascular endothelial function in patients with coronary heart disease(CHD)underwent percutaneous coronary intervention(PCI).Methods Sixty-two CHD patients underwent PCI were included as the research subjects,and they were randomly classified into control group(n=31)and treatment group(n=31).All patients were given routine drug treatment(drugs of anti-platelet aggregation and stabilize plaque),and those in the treatment group were additionally given self-made Yiqi Yangyin Huayu Decoction.A 4-week treatment was performed.The traditional Chinese medicine(TCM)symptoms scores,vascular endothelial function(serum nitric oxide[NO],vascular endothelial growth factor[VEGF],endothelin-1[ET-1]),cardiac function(stroke volume[SV],left ventricular ejection fraction[LVEF],left ventricular end-systolic volume[LVESV],left ventricular end-diastolic diameter[LVEDD],left ventricular end-systolic diameter[LVESD]),and hemorheological indicators(whole blood viscosity[WBV],plasma viscosity[PV],hematocrit[Hct]and erythrocyte aggregation index[AI])were compared between the two groups.The angina pectoris curative effect and the incidence of adverse events were assessed between the two groups.Results After treatment,the dimension scores and total scores of TCM symptoms(chest tightness and pain,palpitations and night sweats,five upsets and fever,and insomnia)in the both groups were significantly lower than those before treatment(P<0.05),and which in the treatment group were more lower relative to the control group(P<0.05).After treatment,the levels of NO and VEGF in both groups were significantly increased than those before treatment(P<0.05),but the levels of ET-1 in both groups were significantly decreased(P<0.05),and the improvements in the treatment group were more common compared to the control group(all P<0.05).After treatment,the levels of LVEF and SV in the both groups were significantly increased than those before treatment(P<0.05),while the levels of LVEDD,LVESD and LVESV were significantly decreased(P<0.05),and the treatment group was superior to the control group for the levels of LVEF,SV,LVEDD,LVESD and LVESV(all P<0.05).After treatment,the levels of WBV,PV,Hct and AI in both groups were significantly lower than those before treatment(P<0.05),and the decreases in the treatment group were more pronounced compared with the control group(P<0.05).The total effective rate of angina pectoris in the treatment group was significantly higher than that of the control group(87.10%[27/31]vs 64.52%[20/31],P<0.05),and there was no statistically significant difference in the incidence of adverse events between the treatment group and the control group(6.45%[2/31]vs 16.13%[5/31],P>0.05).Conclusion Self-made Yiqi Yangyin Huayu Decoction can effectively improve postoperative cardiac function and vascular endothelial function of CHD patients underwent PCI,and it does not increase the occurrence of adverse reactions.