四逆加人参汤联合美托洛尔、胺碘酮治疗冠心病合并室性心律失常的临床研究

Clinical Study of Sini Jia Renshen Decoction Combined with Metoprolol and Amiodarone in the Treatment of Coronary Heart Disease Complicated with Ventricular Arrhythmia

目的:探究四逆加人参汤联合美托洛尔、胺碘酮治疗冠心病合并室性心律失常的效果。方法:选择2022年4月—2024年4月在湖南中医药大学第一附属医院治疗的冠心病合并室性心律失常患者94例,随机分为两组。对照组(n=47)予以美托洛尔、胺碘酮治疗,观察组(n=47)在对照组基础上加四逆加人参汤治疗。对比两组临床疗效、左心室重构情况、细胞因子、心率变异性(HRV)、QT间期离散度(QTd)、炎症因子。结果:观察组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)均小于对照组,血管性血友病因子(vWF)、纤溶酶原激活物抑制剂-1(PAI-1)、内皮素-1(ET-1)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均低于对照组,QTd短于对照组,左室射血分数(LVEF)高于对照组,窦性心搏R-R间期标准差(SDNN)、每5分钟窦性心搏R-R间期平均值标准差(SDANN)、相邻窦性心搏R-R间期差值均方根(RMSSD)均长于对照组,差异均有统计学意义(P<0.05)。结论:四逆加人参汤联合美托洛尔、胺碘酮可改善冠心病合并室性心律失常患者左心室重构、HRV、QTd,作用机制可能与降低CRP、TNF-α、IL-6、vWF、PAI-1、ET-1有关。

Objective:To explore the effect of Sini Jia Renshen Decoction combined with Metoprolol and Amiodarone in the treatment of coronary heart disease complicated with ventricular arrhythmia.Method:A total of 94 patients with coronary heart disease complicated with ventricular arrhythmia treated in First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from April 2022 to April 2024 were randomly divided into two groups.The control group(n=47)was treated with Metoprolol and Amiodarone,and the observation group(n=47)was treated with Sini Jia Renshen Decoction on the basis of the control group.The clinical efficacy,left ventricular remodeling,cytokines,heart rate variability(HRV),QT dispersion(QTd)and inflammatory factors were compared between the two groups.Result:The total effective rate of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).After treatment,the left ventricular end-diastolic volume(LVEDV)and the left ventricular end-systolic volume(LVESV)in the observation group were smaller than those in the control group,von Willebrand factor(vWF),plasminogen activator inhibitor-1(PAI-1),endothelin-1(ET-1),C reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)were lower than those in the control group,QTd was shorter than that in the control group,left ventricular ejection fraction(LVEF)was higher than that in the control group,and the standard deviation of R-R intervals(SDNN),standard deviation of averaged means of five-minute R-R intervals(SDANN)and the root mean square of successive differences in R-R intervals(RMSSD)were longer than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Sini Jia Renshen Decoction combined with Metoprolol and Amiodarone can improve left ventricular remodeling,HRV and QTd in patients with coronary heart disease complicated with ventricular arrhythmia,and the mechanism may be related to the decrease of CRP,TNF-α,IL-6,vWF,PAI-1 and ET-1.