本文選題：芪參益氣滴丸 + 心脈通貼散　； 參考：《南京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：冠心病是目前臨床上的常見病、多發(fā)病,近年來其死亡率不斷上升,2014年中國心血管病死亡(粗)率仍位居各病之首,高于腫瘤和其他疾病,嚴重損害了人民大眾的身心健康。冠心病常規(guī)的治療方法有藥物治療和手術(shù)治療,其中經(jīng)皮冠脈介入術(shù)(PCI)作為治療方法之一,因見效快,療效明確,受到大家一致的關(guān)注。但PCI仍然有很多問題不能解決,如PCI術(shù)后再狹窄,術(shù)后生活質(zhì)量未改善,心理狀態(tài)不平穩(wěn),心絞痛的復(fù)發(fā)等等,這些問題困擾著廣大醫(yī)師和患者。祖國醫(yī)學(xué)中沒有冠心病、PCI術(shù)后胸痛等名詞,根據(jù)其臨床癥狀和表現(xiàn),類似于中醫(yī)名詞"胸痹心痛"所指范疇。中醫(yī)的內(nèi)治法和外治法在幾千年的使用中挽救了無數(shù)人的生命。如今西醫(yī)在臨床上也面臨很多棘手甚至不能解決的問題,中醫(yī)一直倡導(dǎo)辨證論治,始終提倡把人作為一個整體,因此在很多治療方面可以很好的發(fā)揮其優(yōu)勢,和西醫(yī)學(xué)結(jié)合起來,取長補短,以減輕患者的病痛。目的一:對160例行PCI術(shù)的且中醫(yī)辨證為氣虛痰瘀的不穩(wěn)定型心絞痛患者進行研究,以觀察芪參益氣滴丸聯(lián)合心脈通貼散對冠心病PCI術(shù)后氣虛痰瘀型患者臨床療效。方法:選擇160例行PCI術(shù)的冠心病不穩(wěn)定型心絞痛患者,采用隨機數(shù)字表法分為對照組和治療組(A、B、C組),每組40例,四組均采用常規(guī)西藥治療,治療A組在對照組治療基礎(chǔ)上加用心脈通貼散;治療B組在對照組治療基礎(chǔ)上加用芪參益氣滴丸;C組在對照組治療基礎(chǔ)上加用芪參益氣滴丸1包3次/日及心脈通貼散穴位貼敷。療程共4周。觀察臨床療效、中醫(yī)癥候積分、凝血功能(PT、APTT、TT、FIB)、Hs-CRP、MPO、血脂(TC、LDL、LPA)和FFA等的變化。結(jié)果:1.四組心絞痛療效和中醫(yī)證候療效均有一定的改善,而治療組的總有效率高于對照組,尤其是顯效率更是明顯,四組比較有顯著性差異(P0.05),治療C組療效最佳。2.四組生活質(zhì)量均有改善,其中四組治療前后比較心絞痛穩(wěn)定狀態(tài)(AS)、心絞痛發(fā)作情況(AF)、治療滿意程度(TS)和疾病認知程度(DP)均有不同程度改善(P0.05,P0.01),而治療組在治療后AS、AF、TS、DP優(yōu)于同期對照組(P0.05),且C組優(yōu)于A組、B組(P0.05)。四組治療后心電圖及動態(tài)心電圖較治療前改善,其中治療組優(yōu)于對照組。四組治療后左室大小無明顯差異,但治療組射血分數(shù)優(yōu)于對照組。3.四組凝血功能均有改善,其中四組治療前后比較凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、凝血酶時間(TT)均有不同程度延長,但治療前后無明顯差異(P0.05);四組治療前后纖維蛋白原(FIB)均有明顯改善,有不同程度下降,而治療組在治療后優(yōu)于同期對照組(P0.05),且C組優(yōu)于A組、B組(P0.05)。4.四組患者治療前后血Hs-CRP和MPO水平均有不同程度降低(P0.05)。四組治療后比較,治療組血Hs-CRP和MPO水平明顯低于對照組(P0.05),且C組優(yōu)于A組、B組(P0.05)。四組在治療后比較,中西醫(yī)聯(lián)合治療后膽固醇(TC)、低密度脂蛋白(LDL)、脂蛋白a(LPA)、游離脂肪酸(FFA)的降幅也略優(yōu)于對照組。結(jié)論:心脈通貼散和芪參益氣滴丸不但具有改善不穩(wěn)定型心絞痛患者PCI術(shù)后的心絞痛療效及中醫(yī)癥候的作用,還具有改善凝血功能,降低血脂及不穩(wěn)定斑塊炎癥因子水平(Hs-CRP、MPO),提高患者生活質(zhì)量的作用。提示芪參益氣滴丸、心脈通貼散是防治不穩(wěn)定型心絞痛疾病的有效藥物,具有穩(wěn)定不穩(wěn)定性斑塊及抗炎的作用。其不良反應(yīng)少,值得臨床推廣。目的二:探討芪參益氣滴丸聯(lián)合心脈通貼散對缺血再灌注損傷大鼠的心功能、血流動力學(xué)、炎癥因子的影響。方法:對大鼠行冠脈結(jié)扎,繼則松開結(jié)扎線,使大鼠形成缺血再灌注損傷,然后分組予芪參益氣滴丸聯(lián)和心脈通貼散以及阿托伐他汀鈣治療4周。最后分別監(jiān)測各組的心臟彩超、血流動力學(xué)、心肌HE染色、NT-proBNP、CKMB、cTnI及炎癥因子Hs-CRP、MPO。結(jié)果:1.與模型組比較,芪參益氣滴丸聯(lián)合心脈通貼散組和阿托伐他汀組大鼠LVEDD、LVESD不同程度降低(P0.05),EF、FS及SV增加(P0.05)。2.與模型組比較,阿托伐他汀組和芪參益氣滴丸聯(lián)合心脈通貼散組大鼠MAP、LVDP、+dp/dtmax、-dp/dtmax顯著升高(P0.05),LVEDP及ST顯著降低(P0.05)。3.與假手術(shù)組比較,模型組、芪參益氣滴丸聯(lián)合心脈通貼散組和阿托伐他汀組血清NT-proBNP、Hs-CRP、MPO含量均明顯升高(P0.01)。與模型組比較,芪參益氣滴丸聯(lián)合心脈通貼散組和阿托伐他汀組血清NT-proBNP及Hs-CRP、MPO含量顯著性降低(P0.05)。
[Abstract]:Coronary heart disease (CHD) is a common disease in clinic. The mortality rate is increasing in recent years. In 2014, the death rate of cardiovascular disease in China is still the first in all diseases. It is higher than tumor and other diseases, which seriously damage the people's physical and mental health. The conventional treatment methods of coronary heart disease include drug treatment and surgical treatment, including percutaneous coronary intervention. PCI is one of the treatment methods, because of its quick effect and clear curative effect. But PCI still has many problems that can not be solved, such as restenosis after PCI, the quality of life is not improved after the operation, the mental state is not flat, the recurrence of angina pectoris, and so on. These problems have plagued the general doctors and patients. There is no coronal heart in Chinese medicine. Nouns such as disease and chest pain after PCI, according to their clinical symptoms and manifestations, are similar to the category of the Chinese medicine noun "chest pain and heart pain". The internal treatment and external treatment of traditional Chinese medicine have saved countless lives for thousands of years. Nowadays, western medicine is also faced with many difficult and incapable problems in clinical. Traditional Chinese medicine has always advocated syndrome differentiation and treatment. In the end, we advocate taking people as a whole, so they can give full play to their advantages in a lot of treatment, and combine with western medicine to relieve the pain of the patients. Objective: To study 160 cases of unstable angina pectoris with Qi deficiency and phlegm stasis in 160 cases, and to observe the combination of Qi Shen Yiqi dropping pills and heart pulse. The clinical effect of Tong tie powder on patients with Qi deficiency and phlegm stasis after PCI operation. Methods: 160 patients with unstable angina pectoris with PCI were selected and divided into control group and treatment group (A, B, C group), 40 cases in each group. The four groups were treated with conventional western medicine, and the A group was treated with the treatment of the control group. The treatment group B was treated with Qi Shen Yiqi dripping pill on the basis of the control group; group C was treated with 1 packs of Qi Shen Yiqi dropping pill 3 times / day and Xin Mai Tong pasting Acupoint Application on the basis of the control group. The clinical curative effect, TCM syndrome score, coagulation function (PT, APTT, TT, FIB), Hs-CRP, MPO, lipid (TC, LDL, LPA) and FFA and other changes were observed. Results: 1. The effect of four groups of angina pectoris and TCM syndrome were improved, and the total effective rate of the treatment group was higher than that of the control group, especially in the four groups (P0.05). The best quality of life of.2. four groups in the treatment group C was improved, of which four groups were compared with the stable state of angina pectoris (AS), angina pectoris before and after treatment. Seizures (AF), treatment satisfaction (TS) and disease cognition (DP) were improved (P0.05, P0.01) in different degrees (P0.05, P0.01), while AS, AF, TS, DP in the treatment group were better than those of the same group (P0.05) after treatment, and the C group was better than the A group. The four groups were better than the treatment group before treatment, and the treatment group was superior to the control group. The treatment group was better than the control group. There was no significant difference in the size of left ventricle after treatment, but the ejection fraction of the treatment group was better than that of the control group.3. four. Among the four groups, the prothrombin time (PT), the activated partial thromboplastin time (APTT) and the thrombin time (TT) were prolonged in different degrees, but there was no significant difference before and after treatment (P0.05); the four groups were treated before and after treatment. The fibrinogen (FIB) was obviously improved, and the treatment group was better than the control group (P0.05) after treatment, and the C group was better than the A group. The level of Hs-CRP and MPO in the group of group B (P0.05).4. four were reduced in varying degrees (P0.05). The four groups were compared with the control group. .05), and group C was superior to group A and group B (P0.05). The four groups were compared after treatment, and the decrease of cholesterol (TC), low density lipoprotein (LDL), lipoprotein a (LPA), and free fatty acid (FFA) was slightly better than that of the control group after the combination of Chinese and Western medicine. Conclusion: Xin Mai Tong paste and Qi Shen Yiqi dropping pills not only have angina pectoris after PCI operation in patients with unstable angina pectoris. The effect of curative effect and TCM syndrome also have the effect of improving the function of blood clotting, reducing the level of lipid and unstable plaque inflammatory factors (Hs-CRP, MPO), and improving the quality of life of the patients. It suggests that the Qi Shen Yiqi dropping pill is an effective drug to prevent and cure unstable angina pectoris, and it has the effect of stabilizing unstable plaque and anti inflammation. Objective two: To explore the effect of Qi Shen Yiqi dropping pill combined with Xin Mai Tong paste on the cardiac function, hemodynamics and inflammatory factors in rats with ischemia-reperfusion injury. Methods: the rats were ligated with coronary artery, then the ligation line was released to make the rats form the ischemia reperfusion injury, and then group to the Qi Shen Yiqi dropping pill. The treatment of cardiac color Doppler and atorvastatin calcium for 4 weeks. Finally, the cardiac color Doppler ultrasound, hemodynamics, myocardial HE staining, NT-proBNP, CKMB, cTnI and inflammatory factors Hs-CRP, MPO. results were measured respectively. 1. compared with the model group, Qi Shen Yiqi dropping pills combined with the heart Mai Tong paste group and atorvastatin group LVEDD, LVESD decreased in varying degrees (P0.). 05), EF, FS and SV increase (P0.05).2. compared with the model group, the Atorvastatin group and the Qi Shen Yiqi dropping pill combined with the heart Mai Tong paste group, the MAP, LVDP, +dp/dtmax, -dp/dtmax significantly increased (P0.05), LVEDP and ST significantly decreased, the model group, the Qi Shen Yiqi dropping pill combined with the heart Mai Tong paste group and the Atorvastatin group serum The content of NT-proBNP, Hs-CRP and MPO increased significantly (P0.01). Compared with the model group, the content of NT-proBNP and Hs-CRP in the serum of Qi Shen Yiqi dropping pills and the Atorvastatin group was significantly lower than that of the model group (P0.05).
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R541.4

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