本文選題：介入術(shù)后 + 殘余病變心絞痛��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察冠心湯治療氣虛血瘀型冠心病介入術(shù)后殘余病變心絞痛的臨床療效及安全性,并初步探討其作用機(jī)制,為臨床使用冠心湯治療氣虛血瘀型冠心病介入術(shù)后殘余病變心絞痛提供可靠的證據(jù),為中醫(yī)臨床治療冠心病介入術(shù)后殘余病變心絞痛提供新的治療思路和方法。方法:選取2016年4月至2017年1月期間在徐州市中醫(yī)院心血管內(nèi)科治療的氣虛血瘀型冠心病介入術(shù)后殘余病變心絞痛患者60例。以隨機(jī)數(shù)字表法對(duì)60位患者進(jìn)行選擇分組,其中共有27位患者入對(duì)照組進(jìn)行觀察,該組患者在介入術(shù)后采用常規(guī)西藥治療(如以下藥物:阿司匹林、氯吡格雷、阿托伐他汀鈣、美托洛爾等)。33位患者入選冠心湯組進(jìn)行觀察,該組患者除予常規(guī)西藥治療之外加服用冠心湯。臨床觀察周期為3個(gè)月。療程結(jié)束以后,將兩組患者治療前后心絞痛程度分級(jí)、西雅圖心絞痛量表(SAQ)(見(jiàn)附錄一)、中醫(yī)證候積分療效(見(jiàn)附錄二)、生活質(zhì)量評(píng)分(SF-36)(見(jiàn)附錄三)、高密度脂蛋白、低密度脂蛋白、總膽固醇、超敏C反應(yīng)蛋白和安全性指標(biāo)的變化進(jìn)行比較。使用統(tǒng)計(jì)學(xué)軟件SPSS 20.0進(jìn)一步分析以上結(jié)果。結(jié)果:治療后兩組在西雅圖心絞痛量表、中醫(yī)證候積分療效、生活質(zhì)量評(píng)分等方面較治療前均有明顯改善,且冠心湯組相較對(duì)照組以上指標(biāo)改善尤為顯著(P0.05),治療后冠心湯組的中醫(yī)證候有效率較對(duì)照組更高,且差異顯著(P0.05);冠心湯組在心絞痛程度分級(jí)改善較為顯著(P0.05),對(duì)照組在心絞痛程度分級(jí)方面未見(jiàn)明顯改善(P0.05)。治療后兩組的超敏C反應(yīng)蛋白、總膽固醇、低密度脂蛋白等指標(biāo)均降低,高密度脂蛋白相比較治療前明顯上升,統(tǒng)計(jì)學(xué)上存在差異(P0.05);且兩組間的超敏C反應(yīng)蛋白、總膽固醇、低密度脂蛋白等指標(biāo)對(duì)比,冠心湯組各指標(biāo)降低更加顯著,統(tǒng)計(jì)學(xué)上有明顯區(qū)別(P0.05);治療后兩組的高密度脂蛋白相比較,組間無(wú)統(tǒng)計(jì)學(xué)差別(P0.05)。結(jié)論:冠心湯聯(lián)合西藥可以顯著改善氣虛血瘀型冠心病介入術(shù)后殘余病變心絞痛患者的臨床癥狀,降低心絞痛的發(fā)生率,降低炎癥反應(yīng),改善脂質(zhì)代謝,改善預(yù)后,無(wú)不良反應(yīng),具有相對(duì)良好的臨床安全性,因而可以廣泛進(jìn)行臨床推廣并加以使用。
[Abstract]:Objective: to observe the clinical efficacy and safety of Guanxin decoction in treating residual angina pectoris of coronary heart disease with deficiency of qi and blood stasis, and to explore its mechanism.To provide reliable evidence for clinical application of Guanxin decoction in treating residual angina pectoris of coronary heart disease with deficiency of qi and blood stasis after interventional operation, and to provide a new way of treatment for angina pectoris of residual disease after coronary intervention in TCM.Methods: from April 2016 to January 2017, 60 patients with residual angina pectoris of coronary heart disease with Qi deficiency and blood stasis were treated in Xuzhou Hospital of traditional Chinese Medicine from April 2016 to January 2017.Sixty patients were randomly divided into two groups. A total of 27 patients were observed in the control group. The patients were treated with routine western medicine (aspirin, clopidogrel, Atto vastatin calcium) after interventional surgery.Metoprolol et al. 33 patients were selected for observation in Guanxin decoction group.The clinical observation period was 3 months.After the course of treatment, the patients in the two groups were classified as angina pectoris before and after treatment, the Seattle angina scale (see appendix I), the curative effect of TCM syndromes score (see appendix II), quality of life score (see appendix III), high density lipoprotein (HDL),Changes of low density lipoprotein, total cholesterol, hypersensitive C reactive protein and safety index were compared.Statistical software SPSS 20.0 was used to further analyze the above results.Results: after treatment, the two groups in Seattle angina scale, TCM syndromes integral efficacy, quality of life score were significantly improved compared with before treatment.The improvement of above indexes in Guanxin decoction group was more significant than that in control group, and the effective rate of TCM syndromes in Guanxin decoction group was higher than that in control group after treatment.The difference was significant (P 0.05), and the improvement of angina pectoris grade in Guanxin decoction group was more significant than that in control group (P 0.05), but there was no significant improvement in angina pectoris grade in control group.After treatment, the hypersensitive C-reactive protein, total cholesterol and low density lipoprotein in the two groups were all decreased, the high density lipoprotein increased significantly before treatment, and there was statistical difference between the two groups (P 0.05), and the hypersensitive C-reactive protein between the two groups, total cholesterol,Compared with low density lipoprotein and other indexes, the index of Guanxin decoction group decreased more significantly, there was significant difference in statistics between the two groups, and there was no statistical difference between the two groups in terms of high density lipoprotein after treatment (P 0.05).Conclusion: Guanxin decoction combined with western medicine can significantly improve the clinical symptoms, reduce the incidence of angina pectoris, reduce inflammatory reaction, improve lipid metabolism and improve prognosis in patients with residual angina pectoris after intervention of coronary heart disease with Qi deficiency and blood stasis.No adverse reaction, relatively good clinical safety, so it can be widely used in clinical application.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.4

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