本文選題：祝氏降糖方 + 氣陰兩虛��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的旨在通過(guò)運(yùn)用祝氏降糖方加味聯(lián)合單硝酸異山梨酯片治療氣陰兩虛夾瘀型2型糖尿病性冠心病患者,觀察其最終臨床療效、中醫(yī)癥候、客觀臨床指標(biāo)以及安全性。方法在2015年10月至2016年10月就診于武漢市第一醫(yī)院內(nèi)分泌科門(mén)診及病房的患者,參照中西醫(yī)的診斷標(biāo)準(zhǔn),將符合要求的60例確診為2型糖尿病性冠心病(氣陰兩虛夾瘀型)的患者隨機(jī)分為2組,每組患者占30例。所有受試者均給予降糖、調(diào)脂及降壓等基礎(chǔ)治療,對(duì)照組在維持基礎(chǔ)治療同時(shí),加用單硝酸異山梨酯片(20mg/次,2次/日,口服);而治療組在對(duì)照組治療基礎(chǔ)上聯(lián)用中藥祝氏降糖方加味,由藥房統(tǒng)一代煎,每天一付,每付兩袋,各150ml,早、晚飯后半小時(shí)溫服。治療期12周。記錄兩組治療前后觀察指標(biāo)的變化情況。結(jié)果⑴治療組的總有效率82.1%,對(duì)照組總有效率48.1%,兩組相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);⑵治治療后兩組臨床癥狀較治療前均有所改善(P0.05),且治療組改善更加明顯(P0.05),特別在心胸疼痛、口渴喜飲、心悸失眠、倦怠乏力等癥狀上改善更加明顯;⑶兩組治療前證候總積分比較無(wú)顯著差異(P0.05);兩組治療后證候總積分與治療前比較均有差異(P0.05),且治療后兩組間比較積分有差異(P0.05);⑷治療前兩組FBG、2h PG、Hb A1c比較均無(wú)顯著差異(P0.05);治療后兩組各自組內(nèi)FBG、2h PG、Hb A1c比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),治療后組間比較,治療組較對(duì)照組改善明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05);⑸治療前兩組血脂比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);治療后組內(nèi)比較,血脂除HDL-C外,均有顯著差異(P0.05),治療后兩組間LDL-C比較,有統(tǒng)計(jì)學(xué)差異(P0.05),組間TC、TG、HDL-C比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);⑹兩組治療前BP、BMI、CRP比較無(wú)顯著差異(P0.05),治療后組內(nèi)比較BP、BMI、CRP,有顯著差異(P0.05),治療后組間BP、BMI比較無(wú)顯著差異(P0.05),但治療后組間CRP比較,有顯著差異(P0.05);⑺治療前,兩組間血液流變學(xué)指標(biāo)進(jìn)行比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療后,兩組血流變指標(biāo)與治療前比較,有顯著差異(P0.05);治療后兩組間血流變指標(biāo)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);⑻治療后兩組間心電圖總有效率相比較,具有顯著差異(P0.05);⑼治療前兩組間E/A、EF、SV、室間隔厚度、主動(dòng)脈內(nèi)徑比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組治療前后E/A比值,射血分?jǐn)?shù)(EF)、每搏輸出量(SV)均顯著升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后兩組間E/A、EF、SV比較,有顯著差異(P0.05),兩組治療前后室間隔厚度、主動(dòng)脈內(nèi)徑均無(wú)顯著性差異(P0.05),且治療后組間比較也無(wú)差異(P0.05);⑽兩組患者在治療階段都沒(méi)有出現(xiàn)明顯的不良反應(yīng),生命體征平穩(wěn),血常規(guī)、尿常規(guī)、大便常規(guī)、肝腎功能等安全性指標(biāo)均未見(jiàn)明顯異常。治療組出現(xiàn)頭痛、頭暈2例,面紅2例,對(duì)照組出現(xiàn)3例頭暈、頭痛,面紅2例,均可耐受。兩組患者均未出現(xiàn)其他嚴(yán)重并發(fā)癥、終末事件,完成了整個(gè)實(shí)驗(yàn)。結(jié)論通過(guò)運(yùn)用祝氏降糖方加味聯(lián)合單硝酸異山梨酯片治療氣陰兩虛夾瘀型2型糖尿病性冠心病患者,不僅可以顯著提高治療的總有效率,降低患者的中醫(yī)證候總積分,改善患者的中醫(yī)臨床癥狀,而且能夠更好地改善患者血糖、血液流變學(xué)、心功能等水平,但在血脂、血壓、體重指數(shù)、心肌缺血指標(biāo)方面未見(jiàn)明顯優(yōu)勢(shì)。與單用西藥治療相比,未有不良反應(yīng)等,安全性較高,在臨床治療2型糖尿病性冠心病中值得推廣。
[Abstract]:Objective To observe the final clinical efficacy, TCM syndrome, objective clinical index and safety in the treatment of patients with type 2 diabetic coronary heart disease with two deficiency of Qi and Yin and stagnation of stasis type 2 diabetic coronary heart disease by using Zhu's Jiangtang recipe. Methods from October 2015 to October 2016 were diagnosed in the Department of endocrinology of the Wuhan No.1 Hospital and the disease. 60 patients with type 2 diabetic coronary heart disease (Qi Yin deficiency and stasis type) were randomly divided into 2 groups according to the diagnostic criteria of Chinese and Western medicine. All the patients in each group accounted for 30 cases. All the subjects were given basic treatment, such as hypoglycemic, lipid and blood pressure lowering, and the control group was combined with isosorbide mononitrate at the same time with the maintenance of basic treatment. Tablets (20mg/ times, 2 times per day, oral), and the treatment group on the basis of the control group on the basis of the combination of Chinese medicine Zhu Shi Jiangtang prescription added, by the pharmacy unified decoction, one pay per day, two bags, each 150ml, early, after supper half an hour's warm clothes. The treatment period of 12 weeks before and after treatment. Results (1) the total effective rate of treatment group is 82.1%, (1) the total effective rate is 82.1%, and The total effective rate of the group was 48.1%, and the difference of the two groups was statistically significant (P0.05). After treatment, the clinical symptoms of the two groups were improved (P0.05), and the improvement of the treatment group was more obvious (P0.05), especially in the symptoms of heart pain, thirst and joy drink, palpitation and insomnia, fatigue and fatigue, and 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. The symptoms of the symptoms were more obvious in the heart pain, thirst and joy drink, palpitation, insomnia, fatigue and fatigue; 3. 3. 3. 3. 3. 3. 3. There was no significant difference (P0.05) in the total score of the two groups after treatment (P0.05), and there was a difference (P0.05) between the two groups after the treatment (P0.05). (4) there was no significant difference between the two groups of FBG, 2h PG and Hb A1c before treatment (P0.05), and the difference was statistically significant in the two groups of FBG, 2h PG. After treatment, compared with the control group, the treatment group was significantly better than the control group (P0.05). There was no statistical difference between the two groups before the treatment (P0.05). After the treatment, there were significant differences (P0.05) in the blood lipid except HDL-C (P0.05), and there was a statistical difference between the groups after the treatment (P0.05), and the difference of TC, TG, HDL-C in the group was the difference. There was no significant difference (P0.05). There was no significant difference in BP, BMI and CRP before treatment (P0.05). There were significant differences (P0.05) in BP, BMI, CRP in the group after treatment (P0.05). There was no significant difference between the two groups after treatment (P0.05), but there was a significant difference between the groups after treatment (P0.05), but the blood rheology indexes were compared between the two groups before treatment. There was no statistical significance (P0.05). After treatment, the blood rheology index of the two groups was significantly different from that before treatment (P0.05). The blood rheology indexes of the two groups after treatment were statistically significant (P0.05). The total electrocardiogram rate of the two groups after treatment was significantly different (P0.05); E/A, EF, SV, interventricular septum thickness between the groups before the treatment were of the thickness, There was no significant difference in the aortic diameter (P0.05). The E/A ratio, the ejection fraction (EF) and the output of SV were significantly increased in the two groups, and the difference was statistically significant (P0.05). There were significant differences (P0.05) between the two groups after treatment (P0.05). There was no significant difference in the thickness of the interventricular septum between the two groups before and after treatment (P0.05, P0.05). There were no significant adverse reactions between the two groups. The two groups had no obvious adverse reactions in the treatment stage, the signs of life were stable, blood routine, urine routine, routine stool, liver and kidney function and other safety indexes were not obvious abnormality. The treatment group had head pain, dizziness in 2 cases, 2 cases of face red, and 3 cases of dizziness, headache, and face in the control group. 2 cases in red were well tolerated. No other serious complications were found in the two groups. The whole experiment was completed. Conclusion by using Zhu's Jiangtang recipe combined with Isosorbide Mononitrate Tablets to treat patients with type 2 diabetic coronary heart disease with two deficiency of Qi and Yin, not only can the total effective rate of treatment be improved and the patients' traditional Chinese medicine can be reduced. The total score of syndrome can improve the clinical symptoms of Chinese medicine and improve the blood sugar, Hemorrheology and cardiac function of patients, but it has no obvious advantages in blood lipid, blood pressure, body mass index and myocardial ischemia. Compared with the treatment of Western medicine alone, there is no adverse reaction, the safety is higher, and the clinical treatment of type 2 diabetes is very high. It is worth popularizing in coronary heart disease.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R541.4

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