本文關(guān)鍵詞：軟堅通脈湯對PCI術(shù)后Ⅲ期康復(fù)患者心臟標(biāo)志物及生活質(zhì)量研究　出處：《北京中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

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【摘要】：目的：1.對目前冠心病PCI術(shù)后患者的整體情況進(jìn)行摸底,結(jié)合《冠心病康復(fù)與二級預(yù)防中國專家共識》,重點調(diào)查PCI術(shù)后患者的生活方式、危險因素控制及生活質(zhì)量情況,找出目前存在的問題。2.初步觀察軟堅通脈湯對冠心病PCI術(shù)后Ⅲ期心臟康復(fù)患者的療效,并從炎癥及纖維化角度對其作用機(jī)制進(jìn)行初步探討；探索在現(xiàn)有條件下,采取家庭為基礎(chǔ)的心臟康復(fù)配合中藥處方作為PCI術(shù)后心臟康復(fù)形式的可行性。方法：1.采用問卷調(diào)查的方法,對2015年1月至2016年1月期間在我院心血管內(nèi)科門診、住院的PCI術(shù)后患者進(jìn)行調(diào)查,采集患者的基本信息、生活方式、危險因素控制等情況,采用《中國心血管病人生活質(zhì)量問卷(CQQC問卷)》對患者生活質(zhì)量進(jìn)行評價。2.采用隨機(jī)對照試驗的方法,納入2015年1月至2016年1月在我院心血管內(nèi)科門診PCI術(shù)后Ⅲ期心臟康復(fù)患者,隨機(jī)分為對照組和治療組,對照組給予有充分循證證據(jù)的冠心病二級預(yù)防用藥,治療組在對照組的基礎(chǔ)上加用軟堅通脈湯,兩組均給予家庭康復(fù),療程8周。觀察軟堅通脈湯對PCI術(shù)后Ⅲ期心臟康復(fù)患者中醫(yī)癥狀、生活質(zhì)量的改善；對炎癥指標(biāo)IL-6、NF-α、hs-CRP,心衰標(biāo)志物Gal-3的影響。結(jié)果：1.問卷調(diào)查部分：(1)共納入患者132例(Ⅰ期27例,Ⅱ期17例,Ⅲ期88例),其中男性91例(68.9%),平均年齡61.02±8.89歲,女性41例(31.1%),平均年齡66.51+8.24歲,男性年齡明顯小于女性(t=-3.353,P=0.001),男女比例2.2：1。(2)心臟康復(fù)的知曉率極低：88.6%的患者表示從未聽說過心臟康復(fù),9.8%的患者聽說過心臟康復(fù),但不知道具體的涵義,132名患者中只有2名聽過并且知道心臟康復(fù)的內(nèi)容。(3)藥物使用：阿司匹林、p受體阻滯劑、ACEI/ARB.他汀類藥物的使用率分別為89.4%、76.5%、58.3%和94.7%。用藥依從性Morisky問卷得分4分的患者僅占48.57%,一半以上的患者或多或少的存在著不能規(guī)律服藥的問題。(4)多重危險因素控制情況：①血壓：按照130/80mmHg的標(biāo)準(zhǔn),達(dá)標(biāo)率為52.1%,按照140/90mmHg的標(biāo)準(zhǔn),達(dá)標(biāo)率為61.0%；②血糖：達(dá)標(biāo)率為55.2%；③血脂(LDL-C)：高危人群(70/132,53.0%)的達(dá)標(biāo)率為82.9%,極高危人群(62/132,47.0%)的達(dá)標(biāo)率為38.7%；④吸煙：有吸煙史的患者年齡非常顯著的小于無吸煙史的患者(60.0±8.9歲vs66.3+7.9歲；t=-4.2,P0.001),戒煙率62.2%(46/74),仍在吸煙者占比21.2%(28/132)；⑤體質(zhì)量：BMI的總達(dá)標(biāo)率為23.5%,男性達(dá)標(biāo)率19.8%,女性達(dá)標(biāo)率31.7%；腰圍的總達(dá)標(biāo)率為50.0%,男性達(dá)標(biāo)率37.4%,女性達(dá)標(biāo)率為78.0%；⑥運動：Ⅱ、Ⅲ期康復(fù)患者的運動頻率調(diào)查顯示,60.0%的患者3-5次／周,9.5%的患者1-2次／周,3.8%的患者1次/周,26.7%的患者沒有運動,近八成的患者運動形式局限于散步,運動的時間多集中在30～60分鐘。(5)中醫(yī)證候的調(diào)查結(jié)果發(fā)現(xiàn),PCI術(shù)后患者中血瘀證、氣虛證和痰濁證的比例分別為89.4%、60.6%、70.5%,其中氣虛證患者在Ⅰ期(29.6%)、Ⅱ期(58.8%)、Ⅲ期(70.5%)患者中的比例逐漸升高。(6)生活質(zhì)量：①PCI術(shù)后患者CQQC問卷得分為66.86+18.06分,其中男性平均得分70.16+18.34分,女性平均得分59.51+15.19,男性生活質(zhì)量顯著高于女性(t=3.249,P=0.001).②CQQC問卷得分與年齡呈顯著的負(fù)相關(guān)(r=-0.348,P0.001)。(7)生活質(zhì)量與中醫(yī)證候關(guān)系：①CQQC問卷得分與氣虛證積分呈負(fù)相關(guān)(Kendall相關(guān)系數(shù)=-0.317,P0.001；Spearman相關(guān)系數(shù)=-0.425,P0.001)；②CQQC問卷得分與痰濁證積分也呈負(fù)相關(guān)(Kendall相關(guān)系數(shù)=-0.208,P=0.001；Spearman相關(guān)系數(shù)=-0.284,P=0.001)；③氣虛證患者CQQC問卷得分明顯低于非氣虛證患者(62.31±17.85vs73.85±16.18:t=.3.762,P0.001).2.隨機(jī)對照試驗：(1)試驗共納入患者62例,失訪3例,隨訪期間服用其他中藥患者1例,主動退出試驗2例,最后納入分析56例,治療組和對照組各28例。(2)中醫(yī)證候改善有效率：治療組的總有效率為78.6%,明顯高于對照組的總有效率46.4%。(3)炎癥因子：①組內(nèi)比較,治療后hs-CRP水平無論在治療組(P=0.0040.01)還是對照組(P=0.0160.05)均較治療前出現(xiàn)了降低,但治療后兩組之間差異無統(tǒng)計學(xué)意義(P=0.8050.05)；②與hs-CRP結(jié)果一致,組內(nèi)比較,治療后IL-6水平無論在治療組(P=0.0010.01)還是對照組(P=0.0070.01)都較治療前出現(xiàn)了降低,但治療后兩組之間差異無統(tǒng)計學(xué)意義(P=0.7510.05);③TNF-α水平在兩組治療前后均沒有出現(xiàn)顯著差異。(4)心衰指標(biāo)：治療組在治療后出現(xiàn)了GaL-3水平顯著的下降,由3.93±0.29ng/ml下降到3.66±0.33ng/ml (P=0.0040.01),而對照組則治療前后無明顯變化(P=0.2030.05)；治療后兩組間差異無統(tǒng)計學(xué)意義(P=0.3300.05)。(5)生活質(zhì)量：①治療前后CQQC問卷得分比較,治療組和對照組均可以從病情、醫(yī)療狀況、一般生活和社會心理狀況四個維度上提高患者的生活質(zhì)量；②治療前后CQQC問卷得分差值比較,治療組對于患者體力狀況的改善優(yōu)于對照組(P=0.0060.01),因而更能有效提高患者的生活質(zhì)量(P=0.0070.01)；③經(jīng)過治療,70歲以上的高齡患者(11/56)生活質(zhì)量雖然有改善趨勢,但無論治療組(P=0.2170.05)還是對照組(P=0.2460.05)治療前后CQQC問卷得分并未呈現(xiàn)出統(tǒng)計學(xué)意義。結(jié)論：1.PCI術(shù)后患者普遍缺乏系統(tǒng)和全面的健康管理,對于心臟康復(fù)的知曉度極低,在用藥規(guī)范性和依從性方面有待提高,在戒煙、血壓、血脂、血糖、體質(zhì)量的達(dá)標(biāo)率等方面亦不令人滿意,氣虛證和痰濁證的程度的加重顯著降低了患者的生活質(zhì)量。2.經(jīng)過康復(fù)教育、規(guī)范的循證用藥及生活方式調(diào)整等強(qiáng)化管理措施后,PCI術(shù)后Ⅲ期康復(fù)患者在中醫(yī)癥狀、生活質(zhì)量、部分炎性因子(hs-CRP、IL-6)等方面均得到改善；與單純西醫(yī)治療比較,加用中藥軟堅通脈湯后,患者的癥狀和生活質(zhì)量改善更為明顯,提示在PCI術(shù)后Ⅲ期康復(fù)方案中加用中藥軟堅通脈湯可以提高康復(fù)療效。3. 軟堅通脈湯可能通過下調(diào)GaL-3的表達(dá)而在早期延緩心衰的進(jìn)展,值得擴(kuò)大樣本量、延長隨訪時間,進(jìn)行進(jìn)一步研究。
[Abstract]:Objective: 1. to the present situation of patients with coronary heart disease after PCI thoroughly, combined with the "two grade prevention rehabilitation of coronary heart disease and Chinese expert consensus >, focused on the investigation of patients after PCI lifestyle risk factors control and quality of life, to find out the current problems of the.2. preliminary observation of Ruanjian Tongmai Decoction on the curative effect of the patients phase III cardiac rehabilitation after PCI with coronary heart disease, and to explore its mechanism from the perspective of inflammation and fibrosis; explore under the existing conditions, take home based cardiac rehabilitation combined with traditional Chinese medicine prescription for PCI postoperative cardiac rehabilitation. Methods: 1. forms of the feasibility of using the method of questionnaire survey from January 2015 to January 2016 during the cardiovascular clinic of our hospital, the hospital after PCI patients were investigated, the basic information collection, the lifestyle of the patients, the risk factors of control, using the < Chinese effort Pipe the quality of life of patients (CQQC questionnaire) questionnaire > evaluation method of.2. with randomized controlled trial of patients' quality of life, in January 2015 to January 2016 in our hospital cardiology clinic after PCI III cardiac rehabilitation patients were randomly divided into control group and treatment group, the control group was given sufficient evidence of coronary heart disease two preventive medication, the treatment group in the control group plus Tongmai Decoction with soft Kennedy, two groups were given family rehabilitation, treatment for 8 weeks. Observe Ruanjian Tongmai Decoction on PCI postoperative stage of cardiac rehabilitation in patients with clinical symptoms, improve the quality of life; on the inflammatory indexes of IL-6, NF- alpha, hs-CRP, mark effect of Gal-3 heart failure. Results: a questionnaire survey of 1. parts: (1) a total of 132 patients were included (27 patients in stage I, 17 cases of stage II, III in 88 cases), including 91 cases of male (68.9%), mean age 61.02 + 8.89 years old, female 41 cases (31.1%), the average age of 66.51+8.24 years old, Male age was less than that of female (t=-3.353, P=0.001), 2.2:1. (2) and the proportion of cardiac rehabilitation awareness rate is extremely low: 88.6% of the patients had never heard of cardiac rehabilitation, 9.8% patients heard of cardiac rehabilitation, but do not know the specific meaning of the 132 patients, only 2 had heard and that of cardiac rehabilitation. (3) drug use: aspirin, P receptor blockers, statins use ACEI/ARB. rates were 89.4%, 76.5%, 58.3% and 94.7%. Morisky compliance questionnaire score of 4 patients accounted for 48.57%, more than half of the patients there are not regular medication (4) control problem. Multiple risk factors: blood pressure: according to 130/80mmHg standard, the standard rate of 52.1%, according to the 140/90mmHg standards, compliance rate was 61%; the blood sugar compliance rate was 55.2%; the blood lipid (LDL-C): the high-risk population (70/132,53.0%) The compliance rate was 82.9%, extremely high risk (62/132,47.0%) of the compliance rate was 38.7%; the smoking: smoking history in patients younger than significant smoking patients (60 + 8.9 vs66.3+7.9 years old; t=-4.2, P0.001), smoking rate was 62.2% (46/74), smokers accounted for 21.2% (28/132 the body mass:); the overall compliance rate of BMI is 23.5%, the male female compliance rate of 19.8%, compliance rate of 31.7%; the total compliance rate of 50% male waistline, compliance rate of 37.4%, the standard rate of 78% for women; the movement: II, survey frequency of exercise rehabilitation of patients with stage III, 60% patients / 3-5 times week, 9.5% of the patients 1-2 times per week, 3.8% of the patients 1 times per week, 26.7% of the patients did not exercise, nearly 80% of patients with movement is limited to walking, exercise time and more concentrated in 30~60 minutes. (5) the investigation of TCM syndromes were found after PCI in patients with blood stasis syndrome, Qi deficiency syndrome and Phlegm respectively 89.4%, 60.6%, 70.5%, the Qi deficiency in patients with stage I (29.6%), II (58.8%), III (70.5%) patients increased. (6) the quality of life of patients after PCI CQQC score 66.86+18.06 points, the average male score 70.16+18.34, female average score of 59.51+15.19, the quality of life is significantly higher in men than women (t=3.249, P=0.001). A significant negative correlation of CQQC questionnaire scores and age (r=-0.348, P0.001). (7) the relationship between quality of life and traditional Chinese medicine syndrome: the CQQC score was negatively correlated with Qi deficiency syndrome score (Kendall correlation coefficient =-0.317, P0.001; Spearman correlation coefficient =-0.425, P0.001); the CQQC score was negatively correlated with phlegm syndrome score (Kendall correlation coefficient =-0.208, P=0.001; Spearman correlation coefficient =-0.284, P=0.001); the patients with Qi deficiency syndrome CQQC score was significantly lower than that of qi deficiency Patients (62.31 + 17.85vs73.85 + 16.18:t=.3.762, P0.001).2. (1): a randomized controlled trial enrolled 62 patients, 3 cases were lost, 1 cases of other Chinese patients during the follow-up period, take the initiative to withdraw from the test in 2 cases, and 56 cases were included in the analysis, the treatment group and the control group of 28 cases (2). To improve the efficiency of TCM syndrome: the treatment group the total effective rate was 78.6%, significantly higher than the control group in the total efficiency of 46.4%. (3): comparison of inflammatory factors within the group, the levels of hs-CRP after treatment in treatment group (P=0.0040.01) and control group (P=0.0160.05) than before treatment decreased, but no significant the significance of differences between the two groups after treatment (P=0.8050.05); the results were consistent with hs-CRP, the comparison group, the levels of IL-6 after treatment in treatment group (P=0.0010.01) and control group (P=0.0070.01) than before treatment decreased, but there was no significant difference between the two groups after treatment ( P=0.7510.05); the levels of TNF- in two groups before and after treatment were not significantly different. (4) heart failure index: the treatment group after treatment appeared GaL-3 level was significantly decreased, decreased from 3.93 + 0.29ng/ml to 3.66 + 0.33ng/ml (P=0.0040.01), while the control group had no obvious change before and after treatment (P=0.2030.05); no statistically significant differences between the two groups after treatment (P=0.3300.05). (5) the quality of life: a comparison of CQQC scores of before and after treatment, the treatment group and control group were from illness, medical condition, general life and social psychology in four dimensions on improving the quality of life of patients; comparison of CQQC score difference before and after therapy, the treatment group were better than those for the physical condition of patients in control group (P=0.0060.01), so it can effectively improve the patient's quality of life (P=0.0070.01); the after treatment, elderly patients over the age of 70 (11/56) quality of life Although the improvement trend, but in both the treatment group (P=0.2170.05) and control group (P=0.2460.05) before and after treatment, CQQC scores showed no statistical significance. Conclusion: 1.PCI patients generally lack of systematic and comprehensive health management, for cardiac rehabilitation awareness is very low, needs to be improved, in the drug regulatory and compliance aspects in the smoking, blood pressure, blood lipid, blood glucose, body quality compliance rate is not satisfactory, aggravation of qi deficiency and phlegm turbid syndrome had significantly lower levels of the quality of life of patients after.2. rehabilitation education, standardized evidence-based medication and lifestyle adjustment measures to strengthen management, rehabilitation of postoperative patients with PCI III in the period of TCM symptoms, quality of life, some inflammatory factors (hs-CRP, IL-6) and other aspects were improved; compared with the pure western medicine treatment, the use of traditional Chinese medicine Ruanjian Tongmai Decoction after the symptoms and improve the quality of life More significantly, suggesting that PCI in postoperative rehabilitation programs in phase III combined with traditional Chinese medicine Ruanjian Tongmai Decoction can improve the curative effect of rehabilitation on.3. Ruanjian Tongmai Decoction could downregulate the expression of GaL-3 in the early and delayed heart failure, is worthy of a larger sample with increasing duration of follow-up for further research.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R259

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6 李彥州;杜麗蘋;溫志國;李曉建;趙松峰;胡靈;梁德安;;丹參通脈湯對血瘀型下肢動脈硬化閉塞癥介入術(shù)后療效的影響[A];中華中醫(yī)藥學(xué)會周圍血管病分會第四屆學(xué)術(shù)大會暨中華中醫(yī)藥學(xué)會周圍血管病分會25年會慶論文集[C];2011年

7 侯玉芬;馬春媚;;消栓通脈湯治療下肢深靜脈血栓形成的臨床研究[A];中華中醫(yī)藥學(xué)會周圍血管病分會第四屆學(xué)術(shù)大會暨中華中醫(yī)藥學(xué)會周圍血管病分會25年會慶論文集[C];2011年

8 羅新民;;益心通脈湯治療冠心病66例臨床報道[A];心腦病藥物臨床評價專家談[C];1998年

9 孫明;張娟;周宏研;;動脈粥樣硬化中氧化應(yīng)激及血管平滑肌增殖及通脈湯的影響[A];中華醫(yī)學(xué)會心血管病分會第八次全國心血管病學(xué)術(shù)會議匯編[C];2004年

10 李彤;方強(qiáng);吳曉梁;;通脈湯含藥血清對缺氧心肌線粒體和丙酮酸脫氫酶的影響[A];2004年浙江省危重病學(xué)學(xué)術(shù)年會論文匯編[C];2004年

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