本文選題：穩(wěn)定型心絞痛 + 生脈散瘀湯　； 參考：《山東中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:冠心病穩(wěn)定型心絞痛是危害人類健康的常見病,近年來發(fā)病率較前增加,且發(fā)病呈年輕化趨勢(shì)。本研究運(yùn)用中醫(yī)學(xué)理論,遵循中醫(yī)內(nèi)科疾病的辨治原則,研究益氣養(yǎng)陰活血法對(duì)冠狀動(dòng)脈粥樣硬化性心臟病穩(wěn)定型心絞痛中氣陰兩虛、血脈瘀阻證的療效及心率變異性的影響。方法:將符合納入標(biāo)準(zhǔn)的60例冠心病穩(wěn)定型心絞痛,氣陰兩虛、血脈瘀阻證患者隨機(jī)平均分為治療組和對(duì)照組。對(duì)照組30例給予常規(guī)藥物治療,即口服阿司匹林(拜阿司匹靈)100mg qd、琥珀酸美托洛爾緩釋片(倍他樂克)23.75mg qd、立普妥(阿托伐他汀鈣片)20mg qn及單硝酸異山梨酯片(欣康)20mg bid;治療組30例在常規(guī)藥物治療基礎(chǔ)上給予生脈散瘀湯(黨參30g丹參30g茯苓15g白術(shù)15g當(dāng)歸15g熟地黃30g五味子12g赤芍30g麥冬30g甘草6g)口服,在治療4周后分別記錄兩組受試者治療前后的動(dòng)態(tài)心電圖中所記錄之心率變異性指標(biāo),同時(shí)觀察兩組治療前后中醫(yī)癥候積分、中醫(yī)癥候療效、心絞痛癥狀積分、心絞痛療效及安全性指標(biāo)的差異。所有觀察指標(biāo)之結(jié)果均建立數(shù)據(jù)庫,使用“SPSS17.0”統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析處理。結(jié)果:在經(jīng)過4周的治療后,組內(nèi)對(duì)比,兩組治療后的心率變異性指標(biāo)(SDNN、r MSSD、p NN50)、中醫(yī)癥候積分、心絞痛癥狀積分明顯優(yōu)于治療前,差異有統(tǒng)計(jì)學(xué)意義(P0.05);在治療后,所統(tǒng)計(jì)治療組和對(duì)照組的心率變異性指標(biāo)(SDNN、r MSSD、p NN50)、中醫(yī)癥候積分、中醫(yī)癥候療效、心絞痛癥狀積分進(jìn)行組間對(duì)比,其差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療后治療組與對(duì)照組之心絞痛療效對(duì)比,兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05);所統(tǒng)計(jì)治療組和對(duì)照組在治療前的心率變異性指標(biāo)(SDNN、r MSSD、p NN50),其差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組安全性指標(biāo)治療前后對(duì)比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.生脈散瘀湯能明顯改善冠心病穩(wěn)定型心絞痛,氣陰兩虛、血脈瘀阻證患者的心絞痛臨床癥狀、中醫(yī)證候。2.生脈散瘀湯聯(lián)合琥珀酸美托洛爾緩釋片可進(jìn)一步改善冠心病心絞痛,氣陰兩虛、血脈瘀阻證患者的心率變異性指標(biāo)(SDNN、r MSSD、p NN50),改善患者的心臟自主神經(jīng)功能。3.冠心病心絞痛,證屬氣陰兩虛、血脈瘀阻證的患者在常規(guī)藥物治療的基礎(chǔ)上加用生脈散瘀湯可進(jìn)一步增加療效,生脈散瘀湯可起到較好的輔助作用,且安全性良好,亦印證了中西醫(yī)結(jié)合治療本病的優(yōu)勢(shì)。
[Abstract]:Objective: stable angina pectoris of coronary heart disease (CHD) is a common disease harmful to human health. Using the theory of traditional Chinese medicine (TCM) and following the principle of differentiation and treatment of internal diseases of traditional Chinese medicine, this study studied the effect of the method of supplementing qi and nourishing yin and activating blood circulation on the curative effect and heart rate variability in stable angina pectoris of coronary atherosclerotic heart disease. Methods: sixty patients with stable angina pectoris, deficiency of qi and yin, and blood stasis syndrome were randomly divided into treatment group and control group. The control group (30 cases) was treated with routine medicine. Oral aspirin (Beispirin 100mg QD, metoprolol succinate 23.75mg QD, Atto vastatin calcium 20mg QN and isosorbide mononitrate 20mg bid; treatment group: 30 patients) On the basis of treatment, Shengmai Sanyu decoction was given orally (Codonopsis 30g Salvia miltiorrhiza 30g Fuling 15g Danggui 15g Radix angelicae Sinensis 30g Radix Schisandrae 30g Radix Schisandrae 30g Rhizoma Ophiopogonis 30g Licorice 30g). After 4 weeks of treatment, the indexes of heart rate variability were recorded in the dynamic electrocardiogram of the two groups before and after treatment, and the scores of TCM symptoms, TCM symptoms and angina pectoris were observed before and after treatment. The difference of curative effect and safety index of angina pectoris. The results of all the observed indexes were analyzed by SPSS17.0 software. Results: after 4 weeks of treatment, the indexes of heart rate variability (HRV) of the two groups were compared. The scores of symptoms of TCM and angina pectoris were significantly better than those before treatment (P 0.05), and after treatment, the indexes of heart rate variability (HRV) of the two groups were significantly higher than that of before treatment (P 0.05), and the scores of symptoms of TCM and angina pectoris were significantly better than those before treatment. The indexes of heart rate variability (HRV) of the treatment group and the control group were compared between the two groups, including the score of TCM symptom, the curative effect of TCM symptom and the symptom score of angina pectoris. The difference was statistically significant (P 0.05); there was no significant difference between the treatment group and the control group in the effect of angina pectoris (P 0.05); the heart rate variability (HRV) of the treatment group and the control group before treatment was not significantly different from that of the control group (P 0.05). There was no significant difference in safety indexes between the two groups before and after treatment (P 0.05). Conclusion 1. Shengmai Sanyu decoction can obviously improve the clinical symptoms of angina pectoris in patients with stable angina pectoris of coronary heart disease, deficiency of qi and yin, and blood stasis syndrome. Shengmai Sanyu decoction combined with metoprolol succinate sustained release tablet can further improve the heart rate variability index of patients with angina pectoris, deficiency of qi and yin, blood vessel stasis syndrome, and improve cardiac autonomic nervous function. Coronary heart disease angina pectoris, syndrome of deficiency of qi and yin, blood vessel stasis syndrome patients can add Shengmai Sanyu decoction on the basis of routine drug treatment to further increase the curative effect, Shengmai Sanyu decoction can play a better auxiliary role, and the safety is good. Also confirmed the combination of traditional Chinese and Western medicine treatment of the advantages of this disease.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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