本文選題：清熱活血法聯(lián)合益氣養(yǎng)陰法 + AMI�。� 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：研究目的：通過前瞻性觀察方法,觀察清熱活血法聯(lián)合益氣養(yǎng)陰法對(duì)急性心肌梗死患者PCI術(shù)后心功能的影響,為急性心肌梗死PCI術(shù)后的中醫(yī)藥防治提供參考依據(jù)。研究方法：選擇廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院2015年6月至2016年3月符合納入標(biāo)準(zhǔn)的患者100例,隨機(jī)分為單純西藥組(對(duì)照組),西藥+清熱活血湯組(試驗(yàn)1組),西藥+清熱活血湯+益心活血丸組(試驗(yàn)2組)。療程1月,重點(diǎn)觀察治療前后中醫(yī)證候積分、心功能評(píng)級(jí)、抽血指標(biāo)(BNP、ALT、AST、UREA、CREA)和超聲心動(dòng)圖(EF、LA、LVESD、LVEDD、E、A、E/A)的變化。研究結(jié)果：(1)嚴(yán)格遵循西醫(yī)的藥物治療方案能顯著改善急性心梗患者的的胸悶、胸痛、氣促等中醫(yī)證候,在此基礎(chǔ)上聯(lián)用清熱活血類中藥效果更佳,在西藥治療上,應(yīng)用清熱活血法聯(lián)合益氣養(yǎng)陰法,能進(jìn)一步降低中醫(yī)證候積分。(2)AMI患者PCI術(shù)后嚴(yán)格堅(jiān)持冠心病二級(jí)預(yù)防用藥方案能顯著提高急性心�；颊叩脑缙诘男墓δ芊旨�(jí),改善患者預(yù)后；短期內(nèi)使用清熱活血法或清熱活血法聯(lián)合益氣養(yǎng)陰法,于心功能無進(jìn)一步改善作用。(3)急性心肌梗死患者接受血運(yùn)重建后及接受西醫(yī)的藥物治療方案能降低血清BNP,可能與及時(shí)恢復(fù)血供,減少壞死心肌面積和抑制早期心室重構(gòu)有關(guān)。在此基礎(chǔ)上合用清熱活血中藥,血清BNP進(jìn)一步降低,再聯(lián)合益氣養(yǎng)陰法則效果進(jìn)一步增強(qiáng)。(4)本研究觀察以EF作為評(píng)價(jià)收縮功能的指標(biāo),以E、A、EA比作為評(píng)價(jià)心臟舒張功能的指標(biāo),研究結(jié)果提示,經(jīng)過1個(gè)月的規(guī)范西醫(yī)藥物治療,三組EF、E、E/A較治療前改善。但是E/A受流體力學(xué)影響較大,可能出現(xiàn)“假性正常化”現(xiàn)象,并不能完全反映AMI患者心臟的舒張功能,需要聯(lián)合S/D,TDI,Tei指數(shù)等才能較好的用于心臟舒張功能的評(píng)價(jià)。在接收規(guī)范西藥治療的基礎(chǔ)上,聯(lián)合清熱活血中藥則對(duì)心臟舒縮功能的改善更明顯；中醫(yī)使用清熱活血法聯(lián)合益氣養(yǎng)陰法干預(yù)則可以進(jìn)一步增強(qiáng)AMI患者PCI術(shù)后的心臟舒張功能。(5)本研究以LA和LVED作為評(píng)估心室重構(gòu)的指標(biāo),研究結(jié)果初步提示,AMI患者術(shù)后LA短期內(nèi)未見明顯變化,但總體呈現(xiàn)上升趨勢。術(shù)后患者的LVESD及LVEDD均有不同程度的增加,提示心肌發(fā)生急性梗死后出現(xiàn)心室重構(gòu),且心室重構(gòu)的發(fā)生不受血運(yùn)重建(溶栓、PCI、CABG)的影響。使用指南推薦藥物只能延緩其進(jìn)展的速度,極少能完全抑制甚至逆轉(zhuǎn)心室重構(gòu)的進(jìn)程。西藥聯(lián)合清熱活血中藥的療效與單純使用西藥相仿,但是在此基礎(chǔ)上再加用益心活血丸可以明顯抑制心室重構(gòu),提示急性心梗后心室重構(gòu)可能與心氣虧損,心腎陰精耗損有關(guān)。(6) ALT、UREA、CREA較治療前均無明顯上升,提示短時(shí)間內(nèi)接受冠心病二級(jí)預(yù)防的藥物、清熱活血中藥湯劑及益心活血丸的治療,不會(huì)對(duì)患者的肝腎功能造成影響,使用以上藥物治療AMI患者具有安全性。其中,益心活血丸成分包括何首烏,本實(shí)驗(yàn)側(cè)面證明短期內(nèi)按規(guī)定劑量服用何首烏制劑是安全的。AST較治療前明顯下降(p0.01)。AST是心肌酶學(xué)標(biāo)志物之一,本研究納入病例以12h之內(nèi)為多,大部分病例的AST已經(jīng)超過正常值甚至超過3倍以上,經(jīng)過治療,心梗病情經(jīng)已穩(wěn)定,故AST恢復(fù)到正常水平。(7)治療期間所有病例未出現(xiàn)任何不良反應(yīng)。結(jié)論：短期內(nèi)應(yīng)用清熱活血法聯(lián)合益氣養(yǎng)陰法能在西醫(yī)治療的療效基礎(chǔ)上進(jìn)一步降低血清BNP水平、促進(jìn)急性心肌梗死PCI術(shù)后患者心功能的恢復(fù),而且不損害肝、腎功能,服藥期間無明顯不良反應(yīng)。
[Abstract]:Objective: To observe the effect of clearing heat and activating blood method combined with Supplementing Qi and nourishing yin method on the cardiac function of patients with acute myocardial infarction after PCI, and to provide reference for the prevention and treatment of traditional Chinese medicine after PCI operation in acute myocardial infarction. The standard 100 patients were randomly divided into simple western medicine group (control group), western medicine + clearing heat Huoxue Decoction group (test 1 groups), western medicine + clearing heat Huoxue Soup + yigxin Huoxue pill group (test 2 groups). In January, the TCM syndrome score, cardiac function rating, blood pumping index (BNP, ALT, AST, UREA, CREA) and echocardiography (EF, LA, LVESD, LVED) were observed before and after treatment. D, E, A, E/A) changes. (1) strict compliance with western medicine treatment scheme can significantly improve the symptoms of acute myocardial infarction in patients with chest distress, chest pain, and shortness of breath. On this basis, the effect of combination of clearing heat and activating blood type Chinese medicine is better. In the treatment of Western medicine, the combination of clearing blood and blood activating and nourishing yin and nourishing Yin can further reduce TCM syndrome. (2) strict adherence to the two grade prevention of coronary heart disease after AMI patients can significantly improve the early cardiac function classification and improve the prognosis of patients with acute myocardial infarction. In the short term, the method of clearing heat and activating blood or clearing heat and activating blood and supplementing qi and nourishing Yin is used in the short term. (3) patients with acute myocardial infarction receive blood. The drug treatment program after reconstruction and receiving Western medicine can reduce the serum BNP, which may be related to the timely recovery of blood supply, reducing the area of necrotic myocardium and inhibiting the early ventricular remodeling. On the basis of this, the combination of traditional Chinese medicine of clearing heat and blood circulation, the decrease of serum BNP, and the effect of combined supplementing qi and nourishing Yin are further enhanced. (4) this study was evaluated with EF as the evaluation. The index of valence contraction function, using E, A, EA ratio as the index of evaluating cardiac diastolic function. The results suggest that after 1 months of standard western medicine treatment, the three groups of EF, E, E/A are better than before treatment. But E/A is affected by fluid mechanics, may appear "pseudonormalization" phenomenon, and can not completely reflect the heart diastolic function of AMI patients. The combination of S/D, TDI, Tei index and so on can be used to evaluate the cardiac diastolic function better. On the basis of receiving standard western medicine treatment, the combination of clearing heat and promoting blood circulation can improve the cardiac contractile and contraction function more obviously; the use of clearing heat and activating blood and nourishing yin and nourishing Yin can further enhance the heart comfort of AMI patients after PCI operation. (5) (5) this study uses LA and LVED as an indicator of ventricular remodeling. The results of the study suggest that there is no obvious change in LA in the short term after operation in AMI patients, but the overall increase trend. The postoperative LVESD and LVEDD have increased in varying degrees, suggesting ventricular remodeling after acute myocardial infarction and the occurrence of ventricular remodeling. It is not affected by blood revascularization (thrombolytic, PCI, CABG). The guide recommends that drugs can only slow down the speed of its progress and rarely completely inhibit or even reverse the process of ventricular remodeling. The curative effect of Western medicine combined with clearing heat and activating blood medicine is similar to that of Western medicine alone, but on this basis, the combined use of yyxin Huoxue pill can obviously inhibit ventricular remodeling. It is suggested that the ventricular remodeling after acute myocardial infarction may be related to the loss of heart gas and the loss of heart and kidney essence. (6) ALT, UREA, and CREA have no obvious increase compared with those before the treatment. It suggests that the treatment of two grade prevention of coronary heart disease in a short time, the treatment of traditional Chinese medicine decoction and Yixin Huoxue pill, can not affect the liver and kidney function of the patients, and use the treatment of the above drugs. AMI patients are safe. Among them, the ingredients of Yixin Huoxue pill include Polygonum multiflorum. The experimental side shows that the dosage of Polygonum multiflorum is a safe.AST in a short period of time compared with before treatment (P0.01).AST is one of the markers of myocardial enzyme. This study included more than 12h in the case, and the AST in most cases was more than normal. The value is even more than 3 times. After treatment, the condition of myocardial infarction is stable, so AST is restored to normal level. (7) there is no adverse reaction in all cases during the treatment. Conclusion: in the short term, the combination of clearing heat and activating blood and nourishing Yin can further reduce the level of serum BNP on the basis of the curative effect of Western medicine and promote the P of acute myocardial infarction. After CI, the cardiac function of the patients recovered, and the liver and kidney function were not damaged. No obvious adverse reactions were observed during the medication.
【學(xué)位授予單位】：廣州中醫(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

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳偉;彭銳;李榮;吳輝;黃衍壽;;清熱活血方治療冠心病急性心肌梗死60例臨床觀察[J];中醫(yī)雜志;2010年10期

2 姜泉;周新堯;王雷;余衛(wèi);汪平;曹煒;唐曉頗;;A One-year Evaluation of Radiographic Progression in Patients with Rheumatoid Arthritis Treated by Qingre Huoxue Decoction(清熱活血方)[J];Chinese Journal of Integrative Medicine;2012年04期

3 姜泉;李紀(jì)川;焦娟;陳立典;;清熱活血方藥對(duì)活動(dòng)期類風(fēng)濕關(guān)節(jié)炎患者生活質(zhì)量的影響[J];中國康復(fù);2012年02期

4 陳寬生;;清熱活血法治療2型糖尿病的療效觀察[J];中國醫(yī)藥指南;2013年01期

5 韓曉娜;;中藥清熱活血膠囊的制備工藝及臨床應(yīng)用的效果分析[J];大家健康(學(xué)術(shù)版);2013年10期

6 吳錦發(fā);;清熱活血法臨床應(yīng)用一得[J];福建中醫(yī)藥;1988年02期

7 鄭師碧，，鄭關(guān)毅，沈蕓;清熱活血法的臨床應(yīng)用[J];福建中醫(yī)藥;1994年02期

8 廖碧常;;清熱活血方治療冠心病急性心肌梗死療效分析[J];中國保健營養(yǎng);2012年06期

9 譚湘國;清熱活血滋腎法治療陽萎105例[J];實(shí)用中醫(yī)藥雜志;2001年10期

10 母小真;姜泉;史群;;應(yīng)用重復(fù)測量分析評(píng)價(jià)清熱活血法治療活動(dòng)期類風(fēng)濕關(guān)節(jié)炎的臨床研究[J];河北醫(yī)藥;2010年24期

相關(guān)會(huì)議論文 前10條

1 姜泉;李德平;曹煒;吳廣均;唐曉頗;李家t;康浩宸;高波;雷光;翟春紅;翟華強(qiáng);吳振宇;;基于骨免疫的清熱活血方藥“護(hù)骨”作用的機(jī)制研究[A];全國第十一屆中西醫(yī)結(jié)合風(fēng)濕病學(xué)術(shù)會(huì)議論文匯編[C];2013年

2 李德平;劉鵬霄;曹煒;;基于骨免疫的清熱活血方藥“護(hù)骨”作用的機(jī)制研究[A];第十一次中國中西醫(yī)結(jié)合實(shí)驗(yàn)醫(yī)學(xué)學(xué)術(shù)研討會(huì)論文匯編[C];2013年

3 姜泉;周新堯;王雷;余衛(wèi);汪平;唐曉頗;;清熱活血方藥治療類風(fēng)濕關(guān)節(jié)炎1年后雙手X線變化初步觀察[A];第十二屆中國科協(xié)年會(huì)22分會(huì)場——“中醫(yī)藥在重大公共衛(wèi)生事件中的地位和作用論壇”論文集[C];2010年

4 姜泉;周新堯;王雷;余衛(wèi);汪平;唐曉頗;;清熱活血方藥治療類風(fēng)濕關(guān)節(jié)炎1年后雙手X線變化初步觀察[A];經(jīng)濟(jì)發(fā)展方式轉(zhuǎn)變與自主創(chuàng)新——第十二屆中國科學(xué)技術(shù)協(xié)會(huì)年會(huì)（第三卷）[C];2010年

5 周新堯;王雷;余衛(wèi);姜泉;汪平;唐曉頗;;清熱活血方藥治療類風(fēng)濕關(guān)節(jié)炎1年后雙手X線變化初步觀察[A];中華中醫(yī)藥學(xué)會(huì)風(fēng)濕病分會(huì)2010年學(xué)術(shù)會(huì)論文集[C];2010年

6 王京文;王愛強(qiáng);喬碩;王飆;趙力;劉春林;吳增安;;運(yùn)用清熱活血的方法治療血栓外痔的臨床觀察[A];中醫(yī)肛腸理論與實(shí)踐——中華中醫(yī)藥學(xué)會(huì)肛腸分會(huì)成立三十周年紀(jì)念大會(huì)暨二零一零年中醫(yī)肛腸學(xué)術(shù)交流大會(huì)論文匯編[C];2010年

7 姜泉;石英杰;母小真;張鵬翔;曹煒;唐曉頗;焦娟;;清熱活血方藥治療活動(dòng)期類風(fēng)濕關(guān)節(jié)炎臨床療效研究[A];海峽兩岸中醫(yī)藥發(fā)展大會(huì)風(fēng)濕論文集[C];2009年

8 姜泉;石英杰;母小真;張鵬翔;曹煒;唐曉頗;焦娟;;清熱活血方藥治療活動(dòng)期類風(fēng)濕關(guān)節(jié)炎臨床療效研究[A];中醫(yī)藥中青年科技創(chuàng)新與成果展示論壇論文集[C];2009年

9 姜泉;石英杰;母小真;張鵬翔;曹煒;唐曉頗;焦娟;;清熱活血方藥治療活動(dòng)期類風(fēng)濕關(guān)節(jié)炎臨床療效研究[A];自主創(chuàng)新與持續(xù)增長第十一屆中國科協(xié)年會(huì)論文集（3）[C];2009年

10 林東紅;;清熱活血法治療慢性胃炎60例臨床體會(huì)[A];中國中西醫(yī)結(jié)合學(xué)會(huì)第十六次全國消化系統(tǒng)疾病學(xué)術(shù)研討會(huì)論文匯編[C];2004年

相關(guān)重要報(bào)紙文章 前4條

1 賈黎;褥瘡患者可飲清熱活血茶[N];醫(yī)藥養(yǎng)生保健報(bào);2008年

2 上海楊浦 徐菁;清熱活血馬鞭草[N];上海中醫(yī)藥報(bào);2013年

3 龍華醫(yī)院 唐漢鈞教授;散風(fēng)清熱活血法治療神經(jīng)性皮炎[N];上海中醫(yī)藥報(bào);2005年

4 中國中醫(yī)科學(xué)院廣安門醫(yī)院 姜泉 焦娟;治痹：辛溫向辛涼轉(zhuǎn)變[N];中國中醫(yī)藥報(bào);2013年

相關(guān)博士學(xué)位論文 前3條

1 姜泉;清熱活血法治療活動(dòng)期類風(fēng)濕關(guān)節(jié)炎臨床與機(jī)制研究[D];福建中醫(yī)藥大學(xué);2012年

2 焦娟;清熱活血方藥治療類風(fēng)濕關(guān)節(jié)炎的多中心臨床評(píng)價(jià)及遠(yuǎn)期隨訪研究[D];中國中醫(yī)科學(xué)院;2012年

3 張學(xué)智;健脾清熱活血法治療損傷性胃黏膜疾病的研究[D];北京中醫(yī)藥大學(xué);2008年

相關(guān)碩士學(xué)位論文 前10條

1 石林;清熱活血養(yǎng)血疏肝法聯(lián)合維A酸類藥物治療女性成人痤瘡的臨床觀察[D];河北醫(yī)科大學(xué);2015年

2 徐國山;清熱活血法治療瘀熱型類風(fēng)濕關(guān)節(jié)炎的臨床觀察[D];福建中醫(yī)藥大學(xué);2015年

3 智愷;清熱活血方抗類風(fēng)濕關(guān)節(jié)炎滑膜血管新生相關(guān)因子的研究[D];中國中醫(yī)科學(xué)院;2016年

4 許書嘉;清熱活血法聯(lián)合益氣養(yǎng)陰法對(duì)AMI患者PCI術(shù)后心功能的影響及隨訪研究[D];廣州中醫(yī)藥大學(xué);2016年

5 邱藝俊;清熱活血方對(duì)PCI患者圍手術(shù)期心肌損傷的影響[D];廣州中醫(yī)藥大學(xué);2016年

6 龍智城;清熱活血方對(duì)急性冠脈綜合征患者凝血—纖溶功能干預(yù)作用的臨床研究[D];廣州中醫(yī)藥大學(xué);2016年

7 莫捷;清熱活血法治療活動(dòng)期類風(fēng)濕關(guān)節(jié)炎作用機(jī)制初探[D];北京中醫(yī)藥大學(xué);2008年

8 彭銳;清熱活血方治療冠心病急性心肌梗死的短期臨床研究[D];廣州中醫(yī)藥大學(xué);2009年

9 杜羽;清熱活血方藥治療類風(fēng)濕關(guān)節(jié)炎3年遠(yuǎn)期臨床療效評(píng)價(jià)[D];北京中醫(yī)藥大學(xué);2013年

10 劉昕;清熱活血方干預(yù)急性冠脈綜合征患者內(nèi)皮功能的臨床研究[D];廣州中醫(yī)藥大學(xué);2015年

本文編號(hào)：2099577