【摘要】：目的:通過(guò)檢測(cè)試驗(yàn)組與對(duì)照組冠心病心絞痛(氣滯血瘀證)患者的相關(guān)指標(biāo),評(píng)定宣痹通瘀方的有效性及安全性。方法:根據(jù)納入標(biāo)準(zhǔn),將試驗(yàn)組與對(duì)照組以相等的數(shù)量隨機(jī)分為兩組,各36例患者,進(jìn)行試驗(yàn)。對(duì)照組參照指南,采用規(guī)范療法。心絞痛發(fā)作時(shí):即刻舌下含服硝酸甘油1/2-1片(規(guī)格為0.5mg),根據(jù)緩解情況,選擇5分鐘之后繼續(xù)服用。長(zhǎng)期服用:阿司匹林腸溶片(Bayer S.p.A)0.1g日1次口服,阿托伐他汀鈣片(Pfizer Ireland Pharmaceuticals)20mg日1次口服。根據(jù)病情選擇使用:鈣拮抗劑(如拜新同30mg,日1次口服),β受體阻滯劑(如酒石酸美托洛爾片25mg,日2次口服),血管緊張素轉(zhuǎn)換酶抑制劑(如馬來(lái)酸依那普利10mg,日1次口服)。治療組給予西藥常規(guī)治療加宣痹通瘀方,本方由長(zhǎng)春中醫(yī)藥大學(xué)附屬醫(yī)院免煎藥房提供。每天1劑,早晚溫開(kāi)水沖服,觀察4周。結(jié)果:1、中醫(yī)癥狀療效評(píng)定方面:加服宣痹通瘀方組的患者總有效率83.33%,單純西藥治療患者中總有效率74.29%,差異顯著(p0.05);2、心絞痛癥狀方面:加服宣痹通瘀方組的患者總有效率88.57%,單純西藥治療患者中總有效率68.57%,差異顯著(p0.05);3、心電圖療效評(píng)定:加服宣痹通瘀方組的患者總有效率45.71%,單純西藥治療患者中總有效率40.00%;兩組治療方案均可改善心電圖,組間差異不明顯(p0.05);4、硝酸甘油減停率,加服宣痹通瘀方組的患者總有效率91.43%,單純西藥治療患者中總有效率68.57%,存在顯著差異(p0.05),有統(tǒng)計(jì)學(xué)意義,5,兩組方案均可改善患者血脂情況,對(duì)于降低低密度脂蛋白方面,加服用宣痹通瘀方組明顯優(yōu)于單純西藥治療組,6,兩組患者治療前后血常規(guī)、尿常規(guī)、肝功能、腎功能均無(wú)明顯改變。結(jié)論:宣痹通瘀方針對(duì)胸痹心痛(氣滯血瘀證)的患者,關(guān)于改善中醫(yī)癥狀、改善心絞痛及降低硝酸甘油使用率有較好的療效,對(duì)改善心電圖有較好療效,但與常規(guī)西藥治療無(wú)顯著差異;宣痹通瘀方對(duì)肝腎功能無(wú)損傷,可廣泛推廣。
[Abstract]:Objective: to evaluate the efficacy and safety of Xuanbi Tongyu decoction by detecting the related indexes of angina pectoris (Qi stagnation and blood stasis syndrome) in the experimental group and the control group. Methods: according to the inclusion criteria, the experimental group and the control group were randomly divided into two groups, 36 patients in each group. The control group was treated with standard therapy according to the guidelines. Angina pectoris attack: immediately sublingual 1 / 2-1 tablet nitroglycerin (specification is 0.5mg), according to remission, choose 5 minutes to continue taking. Long-term administration: aspirin enteric-coated tablets (Bayer S.p.A) 0.1 g / d, Atto vastatin calcium tablets (Pfizer Ireland Pharmaceuticals) 20mg once a day. Calcium antagonists (30 mg / d), 尾 -blockers (such as metoprolol tartrate 25 mg, twice a day) and angiotensin converting enzyme inhibitors (such as enalapril maleate 10 mg, once a day) were used according to their condition. The treatment group was treated with routine western medicine plus Xuan Bi Tong Yu Fang, which was provided by Changchun University of traditional Chinese Medicine affiliated Hospital. Take 1 dose a day, warm water in the morning and evening, and observe for 4 weeks. Results: in the aspect of evaluating the curative effect of traditional Chinese medicine, the total effective rate was 83.33 in Xuanbi Tongyu prescription group, 74.29 in western medicine treatment group, and the difference was significant (p0.05). In angina pectoris symptom, the patients in Xuan Bi Tongyu prescription group had total effective rate of 83.33, and the total effective rate in western medicine group was 74.29, the difference was significant (p0.05). The total effective rate of western medicine alone was 68.57 and the difference was significant (p0.05). The evaluation of electrocardiogram efficacy: the total effective rate was 45.71 in the group treated with Xuan Bi Tong Yu decoction, and 40.00th in the patients treated with western medicine alone, and the electrocardiogram was improved in both groups. There was no significant difference between the two groups (p0.05) (p0.05). The total effective rate was 91.43 in addition to Xuanbi Tongyu prescription group, and the total effective rate was 68.57 in the patients treated with western medicine alone (p0.05). There was significant difference between the two groups (p0.05), there was significant difference between the two groups (p0.05). The two groups could improve the blood lipid status of the patients. For the reduction of low density lipoprotein, the combination of Xuanbi Tongyu prescription group was significantly better than the western medicine treatment group, the two groups of patients before and after treatment blood routine, urine routine, liver function, renal function have no significant change. Conclusion: Xuanbi Tongyu prescription has better curative effect on improving TCM symptoms, improving angina pectoris and reducing the utilization rate of nitroglycerin for patients with chest arthralgia and heart pain (Qi stagnation and blood stasis syndrome), and has better effect on improving electrocardiogram. However, there is no significant difference between Xuan Bi Tong Yu recipe and conventional western medicine, and Xuan Bi Tong Yu recipe has no damage to liver and kidney function and can be widely popularized.
【學(xué)位授予單位】：長(zhǎng)春中醫(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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