【摘要】：目的：通過對(duì)研究氣陰兩虛型胸痹(ACS)行PCI的患者,評(píng)價(jià)炙甘草湯在對(duì)氣陰兩虛型胸痹(ACS) PCI術(shù)后并發(fā)低血壓的防治作用,并初步探討其發(fā)生機(jī)制,為今后能臨床早期干預(yù)提供參考和依據(jù)。方法：將在無錫市中醫(yī)醫(yī)院2015年01月-2016年3月住院確診為急性冠脈綜合征且為氣陰兩虛型病例60例,且均行PCI,隨機(jī)分為實(shí)驗(yàn)組及對(duì)照組各30例。實(shí)驗(yàn)組加用炙甘草湯口服,統(tǒng)計(jì)兩組病人PCI術(shù)前一般情況,危險(xiǎn)因素,手術(shù)前后的中醫(yī)證候積分、低血壓發(fā)生率、TNF-α、hs-CRP、BNP、左室射血分?jǐn)?shù)(LVEF)數(shù)據(jù)的變化。結(jié)果：1.兩組病例在性別,年齡統(tǒng)計(jì)學(xué)上無統(tǒng)計(jì)學(xué)差別,比較兩組病例的危險(xiǎn)因素：高血壓、吸煙、糖尿病,兩組的危險(xiǎn)因素在統(tǒng)計(jì)學(xué)上無差異。2.統(tǒng)計(jì)比較治療前后證候積分,顯示治療前差異無統(tǒng)計(jì)學(xué)意義,而治療后即積分比較差異有統(tǒng)計(jì)學(xué)意義,其中實(shí)驗(yàn)組顯效率優(yōu)于對(duì)照組。3.術(shù)前兩組TNF-α的比較,提示兩組術(shù)前TNF-α的比較無統(tǒng)計(jì)學(xué)差異,通過實(shí)驗(yàn)組前后的比較、對(duì)照組前后的比較、兩組術(shù)后比較,提示兩組TNF-α在治療后均上升,但是實(shí)驗(yàn)組更有優(yōu)勢(shì)。4.術(shù)前兩組的NBP比較,提示兩組術(shù)前NBP的比較無統(tǒng)計(jì)學(xué)差異,通過實(shí)驗(yàn)組前后比較、對(duì)照組前后比較、兩組術(shù)后比較,提示兩組的BNP均明顯下降,實(shí)驗(yàn)組BNP下降更明顯,提示增加使用炙甘草湯對(duì)于改善心衰更有優(yōu)勢(shì)。5.術(shù)前兩組的LVEF比較,提示兩組術(shù)前LVEF的比較無統(tǒng)計(jì)學(xué)差異,實(shí)驗(yàn)組PCI前后比較、對(duì)照組PCI前后比較、兩組術(shù)后比較,提示在PCI術(shù)后兩組的LVEF均明顯改善,但實(shí)驗(yàn)組對(duì)于LVEF的改善優(yōu)于對(duì)照組。6.術(shù)前兩組hs-CRP的比較,提示兩組術(shù)前hs-CRP的比較無統(tǒng)計(jì)學(xué)差異,實(shí)驗(yàn)組前后比較、治療后對(duì)照組前后比較、兩組術(shù)后比較,提示兩組在治療后CRP均明顯上升,治療后兩組比較統(tǒng)計(jì)學(xué)無差異。7.術(shù)前兩組的血壓基線比較,兩組統(tǒng)計(jì)學(xué)上無差異,提示術(shù)前兩組血壓基線平衡。術(shù)后兩組血壓使用四格表資料的確切概率法,提示使用炙甘草湯,降低了PCI術(shù)后低血壓的發(fā)生。結(jié)論：1.在西醫(yī)規(guī)范化治療PCI術(shù)后基礎(chǔ)上加用炙甘草湯,其臨床中醫(yī)癥候療效較單純西藥治療有所提高。2.炙甘草湯可以明顯降低氣陰兩虛型胸痹患者PCI術(shù)后低血壓發(fā)生率,機(jī)制可能和炙甘草湯改善心肌再灌注損傷的作用有關(guān)。
[Abstract]:Objective: to evaluate the effect of Zhigancao decoction on the prevention and treatment of hypotension after (ACS) PCI of Qi and Yin deficiency type chest arthralgia (ACS) with Qi and Yin deficiency, and to explore the mechanism of its occurrence. To provide reference and basis for early clinical intervention in the future. Methods: from January 2015 to March 2016, 60 cases of acute coronary syndrome with deficiency of qi and yin were diagnosed in Wuxi traditional Chinese Medicine Hospital. All patients were randomly divided into experimental group and control group with PCI,. The patients in the experimental group were treated with Zhigancao decoction. The changes of general condition, risk factors, TCM syndromes, incidence of hypotension, TNF- 偽, hs-CRP,BNP, left ventricular ejection fraction (LVEF) before and after operation were analyzed. Results: 1. There was no statistical difference in sex and age between the two groups. There was no statistical difference in risk factors between the two groups: hypertension, smoking, diabetes. Statistical comparison of syndrome score before and after treatment showed that there was no significant difference before and after treatment, but the difference was statistically significant after treatment, and the significant efficiency of the experimental group was better than that of the control group. The comparison of TNF- 偽 between the two groups before operation showed that there was no significant difference in TNF- 偽 between the two groups before and after treatment. Through the comparison between the experimental group and the control group, the comparison before and after the operation between the two groups, it was suggested that the TNF- 偽 of the two groups increased after treatment. But the experimental group had an advantage. 4. The comparison of NBP between the two groups before operation showed that there was no statistical difference between the two groups in preoperative NBP. Through the comparison between the experimental group and the control group before and after operation, the BNP of the two groups was obviously decreased, and the BNP in the experimental group was more obvious. It is suggested that it is more advantageous to increase the use of Zhigancao decoction for improving heart failure. 5. The comparison of LVEF between the two groups before operation showed that there was no significant difference in preoperative LVEF between the two groups. The comparison between the experimental group and the control group before and after PCI and the comparison between the control group and the control group showed that the LVEF of the two groups was significantly improved after PCI. But the improvement of LVEF in the experimental group was better than that in the control group. 6. 6. The comparison of hs-CRP between the two groups before operation showed that there was no statistical difference between the two groups before and after treatment. The comparison between the experimental group and the control group after treatment and the comparison between the two groups after operation indicated that the CRP of the two groups was obviously increased after treatment. There was no statistical difference between the two groups after treatment. There was no statistical difference in blood pressure baseline between the two groups before operation, suggesting that the blood pressure baseline balance between the two groups before operation. The exact probability method of four grid table data was used in the two groups, suggesting that the use of Zhigancao decoction could reduce the incidence of hypotension after PCI. Conclusion: 1. On the basis of western standard treatment of PCI, the clinical curative effect of traditional Chinese medicine is better than that of western medicine alone. 2. Zhigancao decoction can obviously reduce the incidence of hypotension after PCI in patients with chest obstruction with deficiency of Qi and Yin, and the mechanism may be related to the effect of Zhigancao decoction on myocardial reperfusion injury.
【學(xué)位授予單位】：南京中醫(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)】：R256.22

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