【摘要】：目的：通過觀察清熱活血方對(duì)冠心病急性冠脈綜合征患者凝血-纖維蛋白溶解系統(tǒng)中的特異性指標(biāo)(活化部分凝血活酶時(shí)間APTT、纖維蛋白原FIB、血小板計(jì)數(shù)PLT、D-二聚體D-D)的影響,以探討清熱活血方對(duì)ACS患者凝血-纖溶功能的干預(yù)作用。方法：納入70例熱毒血瘀型急性冠脈綜合征患者,采取隨機(jī)分組方法分為試驗(yàn)組(清熱活血方+常規(guī)西藥治療組,35例)及對(duì)照組(常規(guī)西藥治療組,35例),療程為7天。分別比較兩組患者的基本情況、治療前后凝血-纖溶指標(biāo)(APTT、FIB、PLT、D-D)水平、中醫(yī)熱毒血瘀型胸痹癥狀以及血瘀證積分改變,同時(shí)評(píng)估用藥安全性。結(jié)果：1.凝血-纖溶功能檢測(cè)：試驗(yàn)組APTT、PLT水平較用藥前升高,FIB、D-D水平較用藥前下降,具有統(tǒng)計(jì)學(xué)意義(P0.01)。對(duì)照組PLT水平較用藥前升高、D-D水平較用藥前下降,具有統(tǒng)計(jì)學(xué)意義(P0.05)；組間比較,試驗(yàn)組在升高PLT水平及降低D-D水平更明顯,差異具有顯著性(P0.05)。2.臨床癥狀及療效：兩組在中醫(yī)熱毒以及血瘀癥狀方面均有改善,試驗(yàn)組能更有效改善ACS患者的癥狀。熱證癥狀中,試驗(yàn)組在面赤多汗、渴喜冷飲、口干口苦、小便短黃癥狀改善較對(duì)照組明顯,具有統(tǒng)計(jì)學(xué)意義(P0.05)；血瘀癥狀中,試驗(yàn)組在舌質(zhì)紫暗或有瘀斑、口唇及齒齦暗、脈澀或結(jié)代、四肢末端紫紺或麻木癥狀改善較對(duì)照組明顯,具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.血瘀證積分相關(guān)性分析：三支血管病變血瘀證積分明顯高于雙支病變及單支病變,具有統(tǒng)計(jì)學(xué)意義(P0.05),相關(guān)性檢驗(yàn)中,血管病變數(shù)與血瘀證積分呈正相關(guān)關(guān)系,具有統(tǒng)計(jì)學(xué)意義(P0.01),Pearson相關(guān)系數(shù)=0.485。4.用藥安全性：兩組在用藥安全性評(píng)價(jià)方面(HGB, WBC, ALT, Cr)治療前后無(wú)統(tǒng)計(jì)學(xué)差異,均無(wú)出現(xiàn)不良事件,故清熱活血方具有良好的用藥安全性。結(jié)論：1.熱毒血瘀型急性冠脈綜合征患者凝血-纖溶功能受到一定影響,清熱活血方能協(xié)同降低血小板聚集性、促進(jìn)纖溶系統(tǒng)活性,抑制血栓形成,調(diào)整凝血一纖溶系統(tǒng)平衡,在改善患者機(jī)體血液高凝狀態(tài)方面,較常規(guī)西醫(yī)常規(guī)治療更有療效；2.清熱活血方在改善熱毒血瘀型急性冠脈綜合征患者臨床癥狀較常規(guī)西醫(yī)治療效果更優(yōu)；3.急性冠脈綜合征患者三支血管病變比雙支、單支血瘀證積分顯著升高,且血管病變數(shù)與血瘀證積分呈正相關(guān)關(guān)系,血瘀證積分對(duì)血管病變數(shù)有一定預(yù)測(cè)意義。
[Abstract]:Objective: to observe the effect of Qingre Huoxue recipe on coagulation-fibrinolysis system in patients with acute coronary syndrome (CHD) (activated partial thromboplastin time APTT, fibrinogen FIB, platelet count PLT,) To investigate the effect of Qingre Huoxue recipe on coagulation-fibrinolysis in patients with ACS. Methods: 70 patients with acute coronary syndrome of heat toxin and blood stasis type were randomly divided into two groups: experimental group (routine western medicine treatment group, 35 cases) and control group (routine western medicine treatment group, 35 cases). The course of treatment was 7 days. The basic condition, coagulation-fibrinolysis index (APTT,FIB,PLT,D-D) level before and after treatment, chest impediment symptom of heat toxin and blood stasis syndrome score were compared between the two groups, and the safety of medication was evaluated at the same time. Results: 1. Detection of coagulation-fibrinolysis function: the level of APTT,PLT was higher and the level of FIB,D-D was lower in the test group than that before treatment (P0.01). In the control group, the level of PLT was higher than that before treatment, and the level of D-D was lower than that before treatment (P0.05). Compared with each other, the increase of PLT level and the decrease of D D level were more significant in the experimental group (P0.05). 2. Clinical symptom and curative effect: both groups were improved in heat toxin and blood stasis symptom of traditional Chinese medicine, and the symptoms of ACS patients could be improved more effectively in the test group. The symptoms of heat syndrome, the experimental group in the face of sweating, thirsty cold drink, dry mouth bitter, urinal yellow symptoms were significantly improved than the control group, with statistical significance (P0.05); Among the symptoms of blood stasis, the test group showed significant improvement in tongue purple or ecchymosis, dark mouth lip and gingiva, astringent pulse or junction, cyanosis or numbness at the end of extremities compared with the control group, with statistical significance (P0.05). 3. Correlation analysis of blood stasis syndrome score: the blood stasis syndrome score of three-vessel disease was significantly higher than that of two-vessel disease and one-vessel disease (P0.05). In the correlation test, the blood vessel disease variable was positively correlated with the blood stasis syndrome score, and the blood stasis syndrome score was significantly higher than that of two-vessel disease and one-vessel disease. There was statistical significance (P0.01), Pearson correlation coefficient = 0.485.4). Drug safety: there was no statistical difference between the two groups in the evaluation of drug safety before and after (HGB, WBC, ALT, Cr) treatment, and there were no adverse events, so Qingre Huoxue recipe had good drug safety. Conclusion: 1. Coagulation-fibrinolysis function was affected in patients with acute coronary syndrome caused by heat toxin and blood stasis. Qingre Huoxue recipe could reduce platelet aggregation, promote fibrinolytic system activity, inhibit thrombosis and adjust the balance of coagulation-fibrinolysis system. It is more effective than conventional western medicine in improving the state of blood hypercoagulability in patients. 2. Qingre Huoxue recipe is more effective than conventional western medicine in improving the clinical symptoms of patients with acute coronary syndrome of heat toxin and blood stasis type; In patients with acute coronary syndrome, the blood stasis syndrome score was significantly higher than that of the two branches, and the blood vessel disease variable was positively correlated with the blood stasis syndrome score. The blood stasis syndrome score had certain predictive significance to the blood vessel disease variable.
【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

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