【作者】 李丽恩；

【导师】 郭伟星；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2012， 博士

【摘要】 目的：观察据益气养血、破瘀消积法组方的芪参消积通脉汤治疗胸痹心痛的临床疗效。方法：将符合纳入标准的68例患者按数字表法随机分为2组，治疗组在西药治疗基础上加用自制芪参消积通脉汤口服治疗，对照组采用口服阿司匹林肠溶片，100mg/次，1次/d；单硝酸异山梨酯缓释片（依姆多）20mg/次，2次/d；酒石酸美托洛尔片（倍他乐克）25mg/片，2次/d；阿托伐他汀片（立普妥）20mg/片，1次/d，二组均于疼痛发作时舌下含化硝酸甘油。治疗12周后，对心绞痛主要症状、心电图、硝酸甘油用量、血脂、总有效率及毒副作用等进行评估。结果：①临床症状改善情况：治疗组显效23例（63.89%），有效11例（30．56%），无效2例（5.56%），总有效率94.45%；对照组显效10例（31.25%），有效15例（46.88%），无效7例（21.88%），总有效率78.13%。两组显效率及总有效率比较有显著性差异（P＜0.05或P＜0.01）。②疼痛改善情况：治疗组显效22例（61.11%），有效12例（33.33%），无效2例（5.56%），总有效率94．44%；对照组显效11例（34.38%），有效14例（43.75%），无效7例（21.88%），总有效率78．13%。治疗组总有效率及显效率与对照组比较，均有非常显著性差异（P＜0.05）。③心电图疗效分析：治疗组显效13例（36.11%），有效14例（38.89%），无效9例（25.00%），总有效率75.00%；对照组显效5例（15.63%），有效10例（31.25%），无效17例（53.12%），总有效率46.88%。2组总有效率比较有显著性差异（P＜0.05）。④硝酸甘油用量情况：治疗组治疗前硝酸甘油片用量12.82±2.26片/周，治疗后2.64±0.89片/周，治疗前后硝酸甘油用量比较具有显著差异（P＜0.01）；对照组治疗前硝酸甘油片用量11.87±2.67片/周，治疗后6.11±1.63片/周，治疗后硝酸甘油用量亦明显减少，但二者无统计学差异。治疗组治疗后硝酸甘油用量明显减少，部分停药，与对照组比较有显著性差异（P＜0.01）。⑤治疗组与对照组在治疗后TC、TG、LDL均有降低，差异有显著性（P＜0.05），治疗组下降程度较对照组明显，但2组之间无统计学差异（P＞0.05）。治疗组与对照组在治疗后HDL均有升高，差异有显著性（P＜0.01），治疗组升高程度较对照组明显，但2组之间无统计学差异（P＞0.05）。⑥治疗组与对照组在治疗后Hs-CRP、Hcy均明显降低，治疗前后差异有显著性（P＜0.01）。⑦颈动脉斑块的变化情况：治疗组36例中有13例斑块变小，22例无明显变化，1例较前增大；对照组32例中有4例斑块变小，20例无明显变化，8例较前增大。2组比较有显著差异（P＜0.01）。⑧治疗方法与心绞痛类型的关系：治疗组不稳定型心绞痛28例中显效19例（67.86%），有效8例（28.57%），无效1例（3.57%），总有效率96.43%；稳定型心绞痛8例中显效5例（62.50%），有效2例（25.00%），无效1例（12.50%），总有效率87.50%。对照组不稳定型心绞痛26例中显效9例（34.62%），有效12例（46.15%），无效5例（19.23%），总有效率80.77%；稳定型心绞痛6例中显效2例（33.33%），有效2例（33.33%），无效2例（33.33%），总有效率66.67%。治疗结果显示治疗组对稳定型和不稳定型心绞痛均有效果，且与对照组比较显效率有显著性差异（P＜0.05）。结论：益气养血、破瘀消积法能有效治疗胸痹心痛，且安全无副作用。其作用机制可能与有效调节冠状动脉舒缩功能、稳定或消除动脉粥样硬化斑块、调节血脂、改善冠状动脉供血等综合调节作用有关。更多还原

【Abstract】 Object Clinical effect on treating angina pectoris by applying replenishing qi andblood， removing blood stasis and eliminating mass would be observed．Methods68patients in accordance with the inclusion criteria were divided into twogroups according to random number table． Formulas with function of replenishing qi andblood， removing blood stasis were applied in treatment group． Aspirin andisosorbide-5-nitrate tablets were applied in control group which were basic treatment inwestern medicine，100mg per time， one time a day and20mg per time， three times aday respectively． The main symptoms， electrocardiogram， total effective rate and sideeffect of angina pectoris were evaluated12weeks later．Results①Clinical symptoms improvement:23patients were found taking markedeffect（63.89%）,11patients effective（30.56%）and2ineffective（5.56%） in treatmentgroup. Total effective rate were94.45%.10patients were found taking marked effect（31.25%）,15patients effective（46.88%）and7ineffective （21.88%）. Total effectiverate were78．13%． Significant differences could be found in marked effect and totaleffective rate between two groups（P＜0.01）.②I mprovement on angina pectoris：22patients were found taking marked effect（61.11%）,12patients effective（33.33%） and2ineffective（5.56%）in treatment group. Total effective rare were94.44%．11patientswere found taking marked effec（t34.38%）,14patients effective（43.75%）and7patientsineffective（21.88%） in control group. Total effective rate were78．13%. Significantdifferences could be found in total effective rate and marked effect between two groups（P ＜0.05）．③A nalysis on electrocardiogram:3patients were found taking marked effect（36.11%）,14patients effective（38.89%） and9ineffective（25.00%）in treatmentgroup． Total effective rate were75.00%.5patients were found taking marked effect（15.63%）,10patients effective（31.25%） and17ineffective（53.12%）in controlgroup． Total effective rate were46.88%. Significant differences could be found in totaleffective rate between two groups（P＜0.05）.④N itroglycerin dosage:12.82±2.26and2.64±0.89tablets of nitroglycerin were needed before and after treatment respectively intreatment group every week． Significant difference could be found in dosage ofnitroglycerin before and after treatment.11.87±2.67and6.11±1.63tablets of nitroglycerinwere needed before and after treatment respectively in control group． Dosage ofnitroglycerin decreased largely after treatment， but difference weren’t found． Dosage ofnitroglycerin decrease largely and its medication stopped in some patients in treatmentgroup．Differences could be found between two group（sP＜0.01）.⑤the changes of bloodlipoids: after treatment, the TC, TG, LDL decreased in treatment group and the controlgroup, there was a significant difference (P＜0.01), the treatment group decreasedsignificantly compared with the control group, but there was no difference between the2groups (P＞0.05). The HDL were increased in treatment group and the control group aftertreatment, there was a significant difference（P＜0.01）, the treatment group with elevatedlevels significantly compared with the control group, but there was no difference betweenthe2groups(P＞0.05)。⑥the changes of Hs-CRP and Hcy: after treatment, the Hs-CRPand Hcy decreased in treatment group and the control group, there was a significantdifference (P＜0.01).⑦relationship of treatment and type of angina pectoris19patientswith unstable angina pectoris were found taking marked effect（67.86%）,8patientseffective（28.57%） and1ineffective（3.57%） in treatment group with28unstable anginapectoris patients． Total effective rate were96.43%.5patients with stable angina pectoriswere found marked effect（62.50%）,2patients effective（25.00%） and1ineffective（12.50%）in treatment group with8stable angina pectoris.9patients with unstable anginapectoris were found marked effect（34.62%）,12patients effective （46.15%）and5ineffective（19.23%） in control group with stable angina pectoris patients. Total effectiverate were80.77%.2patients with stable angina pectoris were found marked effect （33.33%）,2patients effective（33.33%）and2ineffective（33.33%）in control group with6stable angina pectoris patients. Total effective rate were66.67%. Effect could be foundon patients with unstable and stable angina pectoris in treatment group. Differences couldbe found between two groups（P＜0.05）.Conclusions Treatment of replenishing qi and blood, removing blood stasis andeliminating mass can be applied in angina pectoris which have no side effect. Its functionalmechanism may have relationship with regulating systolic and diastolic function ofcoronary artery, regulating blood lipid and eliminating atherosclerotic plaque andimproving blood supply of coronary artery.更多还原