【作者】 彭大艳；

【导师】 顾晔；

【作者基本信息】 湖北中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 目的：本课题通过观察两组不稳性心绞痛合并高脂血症患者治疗前后全血黏度、血脂、心绞痛发作次数、心电图的变化,并监测治疗前后两组粪便常规、尿常规、血常规及肝肾功能的变化,来探讨注射用灯盏花素对不稳定性心绞痛合并高脂血症患者的临床疗效及安全性,同时为今后临床中西结合治疗冠心病不稳定性心绞痛提供一定的参考。材料与方法：选择武汉市普爱医院2009年5月至2010年5月收治的不稳定性心绞痛合并高脂血症患者62例,所有病例均符合2003年中华心血管病杂志编辑委员会《心血管病指南和建议》中不稳定性心绞痛及血脂异常诊断标准,随机分为治疗组30例和对照组32例,治疗组男16例,女14例,年龄45～72岁,平均年龄60±5.77岁,合并高血压14例,糖尿病10例,陈旧性心肌梗死3例,合并糖耐量异常3例；对照组男17例,女15例,年龄44～70岁；平均年龄58±7.50岁,合并高血压16例,糖尿病9例,陈旧性心肌梗死5例,糖耐量异常2例,两组性别、年龄、病程、合并症等方面比较差异无统计学意义(P>0.05),具有可比性。两组患者均予不稳定性心绞痛的常规西医治疗及其他治疗如降压、降糖等。治疗组在以上基础上给予灯盏花素注射液50mg加入0.9%氯化钠250ml静脉滴注,每天1次,连用两周。治疗期间进行生活方式的干预,如戒烟酒、避免过饱、过劳、情绪激动等。记录两组治疗前后全血黏度、血脂、心绞痛发作次数、心电图ST-T变化情况,以治疗前后粪便常规、尿常规、血常规、肝功能、肾功能作为安全性观察指标。结果：治疗组心绞痛症状缓解显效12例(40%),有效14例(46.7%),无效4例(13.33%),加重为0例,总有效率为86.67%；对照组显效9例(28.13%),有效15例(46.88%),无效8例(25%),加重0例,总有效率为75%,明显低于治疗组,两者比较有统计学意义(P<0.05)。心电图的变化治疗组显效16例(53.33%),有效9例(30%),无效5例(16.67%),加重0例,总有效率83.33%；对照组显效8例(25%),有效13例(40.63%),无效11例(34.38%),总有效率为65.63%,两者比较有统计学意义(P<0.05)。两组治疗前后血黏度及血脂变化比较,差异有统计学意义(P<0.05)。治疗组心绞痛发作次数及程度明显低于对照组,差异有统计学意义(P<0.05)。两组治疗前后粪便常规、尿常规、血常规、肝功能、肾功能的变化,经计算差异无统计学意义(P>0.05)。结论：21世纪,冠心病是人类最常见的死亡原因之一,不单在经济发达的国家如此,发展中国家以及欠发达国家亦如是,冠心病已成为一个影响人类生存生活的重大公共卫生问题,因此防治冠心病,降低冠心病死亡率显得极为重要。注射用灯盏花素能降低冠心病不稳定性心绞痛患者全血黏度、血脂,扩张冠脉改善微循环从而减少心绞痛发作次数,且安全无不良反应,可作为不稳定性心绞痛治疗的药物。更多还原

【Abstract】 Objective:This topic was to observe the injectable lamps spend grain to merge unstable angina patients with hyperlipidemia, and to find the clinical curative effect for future clinical treatment of coronary heart disease combined with western routine provide method and maybe certain reference by recording the whole blood viscosity, blood fat and anginal attacks, ECG changes before and after the treatment, and monitor stool, urine, blood routine examination, liver and kidney function changes of the between two groups.Materials and methods:Sixty-two cases of merge unstable angina patients with hyperlipidemia from Puai hospital in wuhan city from May 2009 to May 2010 were selected. All cases followed 2003 cardiovascular magazine editors committee "cardiovascular disease" guidelines and suggestions of unstable angina and hyperlipidemia diagnosis criteria.62 cases were randomly divided into the treatment group 30 cases and control group 32 cases. The treatment group consists of male 16 cases, female 14 cases, age range from 45-72, with an average age of 60±5.77 years old,14 cases with amalgamating hypertension,10 cases with diabetes,3 cases with chronic myocardial infarction,3 cases with abnormal glucose tolerance; The control group male 17cases, female 15 cases, age 44-70 years old; with average age 58±7.50 years old,16 cases with amalgamating hypertension,9cases with diabetes,5 cases with chronic myocardial 3 cases with abnormal glucose tolerance, no significant.difference was found in gender, age, duration, and complications between 2 groups (P> 0.05), patients of 2 groups were given western medicine therapy to unstable angina and other treatments such as buck, hypoglycemic, etc. The treatment group give lamps spend grain injection 50mg join 0.9% sodium chloride 250ml intravenous drip per day by two weeks. The control group was simply received routine medicine. During treatment for lifestyle interventions, such as giving up smoking and avoiding eating too much, wine, emotional overwork. Whole blood viscosity, blood fat, anginal attacks and the amount of nitroglycerin usage, electrocardiogram ST-T change were observed before and after the treatment. Stool, urine, blood routine examination, liver and kidney function, before and after treatment were observed as safety index.Results:Whole blood viscosity, blood fat, anginal attacks, and ECG changes before and after the treatment were monitored in the 62 cases with unstable angina and hyperlipemia group. In treatment,12 total effective cases (40%), 14 effective cases (46.7%),4 invalid cases (13.33%),0 aggravated cases, the total effective rate was 86.67%; In control,9 total effective cases, (28.13%), 15 effective cases (46.88%),8 invalid cases (25%),0 aggravated cases, the total effective rate was 75%, there were significant difference between the two goups (P< 0.05). As ECG changes, was concerned in treatment group,16 total effective (53.33%),9 effective cases (30%),5 invalid cases (16.67%),0 aggravated cases, the total effective rate was 83.33%; In control group,8 total effective cases (25%),13 effective (40.63%),11 invalid cases (34.38%), the total effective rate was 65.63%, there was of statistically differences(P< 0.05). Blood viscosity and lipid changes anginal attacks were significantly different between the two groups in treatment group(P< 0.05). There were of no significant differences in urine and stool routine analysis, liver and kidney function changes before and after the treatment (P> 0.05). Conclusion:In 21th century, coronary heart disease has become one of the most common causes of human death, not only in the developed countries, but also in the developing countries. It has become a major public health problem. The injectable lamps spend grain can reduce patients whole blood viscosity, blood fat and expanding coronary artery, improve microcirculation thus decrease anginal attacks, and it is safe and of no obvious adverse drug reaction.更多还原