从标本论治心肌梗死后心绞痛阳气虚衰证的临床探究.pdfVIP

提 要 目的：观察培土益元汤治疗心梗后心绞痛阳气虚衰证的临床疗效，并探讨其作用 机制。方法：60 例心梗后心绞痛阳气虚衰证病人随机分为 A 、B 两组，每组 30 例。 A 组为治疗组，在西医常规治疗基础上加服培土益元汤；B 组为对照组，采用西医常 规治疗。治疗周期为 1 个月。观察治疗前后患者主要临床症状改善情况，治疗期间每 周心绞痛发作次数，24h 动态心电图心肌缺血总负荷，血脂，血管内皮功能，P-选择 素，彩色多普勒超声心动图及血清 Nt-proBNP 等指标的变化。结果：治疗组治疗后 心绞痛疗效、中医症状总疗效与对照组相比，均有显著性差异。治疗组能明显降低心 绞痛的发作次数，与对照组相比，有显著性差异。治疗组治疗后 TC、TG、LDL-C 、 LP(a)水平明显下降，ET-1 、TXB2 、P-selectin 水平明显下降，NO 水平明显上升，与 对照组相比，有显著性差异。治疗组能明显升高彩色多普勒超声心动图 EF 值、E 值， 降低A 值、E/A 值，降低血清脑钠肽N末端前体（Nt-proBNP ）水平，与对照组相比， 有显著性差异。结论：培土益元汤能明显改善心梗后心绞痛患者的临床症状，提高临 床疗效。显著改善血脂代谢紊乱，保护血管内皮，稳定斑块，抗血小板活化，减轻不 稳定斑块破裂后血栓的形成，并在一定程度上促进血栓的溶解，最终达到抗心肌缺血、 缺氧，保护心室功能，防止心梗后心绞痛发作，预防再梗死的目的。本研究结果为心 梗后心绞痛的防治提供了新的思路和方法。 关键词：培土益元汤；心梗后心绞痛；阳气虚衰证；临床研究 The Clinical Research of Yang-Qi Deficiency Syndrome of Postinfaction Angina Pectoris from Biao and Ben Aspect Speciality: Clinical study on the treatment of heart system diseases with Traditional Chinese Medicine Tutor: Prof. Bao Peirong Author: Li Yahui Abstract Objective: To evaluate the effects of Pei Tu Yi Yuan Tang on Yang-Qi deficiency syndrome of postinfarction angina pectoris and investigate the mechanism of it. Methods: Divided 60 myocardial infarction patients into two groups equally. A group named treatment group, B group named control group. We gave Pei Tu Yi Yuan Tang to A group besides western medicine for one month. For B group, we only used the same western medicine. When the treatment cycle was over, we observed the effects of Chinese materia medica. Indexes including frequency of angina pectoris attacks, dynamic electrocardiogram, blood-fat, the function of blood vessel endothelium, P-selectin, Doppler echocardiography and Nt-pro BNP of blood serum were measured respectively.