益气通脉汤治疗孤立性冠状动脉肌桥心绞痛气虚血瘀证临床研究  

Clinical study of Yiqi-Tongmai Decoction on qi deficiency and blood stasis syndrome of isolated coronary artery muscle bridge angina pectoris

作　　者：韩垚[1] 戴梅[1] 刘红旭[1] 张大炜[1] 魏执真[1] Han Yao;Dai Mei;Liu Hongxu;Zhang Dawei;Wei Zhizhen(Department of Cardiovascular Medicine,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院心血管科,北京100010

出　　处：《国际中医中药杂志》2022年第1期22-27,共6页International Journal of Traditional Chinese Medicine

基　　金：北京市自然科学基金项目(7173261);北京市医院管理局重点医学专业发展计划项目(ZYLX201817);北京中医药科技发展项目(QN2016-16);国家中医药管理局“全国名老中医药专家传承工作室”项目-魏执真名老中医工作室(2012-2016);北京中医药薪火传承“3+3”建设项目-魏执真名老中医工作站(2008-2013)。

摘　　要：目的评价益气通脉汤治疗孤立性冠状动脉肌桥心绞痛气虚血瘀证患者的临床疗效。方法将符合入选标准的2016年4月-2020年1月首都医科大学附属北京中医医院64例孤立性冠状动脉肌桥心绞痛气虚血瘀证患者,采用随机数字表法分为2组,每组32人。对照组口服盐酸地尔硫卓片,治疗组在对照组基础上服用自拟益气通脉汤。2组均连续治疗8周。分别于治疗前后进行中医证候评分,采用西雅图心绞痛量表评估患者生活质量及机体功能状态,观察治疗前后平板运动心电图试验情况,记录运动诱发心绞痛需要的时间及平板运动后引起心电图中ST段动态演变的时间;评价心绞痛疗效及中医证候疗效。结果治疗组心绞痛疗效总有效率为84.4%(27/32)、对照组为53.1%(17/32),2组比较差异有统计学意义(χ^(2)=8.09,P<0.05)。治疗后,治疗组西雅图心绞痛量表中躯体活动受限程度[(69.24±14.21)分比(59.42±11.71)分,Z=-2.61]、心绞痛稳定状态[(82.25±21.24)分比(69.11±19.52)分,Z=-2.64]、心绞痛发作情况[(80.24±18.31)分比(69.11±15.54)分,Z=-2.63]、治疗满意程度[(86.16±19.23)分比(61.19±17.35)分,Z=-2.22]、疾病认知程度[(74.41±21.13)分比(60.43±19.42)分,Z=-2.40]评分高于对照组(P<0.05);治疗组运动诱发心绞痛时间[(476.15±62.15)s比(399.38±78.42)s,Z=-2.08]、运动后ST段下移1 mm时间[(394.54±75.61)s比(309.64±81.62)s,Z=-2.40]较对照组延迟(P<0.05)。治疗组中医证候疗效总有效率为93.8%(30/32)、对照组为65.6%(21/32),2组比较差异有统计学意义(χ^(2)=7.96,P<0.05)。治疗组治疗后中医证候积分[(25.15±6.15)分比(36.38±10.42)分,Z=-2.56]低于对照组(P<0.05)。治疗期间,2组均未见明显不良反应。结论益气通脉汤可有效改善孤立性冠状动脉肌桥心绞痛气虚血瘀证患者的临床症状,减少心绞痛发作,延迟运动诱发心绞痛时间,提高临床疗效。Objective To evaluate the clinical efficacy of Yiqi-Tongmai Decoction on isolated coronary muscle bridge angina patients with qi deficiency and blood stasis syndrome.Methods A total of 64 patients with isolated coronary artery muscular bridge angina pectoris with qi deficiency and blood stasis syndrome in Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from April 2016 to January 2020 who met the inclusion criteria were divided into 2 groups by random number table method,with 32 patients in each group.The control group took diltiazem hydrochloride tablets orally,and the treatment group took Yiqi-Tongmai Decoction on the basis of the control group.Both groups were treated for 8 weeks.The TCM syndrome scores were observed before and after treatment,and Seattle Angina Questionnaire was assessed for patient's quality of life and functional status.The exercise ECG test was observed before and after treatment,and the cause of angina pectoris need to be recorded,including the movement time and plate movement caused by time of ST segment in electrocardiogram(ecg)and dynamic evolution.Results The total effective rate of angina pectoris was 84.38%(27/32)in the treatment group,and 53.13%(17/32)in the control group,and the difference between the two groups was statistically significant(χ^(2)=8.09,P<0.05).After treatment,the degree of physical activity limitation(69.24±14.21 vs.59.42±11.71,Z=-2.61),stable state of angina(82.25±21.24 vs.69.11±19.52,Z=2.64),angina(80.24±18.31 vs.69.11±15.54,Z=2.63),treatment satisfaction(86.16±19.23 vs.61.19±17.35,Z=2.22),degree of disease cognition(74.41±21.13 vs.60.43±19.42,Z=2.40)scores in the treatment group were significantly higher than those in the control group(P<0.05).In the treatment group,the time of exercise-induced angina pectoris[(476.15±62.15)s vs.(399.38±78.42)s,Z=-2.08],the time of ST segment descending 1 mm after exercise[(394.54±75.61)s vs.(309.64±81.62)s,Z=-2.40]in the treatment group were significantly longer than thos

关 键 词：冠状动脉疾病 心肌桥 心绞痛 气虚血瘀证 益气通脉汤 

分 类 号：R259[医药卫生—中西医结合]