中西医结合干预对冠心病PCI术后心绞痛患者的预后影响  

Effect of Western Medicine Combined with Traditional Chinese Medicine on the Prognosis of Patients with Angina Pectoris After Percutaneous Coronary Intervention

作　　者：刘亚然 刘宁[2] 王建明[2] 宋宪波[2] 杜志鹏 杨天赐 LIU Yaran;LIU Ning;WANG Jianming;SONG Xianbo;DU Zhipeng;YANG Tianci(The First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Cardiovascular Disease Department,Jining Hospital of Traditional Chinese Medicine,Jining 272000,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250355 [2]济宁市中医院心内科,山东济宁272000

出　　处：《山东中医杂志》2024年第11期1235-1241,共7页Shandong Journal of Traditional Chinese Medicine

基　　金：济宁市重点研发计划项目(编号:2021YXNS143)。

摘　　要：目的:分析西药联合中医药干预对冠心病经皮冠状动脉介入术(PCI)术后心络气虚、络脉瘀阻心绞痛患者预后的影响。方法:采取队列研究和倾向性评分匹配(PSM)设计,使用医院病案管理系统提取患者基本信息、随访患者出院后药物使用情况与终点事件发生情况。基于前期研究结果得出长期应用中医药可降低随访期间终点事件心血管再入院、再发心肌梗死的发生率,故在此基础上比较暴露组(应用中成药或中药汤剂≥28 d者)与非暴露组(应用中成药或中药汤剂<28 d者)心绞痛再入院和再发心肌梗死的发生情况。采用Kaplan-Meier生存分析与Cox生存分析,分析中医药干预与心绞痛再入院、再发心肌梗死终点事件的关系,观察中医药对冠心病PCI术后心绞痛预后的影响。结果:检索到符合要求患者214例,随访成功192例,PSM匹配成功128例。PSM前和PSM后,暴露组心绞痛再入院率及再发心肌梗死率均低于非暴露组。Kaplan-Meier生存分析表明,在相同随访事件节点暴露组心绞痛再入院率和再发心肌梗死率均低于非暴露组,暴露组生存率显著高于非暴露组(P<0.05)。Cox生存分析表明,中医药干预是心绞痛再入院和再发心肌梗死的保护因素。结论:中西医结合干预能降低心绞痛再入院率和再发心肌梗死率,改善患者远期预后。Objective:To analyze the effect of western medicine combined with traditional Chinese medicine(TCM)on patients with angina pectoris after percutaneous coronary intervention(PCI)of qi deficiency of heart collaterals,and stasis in the collaterals syndrome.Methods:The cohort study and propensity score matching(PSM)design were conducted.Through the Hospital Information System(HIS),data of patients,medication after discharge,occurrence of end-point events during the follow-up were collected.In the previous study,it was found that long-term use of Chinese medicinals could reduce the incidence of end-point event such as cardiovascular readmission and recurrent myocardial infarction during the follow-up.Therefore,events such as the angina pectoris readmission and recurrent myocardial infarction in the exposed group(administration of Chinese patent medicine or decoction≥28 days)and non-exposed group(administration of Chinese patent medicine or decoction<28 days)compared.Kaplan and Meier and Cox survival analysis were conducted to analyze the relationship between TCM intervention and end-point events such as angina pectoris readmission,and recurrent myocardial infarction,and to observe the effect on the prognosis of coronary heart disease after PCI.Results:A total of 214 patients meeting the requirements were retrieved,in which 192 patients were successfully followed up,and 128 patients were included for PSM.Before and after PSM,exposed group angina readmission rate and recurrence rate of myocardial infarction were lower than those of non-exposed group.Kaplan-Meier analysis showed that the nodes in the same follow-up events exposed group angina readmission rate and recurrence of myocardial infarction were lower than the critical.Cox analysis showed that the intervention was angina pectoris of TCM hospital again and again hair protection factor in myocardial infarction.Conclusion:Western medicine combined with TCM can reduce angina pectoris readmission rate and recurrent rate of myocardial infarction,and improve the long-

关 键 词：中医药干预 冠心病经皮冠状动脉介入术术后心绞痛 络病理论 队列研究 远期预后 

分 类 号：R256.22[医药卫生—中医内科学] R541.4[医药卫生—中医学]