基于络病理论探讨冠心汤治疗气虚血瘀型心绞痛临床研究  

Clinical Study of Guanxin Decoction in the Treatment of Patients with Angina Pectoris with Qi Deficiency and Blood Stasis Type Based on the Collateral Disease Theory

作　　者：王雪梅 宋广朴 李文大 张彩英 刘俊鹤 WANG Xuemei;SONG Guangpu;LI Wenda;ZHANG Caiying;LIU Junhe(Langfang Fourth People's Hospital,Langfang,Hebei,China 065700;Tangshan Nanhu Hospital,Tangshan,Hebei,China 063013;Guye District Traditional Chinese Medicine Hospital of Tangshan City,Tangshan,Hebei,China 063100)

机构地区：[1]河北省廊坊市第四人民医院,河北廊坊065700 [2]河北省唐山市南湖医院,河北唐山063013 [3]河北省唐山市古冶区中医医院,河北唐山063100

出　　处：《中国药业》2025年第3期89-93,共5页China Pharmaceuticals

基　　金：河北省中医药管理局2022年中医药科研计划项目[2022578]。

摘　　要：目的基于络病理论探讨冠心汤治疗气虚血瘀型心绞痛的临床疗效,以及对患者心率变异性、心肌微循环及运动耐量的影响。方法选取河北省廊坊市第四人民医院2022年1月至2023年1月收治的气虚血瘀型心绞痛患者112例,按随机数字表法分为对照组和观察组,各56例。两组患者均予西药(美托洛尔+阿司匹林+硝酸甘油)对症治疗,观察组患者加用冠心汤治疗,两组患者均连续治疗6周。结果观察组总有效率为94.64%,显著高于对照组的80.36%(P=0.022)。治疗后,两组患者的心率变异性指标(高频功率、正常窦性心搏间期标准差、相邻窦性心搏间期差值>50 ms心搏数百分比、正常相邻窦性心搏间期差值平方根)均显著高于治疗前(P<0.05),且观察组均显著高于对照组(P<0.001);两组患者的6 min步行试验距离均显著长于治疗前(P<0.05),中医证候积分均显著低于治疗前(P<0.05),且观察组均显著优于对照组(P<0.001);观察组患者的心肌微循环指标(左回旋支校正时间流帧计数、右冠状动脉校正时间流帧计数、左前降支校正时间流帧计数)均显著低于对照组(P<0.001);观察组患者的血流分级心肌灌注分级达到3级的占比为91.07%,显著高于对照组的75.00%(P=0.023)。两组患者的不良反应发生率相当(P=0.728)。结论冠心汤治疗气虚血瘀型心绞痛的临床疗效良好,可缓解患者的临床症状,改善心率变异性、运动耐量及心肌微循环指标,且安全性良好。Objective To investigate the clinical efficacy of Guanxin Decoction in the treatment of patients with angina pectoris with Qi deficiency and blood stasis type based on the collateral disease theory,and its effect on heart rate variability,myocardial microcirculation,and exercise tolerance.Methods A total of 112 patients with angina pectoris with Qi deficiency and blood stasis type admitted to the Langfang Fourth People's Hospital from January 2022 to January 2023 were selected and divided into the control group and the observation group by the random number table method,with 56 cases in each group.The patients in the two groups received symptomatic treatment with Western medicine(metoprolol+aspirin+nitroglycerin),on this basis,the patients in the observation group received additional treatment with Guanxin Decoction.Both groups were treated continuously for six weeks.Results The total effective rate in the observation group was 94.64%,which was significantly higher than 80.36%in the control group(P=0.022).After treatment,the heart rate variability indexes[high-frequency power(HF),standard deviation of normal sinus intervals(SDNN),percentage of adjacent normal RR intervals differing>50 ms(PNN50),and square root of difference of normal adjacent sinus boreal interval(RMSSD)]in the two groups were significantly higher than those before treatment(P<0.05),and those in the observation group were significantly higher than those in the control group(P<0.001).The 6-minute walk test(6MWT)distances in the two groups were significantly longer than those before treatment(P<0.05),while the TCM syndrome scores in the two groups were significantly lower than those before treatment(P<0.05),and those in the observation group were significantly better than those in the control group(P<0.001).The myocardial microcirculation indexes[left circumflex corrected time flow frame count(LCX CTFC),right coronary artery corrected time flow frame count(RCA CTFC),and left anterior descending artery corrected time flow frame count(LAD CTFC)]in th

关 键 词：络病理论 冠心汤 气虚血瘀型 心绞痛 心率变异性 心肌微循环 运动耐量 

分 类 号：R932[医药卫生—生药学] R285.6[医药卫生—药学]