温阳通脉汤治疗冠状动脉心肌桥伴频发心绞痛临床研究  

The clinical efficacy of Wenyang Tongmai decoction in the treatment of coronary myocardial bridging with frequent angina

作　　者：艾克荣 张悦 AI Kerong;ZHANG Yue(Cardiovascular Hospital,Xi’an Hospital of Traditional Chinese Medicine,Xi’an 710021,China)

机构地区：[1]西安市中医医院心血管病院,陕西西安710021

出　　处：《陕西中医》2025年第5期638-642,共5页Shaanxi Journal of Traditional Chinese Medicine

基　　金：陕西省自然科学基础研究计划项目(202224JC-YBMS-753)。

摘　　要：目的:观察温阳通脉汤治疗冠状动脉心肌桥(MB)伴频发心绞痛的临床疗效。方法:将冠状动脉MB伴频发心绞痛患者82例随机分为两组,对照组(41例)给予酒石酸美托洛尔片口服治疗,观察组(41例)在对照组基础上加用温阳通脉汤治疗,疗程为4周。记录两临床疗效,比较两组治疗前后中医证候积分、心绞痛发作情况(发作频率和发作持续时间)、运动耐量[6 min步行试验距离(6MWD)]、平板运动心电图试验相关指标和西雅图心绞痛量表(SAQ)的变化情况。结果:观察组临床症状改善的总有效率为92.68%明显高于对照组的73.17%(P<0.05)。观察组心电图改善的总有效率为87.80%明显高于对照组的70.73%(P<0.05)。与治疗前比较,两组治疗后的中医证候积分、心绞痛发作频率和发作持续时间均明显减少,6MWD增加,且观察组改善情况均优于对照组(P<0.05)。治疗后两组运动后诱发心绞痛时间现在延长,ST段压低最大幅度降低、ST段改变的导联数减少、ST段下移1 mm时间和ST段改变恢复至运动前时间缩短(P<0.05),且观察组上述指标改善情况均优于对照组(P<0.05)。两组治疗后SAQ量表各维度评分[心绞痛发作情况(AF)、躯体活动受限程度(PL)、心绞痛稳定状态(AS)、疾病认知程度(DS)、治疗满意程度(TS)]和总分均增加(P<0.05),且观察组增加幅度大于对照组(P<0.05)。结论:在美托洛尔治疗基础上加用温阳通脉汤能够显著缓解冠状动脉MB伴频发心绞痛患者的临床症状,降低心绞痛发作频率和时间,提高运动耐量,改善平板运动心电图试验相关指标和生活质量。Objective:To observe the clinical efficacy of Wenyang Tongmai decoction in the treatment of coronary myocardial bridge(MB)with frequent angina.Methods:A total of 82 patients with coronary MB with frequent angina pectoris were randomly divided into two groups:the control group(41 cases)was treated with metoprolol tartrate tablets orally,and the observation group(41 cases)was treated with Wenyang Tongmai decoction on the basis of the control group,and the course of treatment was 4 weeks.The clinical efficacy of the two groups was recorded,and the changes in TCM syndrome scores,angina pectoris attacks(attack frequency and attack duration),exercise tolerance[6-minute walk test distance(6MWD)],treadmill exercise ECG test and Seattle angina scale(SAQ)were compared between the two groups before and after treatment.Results:The total effective rate of clinical symptom improvement in the observation group was 92.68%,which was significantly higher than that in the control group(73.17%)(P<0.05).The total effective rate of ECG improvement in the observation group was 87.80%,which was significantly higher than that in the control group(70.73%)(P<0.05).Compared with the two groups before treatment,the TCM syndrome score,angina attack frequency and attack duration of the two groups were significantly reduced,and the 6MWD was increased,and the improvement of the observation group was better than that of the control group(P<0.05).After treatment,the time of post-exercise induced angina pectoris in the two groups was now prolonged,the ST-segment depression was reduced to the maximum,the number of ST-segment changes was reduced,the ST-segment shift was reduced by 1 mm,and the time for ST-segment changes to return to pre-exercise was shortened(P<0.05),and the improvement of the above indicators in the observation group was better than that in the control group(P<0.05).After treatment,the scores of each dimension of the SAQ scale[angina attack(AF),physical activity limitation(PL),angina pectoris stability(AS),disease awareness(DS),tre

关 键 词：冠状动脉疾病 心肌桥 心绞痛 胸痹 气虚血瘀证 温阳通脉汤 

分 类 号：R541.4[医药卫生—心血管疾病]