【摘要】 目的 观察麝香保心丸治疗冠心病心绞痛并轻中度焦虑抑郁状态患者的疗效，为中医药治疗双心疾病提供临床依据。方法 选择2019年8月—2020年7月在中南大学湘雅医院心内科门诊治疗的冠心病心绞痛并轻中度焦虑抑郁状态患者240例，随机单盲分为治疗组、对照组，2组均给予冠心病常规药物联合坦度螺酮抗焦虑抑郁治疗，治疗组在此基础上加麝香保心丸口服(2丸/次，每日3次),对照组则加安慰剂口服(2丸/次，每日3次),2组均治疗3个月。观察2组患者治疗前后心绞痛症状及加拿大心绞痛CCSC分级、舌下含服硝酸甘油每周用量、运动平板试验、广泛焦虑问卷7项(GAD-7)评分、患者健康问卷-9项(PHQ-9)评分和心血管不良事件。结果 与治疗前比较，2组治疗后心绞痛每周发作频率降低，舌下含服硝酸甘油每周用量减少，心绞痛CCSC分级Ⅰ、Ⅱ级者比例增加，Ⅲ级、Ⅳ级者比例减少，差异均有统计学意义(P均<0.05);治疗组治疗后心绞痛每周发作频率低于对照组，舌下含服硝酸甘油每周用量少于对照组，心绞痛CCSC分级Ⅰ、Ⅱ级者比例高于对照组，Ⅲ级、Ⅳ级者比例低于对照组，心绞痛CCSC分级改善至少1级者百分率高于对照组，差异均有统计学意义(P均<0.05)。与治疗前比较，2组治疗后运动平板试验各指标均明显改善(P均<0.05),且治疗组治疗后各指标改善情况均明显优于对照组(P均<0.05)。与治疗前比较，2组治疗后GAD-7与PHQ-9评分均明显降低(P均<0.05),且治疗组治疗后GAD-7与PHQ-9评分均明显低于对照组(P均<0.05)。治疗组心血管不良事件发生率低于对照组，但差异无统计学意义(P>0.05)。结论 在常规药物治疗基础上联用麝香保心丸不仅可进一步改善冠心病心绞痛并轻中度焦虑抑郁状态患者心绞痛症状和心肌缺血情况，还可有效减轻患者焦虑抑郁状态。更多还原

【Abstract】 Objective It is to observe the curative effect of Shexiang Baoxin Pill in the treatment of coronary heart disease with angina pectoris and mild to moderate anxiety and depression, and to provide some clinical evidences for the treatment of double heart disease with traditional Chinese medicine. Methods A total of 240 patients with coronary heart disease angina pectoris and mild to moderate anxiety and depression who were treated in the Department of Cardiology, Xiangya Hospital of Central South University from August 2019 to July 2020 were selected and randomly and single-blindly divided into treatment group and control group. Both groups were given conventional drugs of coronary heart disease combined with tandospirenone for anti-anxiety and depression. Additionally, the treatment group was given Shexiang Baoxin Pill orally(2 pills/time, 3 times a day), the control group was given a placebo orally(2 pills/time, 3 times a day), and both groups were treated for 3 months. The symptoms of angina pectoris, Canadian angina pectoris CCSC classification, weekly dosage of sublingual nitroglycerin, exercise treadmill test, scores of Generalized Anxiexy Disorde-7(GAD-7) and Patient Health Questionnaire-9(PHQ-9) were observed before and after treatment and adverse cardiovascular events were recorded in the two groups. Results Compared with before treatment, the weekly attack frequency of angina pectoris and the weekly dosage of sublingual nitroglycerin were decreased, the proportion of angina pectoris CCSC classification I and II was increased, and the proportion of Ⅲ and Ⅳ classification was decreased after treatment in the two groups, and the differences were significant(all P<0.05). After treatment, the weekly frequency of angina pectoris was lower and the weekly dosage of sublingual nitroglycerin was less in the treatment group than those in the control group, and the proportion of angina pectoris CCSC classification Ⅰ and Ⅱ was higher while the proportion of classification Ⅲ and Ⅳ was lower than those of the control group, and the percentage of the CCSC classification of angina pectoris improved by at least one grade was higher than that of the control group, and the differences were statistically significant(all P<0.05). Compared with before treatment, each index of exercise treadmill test was significantly improved in both groups after treatment(P<0.05), and the improvement of each index in the treatment group after treatment was significantly better than that in the control group(P<0.05). Compared with before treatment, the scores of GAD-7 and PHQ-9 in both groups after treatment were significantly decreased(P<0.05), and the scores of GAD-7 and PHQ-9 in the treatment group were significantly lower than those in the control group after treatment(both P<0.05). The incidence of cardiovascular adverse events in the treatment group was lower than that in the control group, but the difference was not statistically significant(P>0.05). Conclusion Combination of Shexiang Baoxin Pills on the basis of conventional drug treatment can not only further improve the symptoms of angina pectoris and myocardial ischemia, but also effectively alleviate the anxiety and depression in patients with coronary heart disease angina pectoris and mild to moderate anxiety and depression.更多还原