【作者】 钱晨；

【导师】 刘庆军；

【作者基本信息】 南京中医药大学 ， 中医学（中西医结合）（本硕连读）（专业学位）， 2016， 硕士

【摘要】 目的：观察急性心梗PCI术后中医证型分布,以及补阳还五汤加减对于急性心肌梗死PCI术后气虚血瘀型患者心室重构的影响。方法：在江苏省昆山市中医院心血管内科行急诊PCI术的急性心肌梗死患者160例,术前、术后1周进行中医辨证分型,观察急性心梗患者PCI术后中医证型的变化。再选取60例急性心梗PCI术后气虚血瘀型患者,随机分为治疗组(n=30)和对照组(n=30),治疗组采用常规西药联合补阳还五汤加减治疗；对照组仅采用常规西药治疗。两组疗程均为3个月,比较两组患者中医证候积分、心功能水平及心室结构等方面的差异。结果： (1)急性心梗患者PCI术后气虚血瘀证的发生率较术前明显升高,且术后气虚血瘀证明显多于非气虚血瘀证(痰瘀互阻证、寒凝心脉证、正虚阳脱证),具有统计学意义(P<0.05)。(2)中药治疗组和对照组经治疗后,中医证候定量积分均下降(P<0.05),且治疗组积分下降更为明显,具有统计学意义(P<0.01)；两组LVEF值较治疗前均有提高(P<0.05),治疗组治疗效果更优于对照组,有统计学意义(P<0.01)；与治疗前相比,两组血清BNP水平均有所下降(P<0.05),治疗组下降更为明显,与对照组相比有显著统计学意义(P<0.01)；两组患者治疗后LVIDd、LVIDs均减小(P<0.05),但与对照组相比,治疗组减小更为明显,有统计学意义(P<0.05)。结论： (1)AMI急诊PCI术后气虚血瘀型最为常见； (2)补阳还五汤加减可改善患者中医临床症状、提高心功能水平,抑制或逆转心室重构。更多还原

【Abstract】 ObjectivesrTo observe distribution of TCM (traditional Chinese Medicine) syndromes after the PCI of patients with acute myocardial infarction; evaluate the effect of Modified Buyanghuanwu Decoction on ventrivular remodeling of patients with AMI who had treated by Percutaneous Coronary Intervention(PCI), and were belong to qi deficiency and blood stasis in the traditional Chinese Medicine.Methods:Choose 160 patients with AMI who had an operation of PCI in the Vasculocardiology Deparment of TCM Hospital of Kunshan in Jiangsu province, in the eastern China. Conduct TCM syndrome differentiation and classify before and 1 week after the operation, and observe the changes of TCM syndrome types after the operation. Afterwards, randomly divide 60 patients with AMI, who suffer from qi deficiency and blood stasis after PCI, into a therapy group (n=30) and a control group (n=30). Patients in the therapy group are treated with western medicine and Modified Buyanghuanwu Decoction, while those in control group only take western medical treatment. After three-month treatment, compare the patients in both groups in terms of TCM syndrome integral, cardiac function level, and ventricular structure.Results:(1)The incident rate of qi deficiency and blood stasis type after AMI-PCI surgery is going higher than that before the operation, and patients suffer from qi deficiency and blood stasis type significantly outnumber those with other syndrome types (such as phlegm and blood stasis, cold congelation, and vital qi deficiency and yang collapse), with statistical significance (P<0.05).(2)Both groups are reported declines in TCM syndrome integral, comparing with that before the treatment (P<0.05), particularly symptom score reducing in the therapy group even more remarkable, representing statistical significance (P<0.01); LVEF in both groups increase in comparison with the pre-operation (P<0.05), and the therapy group is superior to the control group, with statistical significance (P<0.01); In comparison with the pre-operation, the BNP level declines in the two groups (P<0.05), especially more significant difference in the therapy group, which has extraordinarily statistical greatness (P<O.01); After treatment, patients in both groups are reported with the reduction in LVIDd and LVIDs levels (P<0.05). Comparing with the control group, the reduction in the therapy groups are even more significant, with statistical significance (P<0.05).Conclusion:(1) Qi deficiency and blood stasis type is the most common syndrome type diagnosed among patients with AMI after PCI.(2) The Modified Buyanghuanwu Decoction plays a significant role in improving TCM clinical symptom, enhancing cardiac function level, inhibiting or reversing ventricular remodeling.更多还原