通心络胶囊干预急性心肌梗死早期血运重建后自发性改善的临床研究

目的观察和评价通心络胶囊对急性心肌梗死(AMI)患者早期血运重建(CVR)后室壁运动异常节段恢复规律。方法112例AMI患者均为成功实施经皮冠脉介入治疗(PCI)或溶栓治疗者，随机分为两组，分别用常规药物(对照组52例)和常规药物加通心络胶囊(干预组60例)治疗，于PCI后或溶栓后不同时间点观察多普勒二维超声心动图(2DE)的室壁运动异常节段、左室舒张末容积(LVEDV)、左室射血分数(LVEF)等变化。结果(1)AMI患者CVR后1周、2周和1个月时自发改善2DE异常运动节段恢复率，干预组(11．9％、18．1％和18．8％)均明显高于对照组(4．1％、8．3％和11．1％，P<0．05)；3个月时两组相当；6个月时干预组恢复率(70．02％)显著高于对照组(51．68％，P<0．01)。(2)CVR后1周时两组LVEDV相当：但2周和1个月时对照组较干预组均明显增加(P<0．05)；3、6个月时对照组无显著改变，而干预组显著减小(P<0．01)。(3)CVR后1周、2周和1个月时LVEF自发改善两组比较差异无显著性；3、6个月时干预组均较对照组显著改善(P<0．01)，对照组LVEF无显著改变。结论常规西药结合通心络胶囊干预后可以显著缩小心肌梗死面积，改善左室收缩功能，预防心室重构。

Clinical Study on Spontaneous Improvement after Blood Flow Reconstruction Interfered by Tongxinluo Capsule in Patients with Early Stage Acute Myocardial Infarction

OBJECTIVE: To observe and evaluate the effect of tongxinluo capsule (TXL) on recovery of ventricular wall with segmental dyskinesia in patients with early stage acute myocardial infarction (AMI). METHODS: One hundred and twelve AMI patients after percutaneous coronary intervention (PCI) or fibrinolytic therapy, were randomly divided into 2 groups, the control group (CG) treated with conventional medicine and the interfered group (IG) treated with conventional medicine plus TXL. The changes of ventricular wall motion, left ventricular end diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were observed at different time points (1-w, 2-w, 1-m, 3-m and 6-m) after PCI by using two dimensional echocardiography (2DE). RESULTS: The ventricular dyskinetic segment recovery rate at 1-w, 2-w, 1-m and 6-m in IG was 11.9%, 18.1%, 18.8% and 70.02% respectively, which was significantly higher than the respective rates in CG (4.1%, 8.3%, 11.1% and 51.68%, P < 0.01), but the 3-m recovery rate in the two groups was insignificantly different. LVEDV increase rate in the two groups at 1-w was insignificantly different, but it significantly increased at 2-w and 1-m, and showed a higher rate in CG (P < 0.05). However, at 3-m and 6-m, it significantly decreased in IG but was insignificantly changed in CG. Improvement of LVEF was insignificant at 1-w, 2-w and 1-m in both groups, but at 3-m and 6-m, LVEF was significantly improved in the interfered group (P < 0.01), but still showed no obvious change in the control group. CONCLUSION: Conventional western medicine combined with TXL can significantly decrease the infarction area, improve left ventricular diastolic function in patients with AMI.