丹参川芎嗪注射液联合替格瑞洛治疗不稳定型心绞痛的临床研究

目的探讨丹参川芎嗪注射液联合替格瑞洛片对不稳定型心绞痛行经皮冠状动脉介入术(PCI)术后治疗的临床疗效。方法选取2015年9月—2017年8月海南省人民医院收治的不稳定型心绞痛患者108例为研究对象,所有患者均成功择期行PCI治疗随机分为对照组和治疗组,每组各54例。对照组口服替格瑞洛片,首次负荷量180 mg/次,1次/d,此后90mg/次,2次/d。治疗组在对照组治疗的基础上静脉滴注丹参川芎嗪注射液,10 m L加入到5%葡萄糖溶液250 m L中,1次/d。两组患者均连续治疗14 d。观察两组的临床疗效,比较两组的心绞痛发作情况、心功能指标、生活质量、心肌酶学和内皮功能指标。结果治疗后,对照组和治疗组的心电图疗效总有效率分别为75.9%、92.6%,两组比较差异有统计学意义(P0.05)。治疗后,对照组和治疗组的心绞痛疗效总有效率分别为74.1%、90.7%,两组比较差异有统计学意义(P0.05)。治疗后,两组心绞痛发作频率、发作持续时间、硝酸甘油日消耗量显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组心绞痛发作情况明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组每搏输出量(SV)、射血分数(EF)和西雅图心绞痛调查量表(SAQ)评分均明显升高,纽约心脏协会(NYHA)分级明显下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组N末端B型钠尿肽原(NT-pro BNP)、心肌钙蛋白(c Tn T)和肌酸激酶同工酶(CK-MB)水平显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组心肌酶学指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组内皮素-1(ET-1)和血小板源性生长因子(PDGF)水平明显下降,一氧化氮(NO)和血管内皮生长因子(VEGF)水平明显升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组内皮功能指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论丹参川芎嗪注射液联合替格瑞洛片治疗PCI术后不稳定型心绞痛具有较好的临床疗效,能改善临床症状和心功能指标,调节心肌酶学指标和内皮功能指标,提升患者生活质量,具有一定的临床推广应用价值。

Clinical study of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with ticagrelor in treatment of unstable angina pectoris

Objective To investigate the effect of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with Ticagrelor Tablets in treatment of unstable angina pectoris after PCI operation. Methods Patients (108 cases) with unstable angina pectoris in Hainan General Hospital from September 2015 to August 2017 were randomly divided into control and treatment groups, and each group had 54 cases. Patients in the control group were po administered with Ticagrelor Tablets, the first time 180 mg/time, once daily, then 90 mg/time, twice daily. Patients in the treatment group were iv administered with Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection on the basis of the control group, 10 mL added into 5% glucose solution 250 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and angina pectoris condition, cardiac function indexes, quality of life, myocardial enzymology indexes, and endothelial function indexes in two groups were compared. Results After treatment, the electrocardiogram efficacies in the control and treatment groups were 75.9% and 92.6%, respectively, and there was difference between two groups (P < 0.05). After treatment, the efficacies of angina pectoris in the control and treatment groups were 74.1% and 90.7%, respectively, and there was difference between two groups (P < 0.05). After treatment, the frequency and duration of angina pectoris and the daily consumption of nitroglycerin in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the angina pectoris conditions in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, SV, EF, and SAQ scores in two groups were significantly increased, but NYHA grade in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of NT-proBNP, cTnT, and CK-MB in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the myocardial enzymology indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of ET-1 and PDGF in two groups were significantly decreased, but the levels of NO and VEGF in two groups were significantly increased, and the difference was statistically significant in the same group (P< 0.05). And the endothelial function indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with Ticagrelor Tablets has clinical curative effect in treatment of unstable angina pectoris after PCI operation, can improve clinical symptoms and cardiac function indexes, regulate myocardial enzymology indexes and endothelial function indexes, increase quality of life, which has a certain clinical application value.