肉蔻五味丸联合替格瑞洛治疗急性非ST段抬高型心肌梗死的临床研究

目的探讨肉蔻五味丸联合替格瑞洛治疗急性非ST段抬高型心肌梗死(NSTEMI)的临床效果。方法选取2017年7月—2019年7月中国人民武装警察部队北京市总队医院收治的96例NSTEMI患者,随机分为对照组和治疗组每组各48例。对照组口服替格瑞洛片,180 mg首剂负荷,继以90 mg/次、2次/d维持。治疗组患者在对照组基础上口服肉蔻五味丸,2 g/次,3次/d。两组均连续治疗2周。观察两组临床疗效,比较两组治疗前后心电图参数、血清心脏损伤标志物水平、血小板最大聚集率(MAR)及血浆血小板α-颗粒膜蛋白-140(GMP-140)、D-二聚体(D-D)、纤维蛋白原(FIB)变化。结果治疗后,对照组和治疗组的总有效率分别是77.1%、91.7%,两组比较差异具有统计学意义(P0.05)。治疗后,两组ST段下移幅度较治疗前均显著缩小,心肌缺血总时间均显著缩短,心肌缺血总负荷(TIB)则均显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组上述心电图参数的改善效果均显著优于对照组,两组比较差异具有统计学意义(P0.05)。两组治疗后心肌肌钙蛋白(c Tn)I、肌酸激酶同工酶(CK-MB)、心脏脂肪酸结合蛋白(H-FABP)、N末端B型利钠肽原(NT-proBNP)水平均显著下降,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些血清心脏损伤标志物水平显著低于对照组,两组比较差异具有统计学意义(P0.05)。两组治疗后MAR、GMP-140、D-D、FIB水平均显著低于治疗前,同组治疗前后比较差异有统计学意义(P0.05);且治疗后,治疗组MAR、GMP-140、D-D、FIB水平较对照组同期均显著更低,两组比较差异具有统计学意义(P0.05)。结论肉蔻五味丸联合替格瑞洛治疗NSTEMI的整体疗效确切,可明显改善患者心肌缺血状态,抑制血栓形成,减轻心肌损伤,具有一定的临床推广应用价值。

Clinical study on Roukou Wuwei Pills combined with ticagrelor in treatment of acute non-ST-segment elevation myocardial infarction

Objective To investigate the clinical effect of Roukou Wuwei Pills combined with ticagrelor in treatment of acute non-ST-segment elevation myocardial infarction. Methods Patients (96 cases) with acute non-ST-segment elevation myocardial infarction in Beijing General Hospital of the Chinese People''s Armed Police Force from July 2017 to July 2019 were randomly divided into control (48 cases) and treatment (48 cases) groups. Patients in the control group were po administered with Ticagrelor Tablets, the first dosage wsa 180 mg, and maintained at 90 mg/time and twice daily. Patients in the treatment group were po administered with Roukou Wuwei Pills on the basis on the control group, 2 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of electrocardiogram parameters, serum cardiac injury marker levels, MAR, GMP-140, D-D, and FIB in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 77.1% and 91.7%, respectively, and there were differences between two groups (P<0.05). Compared with before treatment, the downshifting amplitude of ST segment in both groups was significantly reduced, and the total time of myocardial ischemia was significantly shortened, and the total myocardial ischemic load (TIB) was significantly reduced, and there were differences in the same group (P<0.05). After treatment, the improvement effects of the above electrocardiogram parameters in the treatment group were significantly better than those in the control group, and there were differences between two groups (P<0.05). After treatment, cTnI, CK-MB, H-FABP, and NT-proBNP were significantly reduced, and there were differences in the same group (P<0.05). After treatment, the serum cardiac injury markers were significantly lower in the treatment group than in the control group, and there were differences between two groups (P<0.05). After treatment, MAR, GMP-140, D-D, and FIB were significantly reduced, and there were differences in the same group (P<0.05). After treatment, MAR, GMP-140, D-D, and FIB were lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Roukou Wuwei Pills combined with ticagrelor has overall efficacy in treatment of acute non-ST-segment elevation myocardial infarction, and can significantly improve the myocardial ischemia status of patients, and can inhibit thrombosis and reduce myocardial injury, which has a certain clinical application value.