益气养阴活血法对103例患者急性心肌梗死再灌注后心肌微循环的影响

目的观察益气养阴活血法对再灌注治疗后急性心肌梗死(acute myocardial infarction,AMI)患者进行干预的临床疗效,探讨其对梗死部位心肌组织微循环血流的作用。方法103例接受急诊直接经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗后的AMI患者(KillipⅠ-Ⅲ),按照随机、对照、双盲的原则分为2组,治疗组(51例)在西药常规治疗基础上加用益气养阴活血的丹参和西洋参制剂,对照组(52例)在西药常规治疗基础上加用安慰剂,观察2组在治疗3个月后心肌微循环血流灌注的变化。结果在治疗3个月后,多巴酚丁胺负荷状态下,治疗组左心室射血分数(LVEF)增至68.40%±10.01%,正常心肌百分比(NCMP)增至89.61%±12.00%,A值显著改善的室壁节段数(NA)增至11.53±3.16,组间比较,治疗组LVEF、NCMP、NA均较对照组显著增加(P<0.05);2组治疗前后自身比较,治疗组LVEF值较治疗前增加显著(P<0.05);治疗前后组间比较,治疗组LVEF值与NA值增加大于对照组,差异有统计学意义(P<0.05)。结论益气养阴活血法可以有效改善AMI患者直接PCI术后的心肌微循环血流灌注,对心肌收缩储备改善有一定作用。

Effect of Replenishing Qi and Nourishing Yin to Promote the Blood Circulation on 103 Patients with Acute Myocardial Infarction after Reperfusion

Objective To evaluate the effect of replenishing Qi and nourishing Yin to promote the blood circulation on 103 patients with acute myocardial infarction(AMI) after reperfusion and observe the change of myocardial microcirculation. Methods A total of 103 patients with AMI who underwent successful immediate percutaneous coronary intervention(PCI) were randomized into two groups. Patients were treated with either Salvia and Ginseng of traditional Chinese medicine(TCM) group or fecula of corn in placebo group for three months. All patients were examined with myocardial contrast echocardiography(MCE) before and after 3-month treatment. Three indexes of myocardial microcirculation, i.e., left ventricular ejection fraction(LVEF), normal cardiac muscle percentage(NCMP), and the number of the segments where value A(contrast agent intensity) was improved significantly(NA) were assessed. Results Compared with the three indexes of the two groups at the 3rd month in the state of dobutamine stress(DS), all indexes were increased. After 3 months of treatment, LVEF, NCMP and NA of TCM group were higher than those of the placebo group(P<0.05 for all). LVEF of TCM group after 3-months treatment was higher than that of pre-treatment level(P<0.05). Compared with the three indexes between the two groups before and after treatment, LVEF and NA of TCM group increased significantly(P<0.05). Conclusion TCM with the effect of replenishing Qi and nourishing Yin to promote the blood circulation could be beneficial to myocardium microcirculation perfusion and improve the quality of life of the AMI patients who had successful reperfusion.