[1]艾克荣,张 悦.温阳通脉汤治疗冠状动脉心肌桥伴频发心绞痛临床研究[J].陕西中医,2025,46(5):638-642.[doi:DOI:10.3969/j.issn.1000-7369.2025.05.013]
　AI Kerong,ZHANG Yue.The clinical efficacy of Wenyang Tongmai decoction in the treatment of coronary myocardial bridging with frequent angina[J].,2025,46(5):638-642.[doi:DOI:10.3969/j.issn.1000-7369.2025.05.013]
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温阳通脉汤治疗冠状动脉心肌桥伴频发心绞痛临床研究
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
46
期数:
2025年5期
页码:
638-642
栏目:
临床研究
出版日期:
2025-05-05

文章信息/Info

Title:
The clinical efficacy of Wenyang Tongmai decoction in the treatment of coronary myocardial bridging with frequent angina
作者:
艾克荣; 张 悦
(西安市中医医院心血管病院,陕西 西安 710021)
Author(s):
AI Kerong; ZHANG Yue
(Cardiovascular Hospital,Xi'an Hospital of Traditional Chinese Medicine,Xi'an 710021,China)
关键词:
冠状动脉疾病;  心肌桥;  心绞痛;  胸痹;  气虚血瘀证;  温阳通脉汤
Keywords:
Coronary artery disease;  Myocardial bridge;  Angina;  Chest palsy;  Qi deficiency and blood stasis syndrome;  Wenyang Tongmai decoction
分类号:
R 541.4
DOI:
DOI:10.3969/j.issn.1000-7369.2025.05.013
文献标志码:
A
摘要:
目的:观察温阳通脉汤治疗冠状动脉心肌桥(MB)伴频发心绞痛的临床疗效。方法:将冠状动脉MB伴频发心绞痛患者82例随机分为两组,对照组(41例)给予酒石酸美托洛尔片口服治疗,观察组(41例)在对照组基础上加用温阳通脉汤治疗,疗程为4周。记录两临床疗效,比较两组治疗前后中医证候积分、心绞痛发作情况(发作频率和发作持续时间)、运动耐量[6 min步行试验距离(6MWD)]、平板运动心电图试验相关指标和西雅图心绞痛量表(SAQ)的变化情况。结果:观察组临床症状改善的总有效率为92.68%明显高于对照组的73.17%(P<0.05)。观察组心电图改善的总有效率为87.80%明显高于对照组的70.73%(P<0.05)。与治疗前比较,两组治疗后的中医证候积分、心绞痛发作频率和发作持续时间均明显减少,6MWD增加,且观察组改善情况均优于对照组(P<0.05)。治疗后两组运动后诱发心绞痛时间现在延长,ST段压低最大幅度降低、ST段改变的导联数减少、ST段下移1 mm时间和ST段改变恢复至运动前时间缩短(P<0.05),且观察组上述指标改善情况均优于对照组(P<0.05)。两组治疗后SAQ量表各维度评分[心绞痛发作情况(AF)、躯体活动受限程度(PL)、心绞痛稳定状态(AS)、疾病认知程度(DS)、治疗满意程度(TS)]和总分均增加(P<0.05),且观察组增加幅度大于对照组(P<0.05)。结论:在美托洛尔治疗基础上加用温阳通脉汤能够显著缓解冠状动脉MB伴频发心绞痛患者的临床症状,降低心绞痛发作频率和时间,提高运动耐量,改善平板运动心电图试验相关指标和生活质量。
Abstract:
Objective:To observe the clinical efficacy of Wenyang Tongmai decoction in the treatment of coronary myocardial bridge(MB)with frequent angina.Methods:A total of 82 patients with coronary MB with frequent angina pectoris were randomly divided into two groups:the control group(41 cases)was treated with metoprolol tartrate tablets orally,and the observation group(41 cases)was treated with Wenyang Tongmai decoction on the basis of the control group,and the course of treatment was 4 weeks.The clinical efficacy of the two groups was recorded,and the changes in TCM syndrome scores,angina pectoris attacks(attack frequency and attack duration),exercise tolerance [6-minute walk test distance(6MWD)],treadmill exercise ECG test and Seattle angina scale(SAQ)were compared between the two groups before and after treatment.Results:The total effective rate of clinical symptom improvement in the observation group was 92.68%,which was significantly higher than that in the control group(73.17%)(P<0.05).The total effective rate of ECG improvement in the observation group was 87.80%,which was significantly higher than that in the control group(70.73%)(P<0.05).Compared with the two groups before treatment,the TCM syndrome score,angina attack frequency and attack duration of the two groups were significantly reduced,and the 6MWD was increased,and the improvement of the observation group was better than that of the control group(P<0.05).After treatment,the time of post-exercise induced angina pectoris in the two groups was now prolonged,the ST-segment depression was reduced to the maximum,the number of ST-segment changes was reduced,the ST-segment shift was reduced by 1 mm,and the time for ST-segment changes to return to pre-exercise was shortened(P<0.05),and the improvement of the above indicators in the observation group was better than that in the control group(P<0.05).After treatment,the scores of each dimension of the SAQ scale [angina attack(AF),physical activity limitation(PL),angina pectoris stability(AS),disease awareness(DS),treatment satisfaction(TS)] and total score of the SAQ scale increased in the two groups(P<0.05),and the increase in the observation group was greater than that in the control group(P<0.05).Conclusion:The addition of Wenyang Tongmai decoction on the basis of metoprolol treatment can significantly alleviate the clinical symptoms of patients with coronary MB with frequent angina,reduce the frequency and duration of angina pectoris,improve exercise tolerance,and improve the relevant indexes and quality of life of treadmill exercise ECG test.

参考文献/References:

[1] DANEK B A,KEARNEY K,STEINBERG Z L.Clinically significant myocardial bridging[J].Heart,2023,110(2):81-86.
[2] 王猛,范兴满,王全龙,等.定量血流分数在冠状动脉心肌桥血流动力学评估中的应用价值[J].中华心血管病杂志,2024,52(2):165-171.
[3] 曹敏,黄斐,余亚鹏.琥珀酸美托洛尔缓释片结合复心合剂治疗冠状动脉心肌桥心绞痛的效果及对血管内皮功能的影响[J].中国医学创新,2024,21(14):48-52.
[4] 闫少华,耿巍,张翔宇,等.冠状动脉心肌桥对心血管事件的影响:Meta分析[J].心血管康复医学杂志,2023,32(3):234-238.
[5] 刘之然,吴希泽,王晓玉,等.庞敏“五位一体”诊疗思路治疗心肌桥经验[J].辽宁中医杂志,2024,51(2):49-53.
[6] 谭薪兴,杨霞,李应宏,等.2012-2022年中医药治疗稳定型心绞痛的研究进展[J].中国中医基础医学杂志,2024,30(5):888-892.
[7] 张志寿.冠状动脉心肌桥现代诊断与治疗 [M].北京:金盾出版社,2010:135-136.
[8] 中国研究型医院学会《冠状动脉心肌桥诊断与治疗专家共识》专家组.冠状动脉心肌桥诊断与治疗的专家共识[J].中国研究型医院,2022,9(5):1-8.
[9] 朱文锋.中医诊断学[M].北京:中国中医药出版社,2004:152.
[10] 中华中医药学会内科分会心病专业委员会.中医心病之心绞痛诊断与疗效标准[J].中国医药学报,2004,19(10):581-583.
[11] 王阶,何庆勇,姚魁武,等.冠心病心绞痛病证结合疗效评价标准的研究[J].中医杂志,2008,49(9):842-844.
[12] 国家食品药品监督管理局.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:23-25.
[13] 李翔,杨旭.6 min步行试验在心脏康复中的作用[J].中国临床医生杂志,2018,46(5):507-510.
[14] 刘淑红.西雅图心绞痛量表(SAQ)中文译本的信度、效度、反应度[D].天津:天津医科大学,2003.
[15] ROVERA C,MORETTI C,BISANTI F,et al.Myocardial bridging:Review on the role of coronary computed tomography angiography[J].J Clin Med,2023,12(18):5949.
[16] VELIBEY Y,YUKSEL G,RENDA E,et al.Myocardial bridging in multiple coronary arteries[J].Acta Cardiol,2022,77(1):93-94.
[17] 刘曙杰,寻增艳.地尔硫卓联合支架植入术治疗冠状动脉心肌桥临床疗效观察[J].陕西医学杂志,2021,50(9):1139-1142.
[18] 吴希泽,康健,刘之然,等.基于倾向性评分匹配法评价调畅气机法治疗心肌桥回顾性队列研究[J].辽宁中医杂志,2024,51(2):33-38.
[19] 王晓玉.中医药治疗心肌桥的Meta分析和网络药理学研究[D].沈阳:辽宁中医药大学,2023.
[20] 吴希泽,庞敏.中医治疗心肌桥的研究概况[J].实用中医内科杂志,2022,36(1):71-74.
[21] 张根生,汤继海,王进京,等.黄芪通痹汤联合尼可地尔片治疗心肾阳虚证冠心病稳定型心绞痛患者的疗效观察[J].世界中西医结合杂志,2024,19(4):764-768,773.
[22] 陈前,申楚翘,程凯,等.当归补血汤调节自噬干预心肌梗死模型大鼠心肌损伤的作用机制[J].安徽中医药大学学报,2023,42(1):92-97.
[23] 陈启庭,林洪,陈利捷,等.基于GEO数据库联合网络药理学研究川芎-赤芍药对治疗动脉粥样硬化的药理过程及分子机制[J].中国医院用药评价与分析,2024,24(6):655-661.
[24] 曾建勇,王小玲,范小虹,等.复方丹参滴丸联合阿托伐他汀治疗冠心病合并心绞痛疗效及对患者氧化应激指标的影响[J].陕西中医,2023,44(1):55-59.
[25] 万进,李七一,王光耀,等.心肌桥患者平板运动试验分析[J].中华心血管病杂志,2012,40(7):593-596.

备注/Memo

备注/Memo:
[基金项目]陕西省自然科学基础研究计划项目(202224JC-YBMS-753)
更新日期/Last Update: 2025-05-08