基于络病理论探讨冠心汤对气虚血瘀型心绞痛患者心率变异性、心肌微循环及运动耐量的影响

王雪梅；宋广朴；李文大；张彩英；刘俊鹤

文章摘要

王雪梅；宋广朴；李文大；张彩英；刘俊鹤.基于络病理论探讨冠心汤对气虚血瘀型心绞痛患者心率变异性、心肌微循环及运动耐量的影响[J].中医药信息,2024,41(2):56-61

基于络病理论探讨冠心汤对气虚血瘀型心绞痛患者心率变异性、心肌微循环及运动耐量的影响

Effect Study of Guanxin Decoction on Heart Rate Variability， Myocardial Microcirculation and Exercise Tolerance in Patients with Angina Pectoris of Qi Deficiency and Blood Stasis Type Based on the Theory of Collateral Disease

投稿时间：2023-05-26 录用日期：2023-07-17

DOI：10.19656/j.cnki.1002-2406.20240210

中文关键词: 络病理论冠心汤气虚血瘀型心绞痛心率变异性心肌微循环运动耐量

英文关键词: Collateral disease theory Guanxin Decoction Qi deficiency and blood stasis type Angina pectoris Heart rate variability Myocardial microcirculation Exercise tolerance

基金项目:课题基金：河北省2022年中医药科研计划项目（编号：2022578）

作者	单位
王雪梅；宋广朴；李文大；张彩英；刘俊鹤

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中文摘要:

目的：基于络病理论探讨冠心汤对气虚血瘀型心绞痛患者心率变异性、心肌微循环及运动耐量的影响。方法：选取符合纳入标准的112例气虚血瘀型心绞痛患者，依据随机数字表随机分为对照组和治疗组，每组各56例。对照组给予常规西药治疗，治疗组在对照组基础上口服冠心汤治疗，两组均治疗6周。比较两组患者治疗前后心率变异性指标［高频功率（HF）、正常窦性心搏间期标准差（SDNN）、相邻窦性心搏间期差值 > 50 ms心搏数百分比（PNN50）、正常相邻窦性心搏间期差值平方根（RMSSD）、运动耐量指标［6分钟步行试验（6MWT）］及中医证候积分的变化情况；比较两组患者治疗后心肌微循环指标，包括左回旋支校正时间流帧计数（LCX CTFC）、右冠脉校正时间流帧计数（RCA CTFC）、左前降支校正时间流帧计数（LAD CTFC）及TIMI心肌组织灌注分级（TMPG）达到3级标准的占比情况；比较两组患者临床疗效与不良反应发生情况。结果：治疗后，两组患者心率变异性指标HF、SDNN、PNN50及RMSSD水平均高于治疗前（P < 0.05），且治疗组高于对照组（P < 0.001）；治疗后，两组患者6MWT水平高于治疗前（P < 0.05），中医证候积分水平低于治疗前（P < 0.05），且治疗组患者6MWT水平高于对照组（P < 0.001），中医证候积分水平低于对照组（P < 0.001）；治疗后，治疗组LCX CTFC、RCA CTFC、LAD CTFC水平低于对照组（P < 0.001），TMPG 3级占比高于对照组（P < 0.05）；治疗组临床总有效率（94.64%，53/56）高于对照组（80.36%，45/56）（P < 0.05）；两组不良反应发生率比较，差异无统计学意义（χ2 = 0.121，P = 0.728）。结论：基于络病理论给予气虚血瘀型心绞痛患者冠心汤治疗疗效确切，可更好地缓解患者临床症状，改善患者心率变异性、运动耐量及心肌微循环，且安全性高。

英文摘要:

Objective：To investigate the effects of Guanxin Decoction on heart rate variability，myocardial microcirculation and exercise tolerance in patients with angina pectoris with qi deficiency and blood stasis based on collateral disease theory. Methods： A total of 112 patients with angina pectoris of qi deficiency and blood stasis type were selected. The subjects were randomly divided into control group and treatment group，with 56 patients in each group. The patients were respectively treated for 6 weeks with Western medicine or Guanxin Decoction combined with the same Western medicine. The indexes of heart rate variability， high－frequency （HF） power，standard deviation of normal sinus boreal interval （SDNN）， difference of adjacent sinus boreal interval > 50 ms percentage of boreal number （PNN50）， square root of difference of normal adjacent sinus boreal interval （RMSSD）， exercise tolerance indicators 6－minute walking test （6MWT）， as well as traditional Chinese medicine syndrome scores were compared between the two groups before and after treatment. After treatment，the myocardial microcirculation indexes of the two groups were compared，including the proportion of left circumflex artery corrected time flow frame count （LCX CTFC）， right coronary artery corrected time flow frame count （RCA CTFC）， left anterior descending artery corrected time flow frame count （LAD CTFC）， and TIMI myocardial tissue perfusion grade （TMPG） reaching grade 3 standard. The clinical efficacy and the occurrence of adverse reactions were also compared between the two groups. Results： After treatment，the levels of heart rate variability indicators HF，SDNN，PNN50 and RMSSD in the two groups were higher than those before treatment （P < 0.05），and these levels in the study group were higher than those in the control group （P < 0.05）. After treatment，the level of 6MWT in the two groups was higher than that before treatment （P < 0.05），and the level of TCM syndrome score was lower than that before treatment （P < 0.05）.The level of 6MWT in the study group was higher than that in the control group （P < 0.05）， and the level of TCM syndrome score was lower than that in the control group （P < 0.05）. After treatment，the levels of LCX CTFC，RCA CTFC and LAD CTFC in the study group were lower than those in the control group （P < 0.05），and the proportion of TMPG grade 3 was higher than that in the control group （P < 0.05）. The clinical efficacy of the study group was higher than that of the control group （P < 0.05） and there was no difference in the incidence of adverse reactions between the two groups （χ2 = 0.121，P = 0.728）. Conclusion： Based on the collateral disease theory，Guanxin decoction is effective in treating angina pectoris of qi deficiency and blood stasis type，and can better alleviate the clinical symptoms of the patients，improve the heart rate variability，exercise tolerance and myocardial microcirculation，and has high safety.

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