血府逐瘀汤对缺血再灌注心肌的保护作用

摘要

目的 观察不同配比的血府逐瘀汤后处理对缺血再灌注心肌的保护作用.方法 纳入冠状动脉粥样硬化性心脏病并行经皮冠状动脉介入(PCI)的患者120例,随机分为对照组(n=30)和血府逐瘀汤后处理组(n=90),后处理组又按桃仁、红花不同配比分为1:1组(n=30)、4:3组(n=30)和3:4组(n=30),对照组患者PCI术前术后均采用常规药物治疗,后处理组在采用常规药物治疗基础上于PCI术前3d起连续应用血府逐瘀汤至PCI术后4d,每天2次.检测PCI术后各组患者心肌酶(CK、CK-MB)峰值变化及超氧化物歧化酶(SOD)和丙二醛(MDA)水平,观察术后24h内心律失常发生率,并统计术后3个月主要心血管不良事件(包括心源性死亡、再发心肌梗死、再发心绞痛、心力衰竭)发生率.结果 血府逐瘀汤后处理组心肌酶峰值及MDA明显低于对照组(P＜0.05)、SOD明显高于对照组(P＜0.01),术后24h心律失常和3个月内主要心血管不良事件发生率低于对照组(P＜0.01),进一步对比不同配比的血府逐瘀汤后处理结果,发现桃仁/红花4:3组疗效最佳.结论 血府逐瘀汤后处理对PCI术后的心肌具有保护作用,可改善患者预后,其中以桃仁与红花4:3疗效最佳.%Objective To observe the protective effect of postconditioning of Xuefu Zhuyu Tang with different compositions on myocardial ischemia-reperfusion. Methods The patients ( n=120 ) with coronary heart disease ( CHD ) and intervened by percutaneous coronary intervention ( PCI ) were randomly divided into control group ( n =30 ) and Xuefu Zhuyu Tang postconditioning group ( postconditioning group, n=90 ) , and the latter was divided again into 1:1 group, 4:3 group and 3:4 group ( each n=30 ) according to different proportions of Taoren ( Semen Persicae ) and Honghua ( Flos Carthami ) . The control group was treated with routine drugs before and after PCI, and postconditioning group was continuously given Xuefu Zhuyu Tang twice a day from 3 days before PCI to 4 days after PCI besides of routine drugs. The peak value changes of myocardium enzymes ( CK and CK—MB ) , and levels of superoxide dismutase ( SOD ) and malondialdehyde ( MDA ) were detected in all groups after PCI. The incidence rate of arrhythmia within 24 hours after PCI was observed, and incidence rate of major adverse cardiovascular events ( MACE, including cardiac death, reinfarction, recurrent angina and heart failure ) were counted 3 months after PCI. Results The peak values of myocardium enzymes and MDA were significantly lower ( P<0.05 ) and SOD was significantly higher ( P<0.01 ) in postconditioning group than those in control group. The incidence rates of arrhythmia within 24 hours after PCI and MACE 3 months after PCI were lower in postconditioning group than those in control group ( P<0.01 ) . The curative effect was the best in 4:3 group after comparing further the sub—groups with different proportions of Xuefu Zhuyu Tang. Conclusion Xuefu Zhuyu Tang postconditioning has a protective effect on myocardium and can improve patients prognosis after PCI. The curative effect was the best when the proportion of Taoren and Honghua is 4:3.