【摘要】：目的：通過觀察比較自擬方藥益氣解毒化濁通痹湯與阿托伐他汀鈣片配合阿司匹林腸溶片治療糖尿病性冠心病的臨床療效,探討采用益氣解毒化濁通痹湯治療糖尿病性冠心病的有效性。方法：選擇就診于延邊大學附屬醫(yī)院和長春中醫(yī)藥大學附屬醫(yī)院(于2014年10月-2016年2月期間)被確診為糖尿病性冠心病的60例門診患者,被隨機分為自擬方組與對照組。患者均給予同樣的飲食控制方法和糖尿病教育,給予富含維生素、優(yōu)質蛋白飲食,并根據(jù)患者日常勞動體力消耗情況的不同制定不同的主食量,選擇制定合適的運動方案；同時充分考慮每位患者空腹、餐后血糖水平給予適宜每個個體的胰島素治療。自擬方組給予基礎治療加益氣解毒化濁通痹湯(由人參、生黃芪、草果仁、川黃連、連翹、姜半夏、桂枝、枸杞子、金銀花、厚樸、瓜蔞、紫丹參、甘草、川芎、香附子、麥門冬等組成)加減治療,肝陽上亢者西洋參易人參、加鉤藤、天麻；心痛甚者加乳香、沒藥；血瘀者加紅花、當歸、三七。水煎取汁300ml,每日早飯前(若服藥后大便稀者早餐后10分鐘再服藥)、晚飯后1小時,溫服。對照組則給予基礎治療加阿托伐他汀鈣片l0mg(晚餐后)配以阿司匹林腸溶片100mg(早餐后10分鐘),均日1次,口服；兩組同時觀察2個療程,每個療程為1個月。自擬方組與對照組患者用藥前后主要觀察比較的指標有：(1)中醫(yī)癥狀、舌苔、脈象的變化；(2)心絞痛的療效；(3)心電圖的療效；(4)空腹血糖、餐后兩小時血糖；(5)糖化血紅蛋白；(6)血脂(TC、TG、HDL)；(7)血液流變學(高切、低切及纖維蛋白原)變化；(8)尿常規(guī)、血常規(guī)；(9)腎功能、肝功能。結果：1.用藥后自擬方藥組與對照組中醫(yī)證候療效的總有效率分別為83.3%、63.3%；心電圖總有效率為分別為70%、43.3%。自擬方藥組與對照組比較中醫(yī)證候及心電圖的療效,均有統(tǒng)計學差異(P0.05)。2.用藥后自擬方組患者FBG、2hPG、HbAlc明顯下降(P0.01)。用藥后自擬方益氣解毒化濁通痹湯組與對照組比較,具有明顯差異(P0.05,P0.01),說明益氣解毒化濁通痹湯在調節(jié)患者血糖代謝方面優(yōu)于阿托伐他汀片配合阿司匹林腸溶片組。3.用藥后兩組患者的TC、TG、HDL均有變化,但兩組比較不存在顯著性差異(P0.05),說明益氣解毒化濁通痹湯在調節(jié)患者血脂含量的方面與對照組具有相同的療效。4.用藥后兩組患者高切黏度、低切黏度、纖維蛋白原值均較用藥前明顯降低(P0.01),自擬方組與對照組用藥后的結果比較可見服用益氣解毒化濁通痹湯的患者血液流變學各指標值改變程度更大(P0.05)。說明益氣解毒化濁通痹湯在改善血液流變學方面的療效優(yōu)于對照組。結論：益氣解毒化濁通痹湯能夠有效的增加心肌血供、改善臨床癥狀,調節(jié)血糖、增強保護心血管功能的作用,降低血液黏度,促進血液循環(huán)流速,增加缺血心肌供血、供氧量,且能夠有效降低因用藥而出現(xiàn)的不良反應及毒副反應的發(fā)生率。
[Abstract]:Objective: To study the clinical effect of the treatment of diabetic coronary heart disease with the combination of the self-formula, the Yiqi Jiedu Decoction and the Atorvastatin calcium tablet in the treatment of diabetic coronary heart disease. Methods:60 out-patients who were diagnosed as diabetic coronary heart disease from the affiliated hospital of Yanbian University and the Affiliated Hospital of Changchun University of Traditional Chinese Medicine (October,2014 to February,2016) were randomly divided into the self-planning group and the control group. The patient is given the same diet control method and the diabetes education, and is provided with a vitamin-rich and high-quality protein diet, Postprandial blood glucose levels are given to the insulin treatment appropriate for each individual. A Chinese medicinal preparation is prepared from Radix Ginseng, Rhizoma Pinelliae, Semen Ginkgo, Rhizoma Coptidis, Fructus Forsythiae, Rhizoma Pinelliae, Ramulus Cinnamomi, Fructus Lycii, Flos Lonicerae, Cortex Magnolia Officinalis, Radix Polygalae, Radix Salviae Miltiorrhizae, Radix Glycyrrhizae, Radix Dipsaci, Radix Aconiti Lateralis Preparata, and Radix Ophiopogonis. Radix Panacis Quinquefolii, Radix Panacis Quinquefolii, Ramulus Uncariae cum Uncariae cum Uncariae, and Rhizoma Gastrodiae are prepared from Radix Panacis Quinquefolii, and Radix Panacis Quinquefolii, Olibanum and Myrrha; and Carthami Flos, Radix Angelicae Sinensis, and The decoction is decocted with water for 300ml, and before breakfast (after taking the medicine for 10 minutes after taking the medicine after taking the medicine), the decoction is heated for 1 hour after supper. The control group was given the basic treatment plus atorvastatin calcium tablet l0mg (after dinner) with aspirin enteric-coated tablets 100 mg (10 minutes after the breakfast), both day and day, and the two groups also observed 2 courses of treatment, each treatment course was 1 month. The main observation of the comparison between the self-proposed group and the control group were as follows: (1) the change of the symptoms of TCM, the tongue and the tongue and the pulse condition, (2) the curative effect of the angina, (3) the curative effect of the electrocardiogram, (4) the fasting blood sugar, the two-hour postprandial blood sugar, and (5) the glycosylated hemoglobin; (6) Blood lipid (TC, TG, HDL); (7) hemorheology (high-cut, low-cut and fibrinogen) changes; (8) routine urine and blood routine; (9) renal function and liver function. Results:1. The total effective rate was 83.3% and 63.3%, respectively, and the total effective rate was 70% and 43.3%, respectively. The curative effect of the traditional Chinese medicine and the electrocardiogram was compared with that of the control group (P0.05). The FBG, 2hPG and HbAlc in the self-proposed group were significantly lower after administration (P0.01). Compared with the control group, the self-prepared and Jiedu Huoxue Tongbi decoction group had a significant difference (P0.05, P0.01). It was indicated that the Yiqi Jiedu Tongbi Decoction was better than that of atorvastatin tablet in regulating the blood sugar metabolism of the patient. The TC, TG and HDL of the two groups were changed, but there was no significant difference between the two groups (P0.05). The results showed that the changes of hemorrheology of the two groups were significantly lower than that of the control group (P0.05). It is indicated that the effect of Yiqi Jiedu Tongbi Decoction in improving hemorheology is superior to that of the control group. Conclusion: Yiqi Jiedu Tongbi Decoction can effectively increase the blood supply of the myocardium, improve the clinical symptoms, regulate the blood sugar, enhance the function of protecting the cardiovascular function, reduce the blood viscosity, promote the blood circulation flow rate, increase the blood supply of the ischemic myocardium and supply the oxygen, And can effectively reduce the adverse reaction and the occurrence rate of the toxic side reaction due to the use of the medicine.
【學位授予單位】：延邊大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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