麝香通心滴丸联合曲美他嗪治疗稳定型心绞痛痰阻心脉证临床研究

Clinical Study on Shexiang Tongxin Dropping Pills Combined with Trimetazidine for Stable Angina Pectoris with Phlegm Obstructing Heart Vessel Syndrome

摘要:

目的：观察麝香通心滴丸联合曲美他嗪治疗稳定型心绞痛痰阻心脉证患者的临床疗效。方法：选取2024年4月1日—2025年4月1日诸暨市第六人民医院收治的96例稳定型心绞痛痰阻心脉证患者，按随机数字表法分为对照组和观察组各48例。对照组给予曲美他嗪等治疗，观察组在对照组基础上加用麝香通心滴丸。2组疗程均为8周。比较2组总有效率、心电图改善率及不良反应发生率，比较2组治疗前后中医证候评分及血液流变学指标、心功能指标［心排血量（CO）、左室射血分数（LVEF）、心脏指数（CI）］、心率变异性指标［RR间期标准差（SDNN）、相邻R-R间期差值均方根（RMSSD）、R-R间期平均值标准差（SDANN）］ 水平。结果： 治疗后， 观察组总有效率为95.83% （46/48）、心电图改善率为95.83% （46/48）， 对照组分别为77.08%（37/48）、81.25%（39/48），2组比较，差异均有统计学意义（P＜0.05）。治疗后，2组胸痛、胸闷、心悸、痰多黏稠、气短等中医证候评分均较治疗前降低（P＜0.05），且观察组各项评分均低于对照组（P＜0.05）。治疗后，2组血浆黏度、全血高切黏度、全血红细胞比容均较治疗前降低（P＜0.05），且观察组3项指标水平均低于对照组（P＜0.05）。治疗后，2组CO、LVEF、CI水平均较治疗前升高（P＜0.05），且观察组3项指标水平均高于对照组（P＜0.05）。治疗后，2组SDNN、RMSSD、SDANN水平均较治疗前升高（P＜0.05），且观察组3项指标水平均高于对照组（P＜0.05）。治疗期间，2组患者均未发生肝肾功能损害、胃肠道反应等不良反应。结论：麝香通心滴丸联合曲美他嗪可显著改善稳定型心绞痛痰阻心脉证患者的临床症状、血液流变学状态、心功能，并改善心电图和心率变异情况，且具有良好安全性。

Abstract:

Abstract： Objective： To observe the clinical efficacy of Shexiang Tongxin Dropping Pills combined with Trimetazidine on patients with stable angina pectoris with phlegm obstructing heart vessel syndrome. Methods：A total of 96 patients with stable angina pectoris with phlegm obstructing heart vessel syndrome who were admitted to Zhuji Sixth People's Hospital from April 1，2024 to April 1，2025 were selected and randomly divided into the control group （n= 48） and the observation group （n=48） using the random number table method. The control group was treated with Trimetazidine，and the observation group was treated with Shexiang Tongxin Dropping Pills in addition to the treatment of the control group. The course of treatment for both groups was eight weeks. The total effective rate， improvement rate of electrocardiogram， and incidence of adverse reactions after treatment were compared. The changes in traditional Chinese medicine syndrome scores， as well as levels of hemorheological indicators， cardiac function indicators [cardiac output （CO）， left ventricular ejection fraction （LVEF）， cardiac index （CI）]， and heart rate variability indicators [standard deviation of normal-to-normal RR intervals （SDNN）， root mean square of successive differences（ RMSSD），standard deviation of the averages of normal-to-normal RR intervals（ SDANN）] before and after treatment were compared between the two groups. Results：After treatment，the total effective rate and improvement rate of electrocardiogram were 95.83% （46/48） and 95.83% （46/48） in the observation group， and 77.08% （37/48） and 81.25% （39/48） in the control group，respectively，differences being significant （P＜0.05）. After treatment，the traditional Chinese medicine syndrome scores of chest pain， chest distress， palpitations， thick and sticky phlegm， and shortness of breath in both groups were decreased when compared with those before treatment （P＜0.05），and the above scores in the observation group were lower than those in the control group （P＜0.05）. After treatment，the plasma viscosity，high shear viscosity of whole blood，and hematocrit in both groups were decreased when compared with those before treatment（ P＜0.05），and the above three indicators in the observation group were lower than those in the control group（ P＜0.05）. After treatment，the levels of CO，LVEF，and CI in both groups were increased when compared with those before treatment （P＜0.05）， and the above three levels of indicators in the observation group were higher than those in the control group （P＜0.05）. After treatment，the levels of SDNN，RMSSD，and SDANN in both groups were increased when compared with those before treatment （P＜0.05）， and the above three levels of indicators in the observation group were higher than those in the control group （P＜0.05）. During treatment，no adverse reactions，such as liver or kidney dysfunction or gastrointestinal reactions， occurred in either group of patients. Conclusion： The combination use of Shexiang Tongxin Dropping Pills and Trimetazidine can significantly improve the clinical symptoms， hemorheology，and cardiac function of stable angina pectoris patients with phlegm obstructing heart vessel syndrome， and also improve the variation of electrocardiogram and heart rate，with great safety.