CN103055122B - The medicine and preparation method thereof of restenosis after prevention percutaneous transluminal coronary stent implantation - Google Patents
The medicine and preparation method thereof of restenosis after prevention percutaneous transluminal coronary stent implantation Download PDFInfo
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Abstract
The invention discloses a kind of medicine preventing restenosis after percutaneous transluminal coronary stent implantation, it is characterized in that: be made up of the composition medicine of following mass component: Radix Astragali 200-250, Radix Ginseng 35-50, Radix Ophiopogonis 65-85, Radix Salviae Miltiorrhizae 220-245, Lignum Dalbergiae Odoriferae 65-90, Fructus Aurantii 100-130, Rhizoma Chuanxiong 100-125, Poria 105-130, Rhizoma Pinelliae Preparata 65-90, Fructus Trichosanthis 105-135, Bulbus Allii Macrostemonis 85-105, Pericarpium Citri Reticulatae 105-138, Radix Glycyrrhizae 60-85.Compared with prior art, the phenomenon of restenosis after percutaneous transluminal coronary stent implantation effectively can be prevented, and can at effective allevating angina pectoris and control ISR.
Description
Technical field
The invention belongs to field of medicaments, be specially a kind of prevent restenosis after percutaneous transluminal coronary stent implantation medicine and preparation method thereof.
Background technology
Along with the generally raising of people's living standard, the sickness rate of coronary atherosclerotic heart disease (CHD) raises year by year, has become the first killer of harm humans health in recent years.Percutaneous tranluminal coronary angioplasty (PTCA) is one of best means of coronary blood transport reconstruction, is the breakthrough of coronary heart disease treatment, and its appearance is a milestone of coronary heart disease treatment, has the advantages such as wound is little, determined curative effect.Vascular Restenosis after Balloom (RS) and in-stent restenosis (ISR) incidence rate, still up to 10% ~ 50%, have had a strong impact on late result.
Medicine at present for ISR prevention is a lot, usually adopts dual anti-method and aspirin to add clopidogrel scheme, prevents ISR to a certain extent, but causes some patients peptic ulcer or the serious complication such as hemorrhage simultaneously.
Chinese medicine has certain preventive and therapeutic effect to in-stent restenosis.Chinese medicine is thought, treatment of instent restenosis and advanced thrombus form the category still belonging to the traditional Chinese medical science " thoracic obstruction ", " angina pectoris ".
Summary of the invention
In order to overcome above-mentioned technical problem, the invention provides a kind of prevent restenosis after percutaneous transluminal coronary stent implantation medicine and preparation method thereof, compared with prior art, the phenomenon of restenosis after percutaneous transluminal coronary stent implantation effectively can be prevented, and can at effective allevating angina pectoris and control ISR.
For achieving the above object, the technical solution adopted in the present invention is as follows:
Prevent a medicine for restenosis after percutaneous transluminal coronary stent implantation, it is characterized in that: be made up of the composition medicine of following mass component: Radix Astragali 200-250, Radix Ginseng 35-50, Radix Ophiopogonis 65-85, Radix Salviae Miltiorrhizae 220-245, Lignum Dalbergiae Odoriferae 65-90, Fructus Aurantii 100-130, Rhizoma Chuanxiong 100-125, Poria 105-130, Rhizoma Pinelliae Preparata 65-90, Fructus Trichosanthis 105-135, Bulbus Allii Macrostemonis 85-105, Pericarpium Citri Reticulatae 105-138, Radix Glycyrrhizae 60-85.
Above-mentioned, be made up of the medicine of following mass component: Radix Astragali 230-240, Radix Ginseng 40-45, Radix Ophiopogonis 70-80, Radix Salviae Miltiorrhizae 230-235, Lignum Dalbergiae Odoriferae 75-80, Fructus Aurantii 110-120, Rhizoma Chuanxiong 110-120, Poria 110-120, Rhizoma Pinelliae Preparata 75-80, Fructus Trichosanthis 110-120, Bulbus Allii Macrostemonis 90-95, Pericarpium Citri Reticulatae 110-120, Radix Glycyrrhizae 75-80.
Further, described medicine is made up of the medicine of following mass parts: the Radix Astragali 232, Radix Ginseng 46, Radix Ophiopogonis 77, Radix Salviae Miltiorrhizae 232, Lignum Dalbergiae Odoriferae 77, Fructus Aurantii 116, Rhizoma Chuanxiong 116, Poria 116, Rhizoma Pinelliae Preparata 77, Fructus Trichosanthis 116, Bulbus Allii Macrostemonis 93, Pericarpium Citri Reticulatae 116, Radix Glycyrrhizae 77.
Further, Radix Ginseng, Poria two taste are ground into fine powder, residue ten add water simply filtrations, decoct, merging filtrate, is condensed into paste, by above-mentioned fine powder and auxiliary materials and mixing, granulate, drying, incapsulate.
Further, described decoction is secondary, each 2 hours.
Further, described adjuvant is medical dextrin, and the ratio of blending is about 30:1.
Pharmacology of the present invention is as follows:
The Radix Astragali: be the root of leguminous herbaceous plant's Radix Astagali, Radix Astragali, has the effects such as invigorating QI to consolidate the body surface resistance, diuretic detumescent, expelling pus and toxin by strengthening QI, granulation promoting.
Radix Ginseng: to the effect of cardiovascular system
A. to the effect of cardiac function: Radix Ginseng suppresses after all having first excitement to the heart of many animals, a small amount of is excited, the effect suppressed in a large number.It is similar to cardiotonic glycoside to action of the heart, can improve myocardial contraction.Heavy dose then weakens contractility and decreased heart rate.Experiment shows: the alcohol extract of Radix Ginseng Rubra and infusion, to isolated frog heart, can make it shrink reinforcement, finally stop at systole; To dog, rabbit, the cat heart in place, it also can be made to shrink enhancing, decreased heart rate.These effects are mainly caused by direct excited cardiac muscle.To animal massive blood loss, acute circulatory failure (heart rate is slow, mental and physical efforts are weak) occurs, Radix Ginseng can make the abnormal increasing of heartbeat amplitude, and heart rate significantly speeds.Ginsenoside has the rat ventricular effect that stronger anti-barium chloride brings out, and has stronger role of correcting to produced tachycardia, and the rhythm of the heart can be made to return to normal level.Report is had to point out, the Experimental Arrhythmia that Herba Herminii or Radix Ginseng Saponin can cause antiadrenergic drug.Ginsenoside contains measurer dual regulation to cAMP and cGMP in myocardial cell, therefore the balance maintaining cAMP and cGMP is also a factor of antagonism cardiac arrhythmia under stress state.Stem and leaf of Radix Ginseng total saponins has protective effect to the experimental sinus node function damage of rabbit.
B. to the effect of cardiac muscle: Radix Ginseng has protective effect to cardiac muscle.Ginsenoside can reduce the lactic acid content of mice brain and cardiac muscle in severe depletion of oxygen situation, content of cAMP/cGMP ratio when can recover anoxia, and has protection heart muscle capillary endotheliocyte and alleviate the effect of mitochondrial injury.From the Saponin that the positions such as Stem and leaf of Radix Ginseng, reed head, fruit and main root are extracted, the rat heart muscle that p-isopropyl epinephrine causes is downright bad, all has obvious myocardium protecting action, disease damage can be made to alleviate, especially act as with Herba Herminii saponin good.Different extract fractions of Radix ginseng Saponin and gains in depth of comprehension are equipped with similar action effect.Ginseng rhizoma saponin can promote that the DNA of myocardial cell synthesizes, and has certain protective effect to scarce sugared anoxia-induced apoptosis cultured myocyte.Research is thought, Radix Ginseng total saponins resists myocardial ischemia and the mechanism of reperfusion injury, is to promote cardiac muscle to generate and release prostaglandin, suppresses the generation of thromboxane A2, and by antioxidant radical and lipoid peroxidization resistant protecting myocardial cell.
C. to the effect of blood vessel: Radix Ginseng, to the effect of blood vessel, it is generally acknowledged that it is vasodilator, but also have low dose of contraction, heavy dose is expanded or is first shunk the report expanded afterwards.Radix Ginseng shows difference to the effect of blood vessel because of blood vessel kind difference or fuselage state.Radix Ginseng has contraction to rabbit ear blood vessel and rat hindlimb blood vessel.But there is dilating effect to whole animal coronary artery, cerebrovascular, optical fundus blood vessel.Intravenous injection Total saponin can reduce dog hind leg blood vessel and cerebral vascular resistance, but can increase kidney of rats vascular resistance.Ginsenoside Rg1, Re to dog blood vessel also in dilating effect, effect be respectively 1/20 and 1/50, Rc of papaverine, Rb2 effect very weak, and Rb1 is invalid.The research of effective ingredient and mechanism of action that Radix Ginseng affects vascular function shows: ginsenoside Rb1 and the dilating effect of R0 to blood vessel are nonselective, and the Rg1 only vasoconstriction that causes of selectivity antagonism Ca++, and its mechanism of action still needs research further.Someone thinks, Radix Ginseng may be the reason of Radix Ginseng two-ways regulation blood pressure to the different regulating action of blood vessel under different classes of, different physiological status.
D. to the effect of blood pressure: most data shows: animal is at normal or hypertensive state, and Radix Ginseng has the effect reduced blood pressure, but also has the report making blood pressure raise.Radix Ginseng is to the blood pressure of anesthetized animal, and low dose is boosted, heavy dose of blood pressure lowering.Therapeutic dose has no significant effect patient's blood pressure.The boosting of Radix Ginseng may be relevant with kidney, spleen volume-diminished, splanchnic vasoconstriction.Blood pressure lowering is then caused by release histamine.The hypotensive effect of anesthetized dog to Radix Ginseng has tachylaxis.The two-way function that ginsenoside Rb1, Rb2, Rc, Rd, Re, Rf decline after having first microlitre to blood pressure, the strongest with Rg1, boosting when Rb1 is heavy dose of.But it is not subject to the impact of atropine, diphenhydramine, phenol azoles quinoline and propranolol on the effect of blood pressure.Radix Ginseng ether extract 40mg/kg intravenous injection, can make the dog decreased heart rate of halothane light anesthesia, and central venous pressure reduces.It should be noted that: intravenous injection Radix Ginseng extractum, can make that breathing stops, cat that blood pressure drops, reflection disappear completely recovers from moribund condition.
It is generally acknowledged, the mechanism of Radix Ginseng hypotensive effect is: Radix Ginseng has intends choline effect; Radix Ginseng Rubra ether extract starts the of short duration hypotensive effect occurred, relevant with histamine release, and the lasting hypotensive effect then occurred belongs to other reasons; Radix Ginseng can cause Ink vessel transfusing Ca++ to reduce, and its hypotensive effect is the result of Radix Ginseng to vascular smooth muscle effect, and ginsenoside Rb1 has lasting hypotensive effect; Due to excision animal brain or with the hypotensive effect all can eliminating Radix Ginseng after ganglionic block agents, the hypotensive effect of old friend's ginseng, may have the participation of nervus centralis and reflex mechanism.
Radix Ophiopogonis: nature,taste and action: sweet, micro-hardship, cool, Yin-nourishing and body fluid promoting, nourishing the lung to arrest cough, clear away heart-fire relieving restlessness.Cure mainly consumption of body fluid caused by febrile disease, vexed, thirsty, dry pharynx lung-heat, cough, pulmonary tuberculosis.
Radix Salviae Miltiorrhizae has another name called Radix Salviae Miltiorrhizae, Radix Salviae Miltiorrhizae, Arisaema balansae Engl. etc.For dicotyledon Labiatae, dry root and rhizome.Main product in Anhui, Henan, the ground such as Shaanxi.Effect: promoting blood flow to regulate menstruation, stasis-dispelling and pain-killing, removing heat from blood eliminating carbuncle, clear away heart-fire relieving restlessness, nourishing blood to tranquillize the mind.
Lignum Dalbergiae Odoriferae: promoting flow of QI and blood, pain relieving, hemostasis.
Fructus Aurantii: dispelling the stagnated QI, row expectorant, removing food stagnancy.Control chest and diaphragm expectorant stagnant, the feeling of stuffiness in chest, coerce swollen, food stagnation, eructation, vomiting.
Rhizoma Chuanxiong; Acrid in the mouth, warm in nature.Return liver, gallbladder, pericardium channel.
Poria; Sweet in the mouth, light, property are put down, and are used as medicine and have the function of promoting diuresis to eliminate damp pathogen, strengthening the spleen stomach function regulating, mind tranquilizing and the heart calming.Modern medicine study: Poria energy enhancing human body immunity function, pachyman has obvious antitumor and protects the liver dirty effect.
The Rhizoma Pinelliae: pungent, temperature.Poisonous.Return spleen, stomach, lung meridian.Drying dampness to eliminate phlegm, stopping nausea and vomiting by lowering the adverse flow of QI, dissolving lump and resolving mass; Externally used detumescence pain relieving.
Fructus Trichosanthis: fruit is containing Saponin, organic acid, fatty wet goods.Sweet in the mouth, cold in nature.Have lung moistening to eliminate the phlegm, the effect of promoting the circulation of QI the chest stuffiness relieving.Treatment cough with ropy sputum, uncomfortable in chestly has a pain.Angina pectoris controlled by Fructus Trichosanthis preparation certain curative effect.
Bulbus Allii Macrostemonis: activating YANG and eliminating stagnation, circulation of qi promoting intestinal stasis relieving.The thorough back of the body of obstruction of qi in the chest and cardialgia; Breast gastral cavity painful abdominal mass is vexed; Cough with asthma abundant expectoration; Epigastric pain; Heavy after letting out dysentery; Leucorrhea; Furuncle carbuncle.
Pericarpium Citri Reticulatae: appetizing drying dampness to eliminate phlegm of regulating the flow of vital energy controls the spleen-stomach disease.
Radix Glycyrrhizae: function cures mainly heat-clearing and toxic substances removing, expelling phlegm for arresting cough, gastral cavity abdomen etc.
Monarch drug: Radix Ginseng strongly invigorating primordial QI, the prosperous handsome blood of gas, blood circulation depending on qi flow; Radix Salviae Miltiorrhizae blood circulation promoting and blood stasis dispelling, coronary circulation-promoting pain-relieving; Fructus Trichosanthis dissipating phlegm and resolving masses, the chest stuffiness relieving is regulated the flow of vital energy; Three is harmonious, and plays replenishing qi and promoting blood flow altogether, phlegm reduction of blood circulation promoting, the merit of coronary circulation-promoting pain-relieving.
Ministerial drug: Radix Astragali QI invigorating is activated yang, Rhizoma Chuanxiong blood-activating and qi-promoting, Rhizoma Pinelliae drying dampness to eliminate phlegm, Poria invigorating the spleen to clear away damp pathogen, coordinates monarch drug to help pectoral qi, and the loose expectorant stasis of blood, Tong Xinmai, except arthralgia pain.
Adjuvant drug: the pungent temperature of Lignum Dalbergiae Odoriferae is kind loose, and promoting flow of QI and blood, is good at pain relieving; Fructus Aurantii promoting the circulation of QI to alleviate the stagnation in middle-JIAO, Pericarpium Citri Reticulatae is regulated the flow of vital energy and is eliminated the phlegm, and the two is harmonious and expectorant is disappeared with gas, tonify without causing stagnation; The pain relieving of Bulbus Allii Macrostemonis the chest stuffiness relieving, the logical sliding profit of temperature, it is turbid that hardship lets out expectorant, activating YANG and eliminating stagnation, circulation of qi promoting intestinal stasis relieving, and the expectorant of YIN-cold of faling apart is turbid sluggish, declare in the heart yang-energy with the chest stuffiness relieving; In addition Radix Ophiopogonis, YIN nourishing soft pulse, holding concurrently can righting, makes pungently loosely not rob blood, and warm-dryness syndrome is not just being hindered.
Make medicine: Radix Glycyrrhizae coordinating the actions of various ingredients in a prescription.
Make a general survey of full side, logical benefit is taken into account, strongly invigorating primordial QI, and pungent loose temperature is led to, qi and blood circulation promotion, Tong Xinmai, the expectorant stasis of blood, and except arthralgia pain, tonify without causing stagnation, lead to and do not fall apart, treating both the principal and secondary aspects of a disease, brings out the best in each other, the good recipe that reality is reduced phlegm for supplementing qi and invigorating vasculum.
This medicine can not only improve the malaise symptoms such as coronary artery bracket postoperative patient person feeling of oppression and pain in the chest, effectively improve patients ' life quality, and curative effect has been confirmed in clinical practice, has definite curative effect to control ISR.
Innovation: 1. embody be combineding with each other of the compatibility of medicines in a prescription of the traditional Chinese medical science, determination for the treatment of based on pathogenesis obtained through differentiation of symptoms and signs and modern pharmacology and achievement in research.2, beneficial heart capsule for freeing collateral vessels is pure Chinese medicinal preparation, safety non-toxic, and curative effect is reliable, taking convenience.3, there is no the medicine of special control ISR both at home and abroad at present, it is blank both at home and abroad that this medicine can fill up this field.4, good Social benefit and economic benefit can be obtained, have wide DEVELOPMENT PROSPECT.Benefit more patient.
Full side totally ten three taste Chinese medicines, letter and not numerous, prescription is careful, and compatibility is rigorous.Radix Ginseng sweet in the mouth in side, micro-hardship, property is put down, strongly invigorating primordial QI, and multiple arteries and veins takes off admittedly, invigorating the spleen to benefit the lung, promoting the production of body fluid and inducing sedation of the mind Fructus Alpiniae Oxyphyllae, " Mingyi Bielu " meaning cure mainly intestinal cold in the stomach, trusted subordinate's drum pain, feeling of fullness and discomfort in the hypochondrium, cholera is told inverse, and in tune, promoting blood circulation of only quenching one's thirst, brokenly hardly to amass, and makes us not forgetting." property of medicine opinion ": main five hide QI-insufficiency, and five kinds of strain and seven kinds of impairment is deficient, thin and weakly tells inverse, and lower food, only cholera unhappiness is vomitted the sound of vomiting, and tonifying five ZANG-organs six internal organs, keep god in guarantor.Radix Ginseng strongly invigorating primordial QI, the prosperous handsome blood of gas, blood circulation depending on qi flow; Radix Salviae Miltiorrhizae bitter in the mouth, cold nature, effect stasis-dispelling and pain-killing, promoting blood circulation to restore menstrual flow, nourishing blood to tranquillize the mind, Shennong's Herbal is called it " can control trusted subordinate's pathogen, “ Po Disorder is except abdominal mass ", and Jing-Yue Complete Works says its energy nourshing blood and promoting blood circulation, tissue regeneration promoting blood, row stagnated blood; Fructus Trichosanthis sweet in the mouth, bitter in the mouth, cold in nature, function clearing away heat and eliminating phlegm, relieving stuffiness of the chest by dispersing aggregation of pathogens, loosening bowel to relieve constipation, Compendium of Material Medica is said: sweet trembling with fear does not violate gastric qi, can fall the fire of the part of the body cavity above the diaphragm housing the heart and lungs, and mental disorder is declined also.Radix Ginseng, Radix Salviae Miltiorrhizae, Fructus Trichosanthis are monarch drug altogether, and three is harmonious, and plays replenishing qi and promoting blood flow altogether, phlegm reduction of blood circulation promoting, the merit of analgesic therapy of promoting blood circulation.
In side, Radix Astragali sweet in the mouth, warm in nature, returns the warp of spleen lung, the inclined invigorating QI to consolidate the body surface resistance of merit, and exopathogen can be prevented to invade body surface, Guo Wenqin meaning " hat of all resistance and supplementing qi medicines called by ginseng, stilbene ", and the power of the Radix Astragali, Radix Ginseng two medicine compatibility QI invigorating is rich; Rhizoma Chuanxiong acrid in the mouth, warm in nature, be good at blood-activating and qi-promoting, wind-expelling pain-stopping, " herbal lease making " is called gas medicine in blood, yang invigorating dissipating depression of QI ... the up head, the descending sea of blood, and blood gas.Rhizoma Chuanxiong closes Radix Salviae Miltiorrhizae and enriches blood and to invigorate blood circulation and not stagnant; The Rhizoma Pinelliae is drying dampness to eliminate phlegm, stopping nausea and vomiting by lowering the adverse flow of QI, the good medicine of dissolving lump and resolving mass, and the Rhizoma Pinelliae closes Fructus Trichosanthis and to eliminate the phlegm the excellent compatibility of sending down the abnormal ascending QI, and as Zhong Jing controls the thoracic obstruction with Gualou Xiebai Banxia Tang, the little sunken chest soup of epigastric fullness, all with the Rhizoma Pinelliae, Fructus Trichosanthis collocation; Poria sweet in the mouth, light, property is put down, can promoting diuresis to eliminate damp pathogen, spleen invigorating mind calming, and Shennong's Herbal carries it can " the inverse gas of the main breast side of body, melancholy is angerd, and frightened heresy is probably throbbed with fear, knot pain under the heart, cold and heat, stuffy sensation with restlessness ... clothes peace soul is reposed for a long time ".The Radix Astragali, Rhizoma Chuanxiong, the Rhizoma Pinelliae, Poria are ministerial drug altogether, close the merit that monarch drug reinforcement benefiting QI for activating blood circulation eliminates the phlegm.
The pungent temperature of Lignum Dalbergiae Odoriferae is kind loose, and promoting flow of QI and blood, is good at pain relieving; Fructus Aurantii promoting the circulation of QI to alleviate the stagnation in middle-JIAO, Pericarpium Citri Reticulatae is regulated the flow of vital energy and is eliminated the phlegm, and the two is harmonious and expectorant is disappeared with gas, tonify without causing stagnation; The pain relieving of Bulbus Allii Macrostemonis the chest stuffiness relieving, the logical sliding profit of temperature, it is turbid that hardship lets out expectorant, activating YANG and eliminating stagnation, circulation of qi promoting intestinal stasis relieving, and the expectorant of YIN-cold of faling apart is turbid sluggish, declare in the heart yang-energy with the chest stuffiness relieving; In addition Radix Ophiopogonis, YIN nourishing soft pulse, holding concurrently can righting, makes pungently loosely not rob blood, and warm-dryness syndrome is not just being hindered, and is adjuvant drug in side altogether.Radix Glycyrrhizae coordinating the actions of various ingredients in a prescription, for making medicine.
Make a general survey of full side, logical benefit is taken into account, strongly invigorating primordial QI, and pungent loose temperature is led to, qi and blood circulation promotion, Tong Xinmai, the expectorant stasis of blood, and except arthralgia pain, tonify without causing stagnation, lead to and do not fall apart, treating both the principal and secondary aspects of a disease, brings out the best in each other, the good recipe that reality is reduced phlegm for supplementing qi and invigorating vasculum.
Radix Ginseng strongly invigorating primordial QI, handsome blood and going.Modern pharmacological research is thought: the Saponin energy blood vessel dilating in Radix Ginseng, makes microcirculation improve, prevent blood coagulation, promotes fibrinolysis, has inhibition, improve the mobility of blood to erythrocytic aggregation.The nonspecific resistance of body can be increased, to various harmful factor, as physics, biological harmful effect all can increase the resistance of body.To the effect of cardiovascular system, there is adjustment heart body, blood vessel dilating, adjustment blood pressure and antibody gram effect.Radix Salviae Miltiorrhizae has another name called Radix Salviae Miltiorrhizae, Radix Salviae Miltiorrhizae, Arisaema balansae Engl. etc., kind blood circulation promoting and blood stasis dispelling, stasis-dispelling and pain-killing, dispersing swelling and dissipating binds, removing heat from blood eliminating carbuncle; Modern medicine finds that Radix Salviae Miltiorrhizae contains a lot of composition, wherein TANSHINONES, danshensu, succinic acid, vitamin E, Radix Scutellariae young pilose antler, daucosterol etc. confirm through zoopery, the reduction of fibrinolytic in atherogenesis process can be stoped, delay and stop atherosclerotic formation.Red sage formulation is the key agents of state's internal therapy coronary heart disease, has obvious function of resisting myocardial ischemia, can act on multiple prothrombin factor and anticoagulant, activation fibrinolytic and anticoagulant, cause it to reach the curative effect of anti-microthrombusis; Also can promote the reparation of vascular endothelial cell, coronary artery blood flow is increased, reduce myocardial oxygen consumption; As can be seen from this research, treatment group TXA2 level is significantly lower than matched group, and difference has statistical significance (P < 0.05); In addition also have blood fat reducing, prevent and treat atherosclerotic effect.Fructus Trichosanthis energy removing heat-phlegm, promoting the circulation of QI dissipating depression of QI, the chest stuffiness relieving profit diaphragm, relieving restlessness resolving depression, clearing away phlegm eliminating stagnation.Experiment shows, the Fructus Trichosanthis of suitable dosage can make guinea pig isolated heart contractility strengthen to some extent, and Pericarpium Trichosanthis dilate coronary effect is relevant with Alkaloid contained by it, and its total amino acids may have phlegm-dispelling functions instead of dilate coronary effect.
The Radix Astragali not only has coronary artery dilator, improve myocardial blood flow and myocardial metabolism and reduce the effect of infarct size, can also strengthen myocardial contraction and improve left heart function.There is obvious antifatigue effect, enhancing body anoxia enduring and stress ability, the metabolism of body can be promoted.The Radix Astragali can also affect blood pressure, reduces blood viscosity and improve abnormal hemorheology index.Rhizoma Chuanxiong: pungent, warm, returns liver, gallbladder, pericardium channel, and primary efficacy is blood-activating and qi-promoting, wind-expelling pain-stopping.The effects such as modern pharmacology research confirms that Rhizoma Chuanxiong has suppression vascular smooth muscle cell proliferation, reduces platelet adhesion reaction, gathering, prevents thrombosis, protection vascular endothelial cell; Also there is the effect of control coronary artery bracket restenosis after vascular intervention.Rhizoma Chuanxiong Aqueous extracts and alkaloid thereof can expand crown and blood vessel, increase coronary flow, improve myocardial ischemia situation.Anesthetized dog is quiet push away ligustrazine after, arteria coronaria and cerebral blood flow increase, arteria coronaria, cerebrovascular and Peripheral resistance reduce.Poria: sweet, light, flat, GUIXIN, lung, spleen, stomach warp, function promoting diuresis to eliminate damp pathogen, spleen invigorating mind calming.The report such as Kang Shi is reused Poria and is treated 55 routine cardiac edemas, has obvious diuresis.Be mainly manifested in enhancing myocardial contraction to the effect of cardiovascular system, Poria aqueous extract also has hypotensive activity.The Rhizoma Pinelliae: pungent, warm, poisonous, returns spleen, stomach, lung meridian, and primary efficacy is drying dampness to eliminate phlegm, stopping nausea and vomiting by lowering the adverse flow of QI, dissolving lump and resolving mass.The Rhizoma Pinelliae has obvious antiarrhythmic effect, and its decoct has antagonism to dog ventricular tachycardia and ventricular premature contraction.The Rhizoma Pinelliae also has significant effect for reducing blood fat, can reduce rat TC, LDL-C and TC/TG, LDL-C/HDL-C ratio, stop or delay the formation of hyperlipemia, and have certain therapeutical effect to hyperlipemia.In addition, the Rhizoma Pinelliae also has suppression heart rate and of short duration hypotensive effect.
Lignum Dalbergiae Odoriferae primary efficacy is promoting flow of QI and blood, pain relieving, hemostasis.The research such as Wang Hongbo shows, Lignum Dalbergiae Odoriferae oil significantly can recover the ST field offset degree of Rat Ecg, obviously improves the acute myocardial ischemia brought out by element on isopropyl kidney, and have remarkable effect in anti-platelet aggregation.Lignum Dalbergiae Odoriferae also has the effect reducing myocardial cell interstitial I type/III collagen type ratio, improves the remodeling ventricle of myocardial infarction prognosis.Radix Ophiopogonis is sweet cold clear and rich, the heat of the kind lung that clears away heart-fire and yin nourishing relieving restlessness.Radix Ophiopogonis polysaccharide can protect cardiac muscle, has the effect that the free radical suppressing myocardial ischemia to cause generates increase and scavenging activated oxygen simultaneously.The experiment such as Xu Desheng proves that Radix Ophiopogonis, active polysaccharide can the S-T section that causes of antagonism pituitrin be raised, the ST section raised after can making rat coronary ligation obviously reduces, reduce CK and suppression serum lactate dehydrogenase (SLD) (LDH) content in animal serum to raise, superoxide dismutase (SOD) reduction cause myocardial ischemia and malonaldehyde (MDA) increase certain inhibitory action simultaneously.Bulbus Allii Macrostemonis acrid in the mouth is bitter, and return lung, stomach, large intestine channel, primary efficacy is activating YANG and eliminating stagnation, circulation of qi promoting intestinal stasis relieving, energy anticoagulant, and coronary artery dilator, reduces oxygen consumption, arrhythmia, cholesterol reducing and antioxidation.Bulbus Allii Macrostemonis and the platelet aggregation of composition to induction thereof have inhibitory action, and its active component is that N-is to coumaric acyl tyramine, the anti-feruloyltyramine of N-, adenosine.Fructus Aurantii warming middle-JIAO is regulated the flow of vital energy, clearing heat in QI system raises up, promoting flow of QI and blood, pain relieving.N-methyltyramine contained in Fructus Aurantii can increase coronary flow and renal blood flow, significantly can reduce myocardial oxygen consumption, and have obvious diuresis.Neosynephrine contained in Fructus Aurantii is epinephrine a-receptor agonist, also has certain excitation, have vasoconstrictive to heart beta-receptor, produces the effect of raising blood pressure.Pericarpium Citri Reticulatae drying dampness to eliminate phlegm, can help Fructus Trichosanthis to reduce phlegm, again can circulation of qi promoting, the capable then blood of gas, and gasification is wet eliminating the phlegm then, and enhancing is eliminated the phlegm the power of blood stasis dispelling.Pericarpium Citri Reticulatae can improve hemorheological property, and reduce blood viscosity, antiplatelet aggregation, the main component hesperidin of Pericarpium Citri Reticulatae can strengthen myocardial contraction, and cardiac output is increased.Extrasomatic rabbit heart perfusion experiment shows that Pericarpium Citri Reticulatae decoct still can coronary artery dilator.
All medicines are for pathogenesis above, and compatibility is rigorous, share and can reach blood circulation promoting and blood stasis dispelling, activating QI to eliminate phlegm heat clearing away, hold concurrently with QI invigorating, warming YANG, dredging collateral, the effect for the treatment of both the principal and secondary aspects of a disease.This prescription is in fact anticoagulant, anti-fibre are organically combined with antiplatelet aggregation, after can alleviating early stage stenting, body is to the inflammatory reaction of coronary artery bracket, the obvious relation improving vascular endothelial injury and Platelet Activation, PCI postoperative patients with coronary heart disease immunologic hypofunction state is regulated, thus reaches the object reducing restenosis.This Chinese patent medicine, not only effectively can improve the malaise symptoms such as coronary artery bracket postoperative patient person feeling of oppression and pain in the chest, effectively improve patients ' life quality, and curative effect be confirmed in clinical practice, to prevention ISR there is obvious effect.
Be described below in conjunction with detailed description of the invention.
Detailed description of the invention
My institute accepts patients with coronary heart disease 605 example year January in January, 2007 to 2012 altogether for medical treatment, from safety with ensure the angle of sample size, select the successful patient of wherein intracoronary stening totally 363 examples study.
" percutaneous coronary intervention (pci) guide " that all patients all meet the formulation in 2002 of angiocardiology branch of Chinese Medical Association treats indication.Carry out coronary stenting, and the standard that hits pay dirk.And after percutaneous transluminal coronary stent implantation within 6 months coronarography confirm coronary artery have significantly narrow (> 50%).
Method: select eligible personnel 350 example immediately, and be divided into treatment group 280 example and matched group 70 example at random.Matched group conventional Aspirin sheet 100mg(Bayer A.G produces), every day 1 time, clopidogrel sheet 75mg (Plavix) (production of Hangzhou Sai Nuofei-Sheng Delabao people's livelihood pharmaceutical Co. Ltd), every day 1 time, treatment group is divided into four groups according to embodiment 1-4 and adds in institute on the basis of matched group makes capsule by oneself.Two groups of courses for the treatment of are 6 months.
Result: observe postoperative 6 months coronary angiography restenosis rate, late period internal diameter numerical value, on the impact of serological index, electrocardiogram, clinical symptoms.Above difference all has statistical significance (P < 0.05).Adverse reaction rate no significant difference (P > 0.05) during two groups of medications.
1. health giving quality index:
Before and after stenting and postoperative 6 months, look into two groups of Coronary Artery in patients radiography situations, the electrocardiogram ST-T changes, serum enzyme index, angina pectoris attacks number of times and persistent period respectively.
Result of study
Untoward reaction during medication is as digestive tract reaction, dermoreaction, leukopenia etc., and whether concurrent sudden cardiac death, myocardial infarction, heart failure, with or without death.
1. check coronary angiography to compare:
1.1 postoperative 6 months row coronary angiographies (CAG): treatment group obtains all be greater than matched group at pathological changes minimum diameter, internal diameter acquisition in late period, clean internal diameter, and pathological changes percent stenosis, late period internal diameter lose, late period internal diameter lose index be all less than matched group, difference has statistical significance (P < 0.05).
1.2 restenosis rate: the restenosis for the treatment of group is 6 examples, and restenosis rate is 8.57%, the restenosis of matched group is 22 examples, and restenosis rate is 27.5%, and treatment group is significantly lower than matched group, and difference has statistical significance (P < 0.05).
2. the electrocardiogram ST-T changes: the ST section reduction >=0.05mV of two groups of patients or ST section obviously raise in mo(u)ld top half dorsad and T ripple low flat, two-phase or measurement have pathologic all obviously to reduce, matched group decline number of cases is more, and difference has statistical significance (P < 0.05).
3. serum enzyme index contrast:
After 3.1 liang of group patient treatments, η b, η p, HCT, RFC, IR, VAI, TFL, DI all have remarkable reduction, and treatment group fall is larger, and difference has statistical significance (P < 0.05).
TC, TG, LDL-C of 3.2 liang of group patients all obviously decline, HDL-C significantly raises, TC, LDL-C fall for the treatment of group is larger, and illustrate that the improvement for the treatment of group patient TC, LDL-C is obviously better than matched group, difference has statistical significance (P < 0.05).
IL-8, the super quick CRP level of 3.3 liang of group patients all obviously decline, and treatment group fall is larger, and the TXA2 level of two groups of patients obviously declines, and treatment group fall is larger; PGI2 level has remarkable rising, and treatment group elevation amplitude is larger, and above difference has statistical significance (P < 0.05).
4. clinical symptoms compares: the number of times of angina pectoris attacks weekly and each persistent period of two groups of patients obviously reduce, and treatment group fall is larger, and difference has statistical significance (P < 0.05).
5. adverse effect: mainly contain that digestive tract reaction is felt sick, allergic rash and leukopenia, all disappears after anti symptom treatment.Treatment group adverse reaction rate is 7.5%, and matched group adverse reaction rate is 10.0%, no significant difference P > 0.05), two groups all without death.
Conclusion
The syndrome performance of the postoperative restenosis ISR patient of coronary artery bracket many genus traditional Chinese medical science blood stasis due to qi deficiency phlegm retention, benefit heart capsule for freeing collateral vessels compatibility rigorous and scientific, can invigorating the spleen and replenishing QI, blood circulation promoting and blood stasis dispelling, can also reduce phlegm and promote blood circulation, significantly can improve the blood stasis due to qi deficiency stagnation of phlegm state of coronary artery bracket postoperative patient person, after alleviating early stage stenting, body is to the inflammatory reaction of coronary artery bracket, improves body's immunity, reduce the incidence rate of postoperative restenosis, and without obvious adverse reaction.The digestive tract reaction that few patients occurs, allergic rash and leukopenia, all disappear after anti symptom treatment very soon.This medicine is effective and safe to prevention ISR.
Claims (6)
1. prevent a medicine for restenosis after percutaneous transluminal coronary stent implantation, it is characterized in that: be made up of the composition medicine of following mass component: Radix Astragali 200-250, Radix Ginseng 35-50, Radix Ophiopogonis 65-85, Radix Salviae Miltiorrhizae 220-245, Lignum Dalbergiae Odoriferae 65-90, Fructus Aurantii 100-130, Rhizoma Chuanxiong 100-125, Poria 105-130, Rhizoma Pinelliae Preparata 65-90, Fructus Trichosanthis 105-135, Bulbus Allii Macrostemonis 85-105, Pericarpium Citri Reticulatae 105-138, Radix Glycyrrhizae 60-85.
2. the medicine of restenosis after prevention percutaneous transluminal coronary stent implantation according to claim 1, is characterized in that: be made up of the medicine of following mass component: Radix Astragali 230-240, Radix Ginseng 40-45, Radix Ophiopogonis 70-80, Radix Salviae Miltiorrhizae 230-235, Lignum Dalbergiae Odoriferae 75-80, Fructus Aurantii 110-120, Rhizoma Chuanxiong 110-120, Poria 110-120, Rhizoma Pinelliae Preparata 75-80, Fructus Trichosanthis 110-120, Bulbus Allii Macrostemonis 90-95, Pericarpium Citri Reticulatae 110-120, Radix Glycyrrhizae 75-80.
3. the medicine of restenosis after prevention percutaneous transluminal coronary stent implantation according to claim 1 and 2, is characterized in that: described medicine is made up of the medicine of following mass parts: the Radix Astragali 232, Radix Ginseng 46, Radix Ophiopogonis 77, Radix Salviae Miltiorrhizae 232, Lignum Dalbergiae Odoriferae 77, Fructus Aurantii 116, Rhizoma Chuanxiong 116, Poria 116, Rhizoma Pinelliae Preparata 77, Fructus Trichosanthis 116, Bulbus Allii Macrostemonis 93, Pericarpium Citri Reticulatae 116, Radix Glycyrrhizae 77.
4. prepare the method that claim requires the medicine of restenosis after 1-3 any one prevention percutaneous transluminal coronary stent implantation for one kind, it is characterized in that: Radix Ginseng, Poria two taste are ground into fine powder, residue ten add water simply filtrations, decoction, merging filtrate, be condensed into paste, by above-mentioned fine powder and auxiliary materials and mixing, granulate, drying, incapsulates.
5. the method for medicine of restenosis after preparation prevention percutaneous transluminal coronary stent implantation according to claim 4, is characterized in that: described decoction is secondary, each 2 hours.
6. the method for medicine of restenosis after preparation prevention percutaneous transluminal coronary stent implantation according to claim 4, is characterized in that: described adjuvant is the ratio 30:1 of medical dextrin, blending.
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