CN104524421B - 一种治疗心肌梗塞术后再狭窄的中药 - Google Patents
一种治疗心肌梗塞术后再狭窄的中药 Download PDFInfo
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Abstract
一种治疗心肌梗塞术后再狭窄的中药，属于中医药领域。本发明的目的是采用中医理论，以活血化瘀，疏通脉络，益气温阳为主，佐以宽胸利膈，除烦解郁的一种治疗心肌梗塞术后再狭窄的中药。本发明制成有效成分的原料重量份组成为：白芍、太子参、田三七、水蛭、三棱、莪术、瓜蒌、薤白、山楂。本发明制备简单，价格低廉，疗效好，无毒副作用，治疗时间短，社会及经济效益好。本发明主要用于治疗冠心病，心肌缺血，心肌梗塞术后再狭窄等。
Description
技术领域
本发明属于中医药领域。
背景技术
冠心病心肌缺血，心肌梗塞，药物治疗效果不确定，复发率高，死亡率更高，严重危害人类的生命。心肌梗塞属于中医学的“胸痹心痛”，“真心痛”，“厥心痛”等范畴，常发生在中老年人群，其病因多与外部侵袭；情绪失调，年老体弱，饮食不节等因素有关。为本虚标实之病，其病心，脏气亏虚，是其发病基础。《李向·痹论》曰：“心痹者，脉不通，不通则痛。中医学认为本病为本虚标实，气虚血瘀之证。其正气，气虚是再狭窄的重要病机，瘀血内停是再狭窄的重要发病环节，毒瘀阻络是再狭窄的局部特点，使局部动脉损伤，影响心脉运行气血，导致局部瘀阻内停，蕴积日久化生为毒，使气血凝滞，毒邪雍遏而发生心肌梗塞术后再狭窄。
在西医西药也有治疗心肌梗塞术后再狭窄的。但其药品价格昂贵，疗效不确定，并且治疗时间较长，易复发等不足，而有些中医中药也存在疗效不佳等缺点。
发明内容
本发明的目的是采用中医理论，以活血化瘀，疏通脉络，益气温阳为主，佐以宽胸利膈，除烦解郁的一种治疗心肌梗塞术后再狭窄的中药。
本发明制成有效成分的原料重量份组成为：
白芍10-25 太子参10-20 田三七5-15
水蛭5-10 三棱5-10 莪术5-10
瓜蒌 10-30 薤白10-25 山楂10-30。
本发明制备简单，价格低廉，疗效好，无毒副作用，治疗时间短，社会及经济效益好。本发明主要用于治疗冠心病，心肌缺血，心肌梗塞术后再狭窄等。
具体实施方式
本发明制成有效成分的原料重量份组成为：
白芍10-25 太子参10-20 田三七5-15
水蛭5-10 三棱5-10 莪术5-10
瓜蒌 10-30 薤白10-25 山楂10-30。
制备方法是：
将以上9味中药，加入8倍量水浸泡30分钟，煎煮二次，每次0.5小时，滤过，再合并滤液，浓缩至约1000ml，加入苯甲酸钠2g，使其溶解，再冷藏12小时，滤过，滤液加蒸馏水调至1000ml，搅匀，分装即得。
实施例1：
本发明制成有效成分的原料重量份组成为：
白芍10 太子参10 田三七5
水蛭5 三棱5 莪术5
瓜蒌 10 薤白10 山楂10 。
制备方法同上。
实施例2：
本发明制成有效成分的原料重量份组成为：
白芍15 太子参15 田三七7
水蛭7 三棱7 莪术7
瓜蒌 20 薤白20 山楂25。
制备方法同上。
实施例3：
本发明制成有效成分的原料重量份组成为：
白芍25 太子参20 田三七15
水蛭10 三棱10 莪术10
瓜蒌 30 薤白25 山楂30。
制备方法同上。
实施例4：
本发明制成有效成分的最佳原料重量份组成为：
白芍15 太子参15 田三七5
水蛭5 三棱5 莪术5
瓜蒌 15 薤白20 山楂25。
制备方法同上。
【本发明的用法及用量】：
口服，一次100ml，一日2次，温热饭后服。
不良反应：个别患者偶有轻微的恶心，停药后消失。
禁忌和注意事项：①孕妇忌服；②对本中药过敏者忌服；患感冒及妇女月经期慎服。
本发明君药用白芍、太子参，白芍养血柔肝,缓中止痛,敛阴收汗，太子参能益气温阳，并能快速补气通阳，使气虚者补，血瘀者通，通则不痛，故有“大气一转，其结及散”之理。臣药是田三七，三棱，莪术三者得配，具有活血化瘀，疏通脉络之功，佐药是水蛭，具有解除冠脉血管肌痉挛，以减少冠状动脉阻力，增加冠脉血液量；使药是瓜蒌，薤白，山楂，具有宽胸利膈，除烦解郁，通阳散结，行气导滞，行气散淤。
诸药综合，相得益彰，故全方标本兼治，先攻后补，使阳气得补，气行则血行，脉络舒通，通则不痛，疾病解除，患者安康之功效。
目的：观察本发明处方的中药疗效观察。方法：选择符合标准的患者60例，随机分为治疗组30例，对照组30例，治疗组：服用本发明中药口服液；对照组投服益心舒治疗，两组均连续服6个月后观察冠心病心绞痛及心电图和心冠脉搏造影检查变化并作对照比较。结果：治疗组总有效率76.67%，对照组总有效56.67%，心电图的改变治疗组好于对照组（p<0.05）。结论：一种治疗心肌梗赛术后再狭窄的中药有一定效果，有显著性差异（p<0.01）。
冠状动脉硬化性心脏病（冠心病）或心肌梗塞药物治疗效果不尽如人意，复发率高，死亡率居高不下，严重危害人类的生命，当前，经皮冠状动脉腔内成形术（PTCA）是治疗的主要有效手段，逐渐让患者接受，但术后2—4个月病变再狭窄率较高，影响了治疗，远期疗效，中药治疗此病报道很少。因此，笔者研发了治疗此病的中药，应用一种治疗心肌梗塞术后再狭窄的中药预防及治疗，取得一定疗效。
临床资料：
1.1 诊断标准：60例冠心病，心绞痛，心肌梗塞患者有符合WHO1979年冠心病的诊断标准和王吉耀主编《内科学》急性心肌梗死的诊断标准。年龄49—76岁（平均61±3岁），其中男36例，女24例，病程1-17年。
1.2 对象：其观察冠心病、心绞痛、心肌梗死的患者60例，其中治疗组30例，对照组30例，两组患者在性别分布，年龄分布，病程分布，心绞痛及急性心肌便死的程度均心电图证实ST段压低≥0.05MV，T液低平，双相或倒置，有病理性Q液，ST段抬高呈弓背向上型，并排除其他因素影响等方面均无显著性差异（p>0.05），具有可比性。
1.3 治疗方法：治疗组服用中药口服液；吉林大学第一院中药制剂室提供中药处方：白芍15g、太子参25g、田三七10g、水蛭5g、三棱5g、莪术5g、瓜蒌25g、薤白10g、山楂15g至200min，分早晚口服，4周1疗程，连服6个月，对照组投服益心舒，3片/日，3次口服，4周为一疗程，连服6个月。然后观察两组的冠心病，心绞及心肌梗死的疗效，及心电图的变化与心脏冠脉造影的改变作用。
1.4 疗效标准：A：按照修订的1984年的《冠心病心绞痛，心肌梗死及心电图和心脏冠脉造影的疗效评定参考标准》评定[1]；
显效：以心绞痛，胸闷7d内消失者；
有效：以心绞痛，胸闷8-14d消失或妇者；
无效：以心绞痛，胸闷15d规妇者。
B：心电图疗效评定标准[3]
显效：心电图恢复到“大致正常”，即正常范围或达到正常人心电图。女子转ST段的降低在治疗后回升0.05MV以上，或T波变浅（达25%以上者）或T波由平坦为直立，房室或室内传导阻滞改善者；
无效：心电图与治疗前基本相同；
加重：ST段较治疗前降低0.05MV以上，在主要导联测量T波加深（达25%以上）或直立T波平坦，平坦T波变例量，以及出现异位心律，房室传导阻滞或室内传导阻滞。
C：心脏冠状动脉造影
用QCA评价支架置入前，支架置入后即刻和6-12个月后，造影结果的最小管腔直径（MLD），狭窄程度（%）。
1.5 统计学处理：所有计量数据均以±s表示，两组间比较采用t检验，两组间计数资料采用x2检验，多变量与支架术后再狭窄的关系用SPSS11.5软件行多元logistic回归分析，p<0.05视为有统计学意义。
结果
2.1 经过6个月的治疗后，两组患者临床疗效详见表1；心电图变化结果详见表2；心脏冠状动脉造影改变详见表3。
表1 两组临床总疗效比较（+s）
注：与对照组比较p<0.05。
表2 两组治疗前后心电图变化比较（+s）
注：△与对照组治疗后比较p<0.01。
表3 两组支架术后服药治疗随访QCA结果比较（+s）
注；与对照组比较p<0.01。
讨论
介入性治疗如腔内冠状动脉血管或形术（PTCA）或支架植入（CASI）等已成为冠心病，心肌梗死的一种有效治疗手段，近年来在我国已广泛开展，提高疗效，延长生命，减少死亡率，深受患者和医者的好评，但仍约有30-50%的患者在CASI后6个月内发生再狭窄（RS），目前，认为其发生机制与血管内皮损伤，炎症增生和血管重塑等有关[6]，或认为支架术后再狭窄发生的可能机制主要是支架置入局部的冠状动脉血管内膜过度增生以及血管壁的重构。炎症反应在支架置入后新生内膜形成中起相当重要的作用[10]。而中医学的病因病机认为：冠状动脉粥样硬化性心脏病（CHD）、心绞痛、心肌梗死等属于中医的“胸痹心痛”，“真心痛”、“厥心痛”等范畴，多发于老年人。其病因多与外邢侵袭；情志失调，年老体衰，饮食不节，多食高梁厚味之品等有关。为本虚标实之疾，其病在心。脏气亏虚是其发病基础。《李向·痹论》曰：“心痹者，脉不通”及不通则痛。中医学认为本病为本虚较实，气虚血瘀之证。其正气虚是再狭窄的重要病机，瘀血内停是再狭窄的重要发病环节，毒瘀阻络是再狭窄的局部特点[6]。由于PCI手术的实施，使局部动脉损伤，影响心脉运行气血，导致局部瘀阻内停，蕴积日久化生为毒，气血凝滞，毒邪壅遏而发生再狭窄。认为阳气不足，瘀血阳滞是冠心病及心肌梗死和PTCA后再狭窄的根本病机[7]，故在气虚的情况下，心脉失于鼓舞，出现胸闷、气短、心悸、心前疼痛及放射痛等表现。故方中投的太子参为君药，能益气温阳，并能快速补气通阳，使气虚者补、血瘀者通、通则不痛，故有“大气一转，其结及散”之理。瓜篓宽胸利膈，除烦解郁等活血化瘀，疏通脉络，具有治疗PCI术后再狭窄的作用。田三七、三棱、莪术、薤白、山楂具有通络、利尿，以减轻心脏负荷，增强心功能及心绞痛的作用。水蛭具有解除冠状血管肌痉挛，以减少冠状动脉阻力，增加冠脉血流量，亦治疗PCI术后再狭窄的作用。故全方标本兼治，主攻后补使阳气得补，气行则血流，脉络舒通，通则不痛，疾病解除。故而收到满意的疗效。
Claims (1)
1.一种治疗心肌梗塞术后再狭窄的中药，其特征在于：由以下重量份的原料药组成：
白芍10-25 太子参10-20 田三七5-15
水蛭5-10 三棱5-10 莪术5-10
瓜蒌 10-30 薤白10-25 山楂10-30。
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