CN105456652A - 一种治疗血脂异常和冠心病的中药制剂及其制备方法 - Google Patents
一种治疗血脂异常和冠心病的中药制剂及其制备方法 Download PDFInfo
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Abstract
一种治疗血脂异常和冠心病的中药制剂及其制备方法,该中药制剂是由如下重量份数的中草药原料组成的:丹参15~30份、清半夏9~15份、藏红花9~18份、当归9~15份、瓜蒌15~30份、薤白9~18份、炒白术15~30份、生蒲黄6~12份、焦山楂9~30份、炙黄芪15~30份、桂枝6~15份、橘络6~12份、鸡血藤15~30份、炙甘草9~15份。本发明提供的制备方法简便易实施,可制成中药汤剂、颗粒剂等;同时,该中药制剂组方配伍得当、疗效确切、安全性高、无副作用,能够调节血脂,延缓动脉粥样硬化,减少冠心病发作次数、减轻症状,提高患者生活质量,为防治、改善血脂异常和冠状动脉粥样硬化性心脏病的有效中药复方制剂。
Description
技术领域
本发明涉及中药内治技术领域,尤其涉及一种治疗血脂异常和冠状动脉粥样硬化性心脏病的中药制剂及其制备方法。
背景技术
冠状动脉粥样硬化性心脏病,是指冠状动脉粥样硬化引起血管痉挛或阻塞或因冠状动脉功能性改变导致心肌缺血缺氧或坏死所引起的,其发生主要与脂质代谢异常有关,常常被称为“冠心病”。动脉粥样硬化是其发病重要病理基础,也是临床心血管疾病发生和引起死亡的主要原因。近年来,冠心病作为最常见的一种心脏病,在我国目前的心血管疾病中患病率最高,已成为我国严重威胁人民健康的主要疾病。
祖国医学认为,冠心病属中医“胸痹”范畴,本病的发生多与寒邪内侵、情志失调、饮食失节、年老体虚等多因素综合作用的结果相关,为“本虚标实”之证,“本虚”指气血阴阳亏虚,“标实”则有指气滞、血瘀、痰浊、寒凝之不同,而痰浊、血瘀为最终病机格局。痰浊和瘀血分别是水液和血液代谢失调的病理产物,痰来自津,瘀来自血,二者同源异流,反映人体血运失常。生理上属“津血同源”,病理上为“痰瘀互结”。津液亏虚,生瘀生痰;津运障碍,因痰致瘀;血运失调,因瘀致痰,均可形成痰瘀互结为病。津血同源,痰瘀相关,痰浊与瘀血同属病理产物,二者又相辅相成、相互转化,痰可生瘀,瘀可致痰,单化痰则瘀血不祛,单祛瘀则痰浊不化,故治疗时必须权衡痰浊、瘀血之轻重。现代医学认为血脂异常和冠状动脉粥样硬化与中医痰浊瘀血密切相关,应用“痰瘀互结理论”可阐释冠心病形成发展的病因病机。因此,如何有效地辨治“痰浊”、“瘀血”是冠心病防治研究的焦点。
目前,现代医学通过对症治疗能够减轻冠心病急性发作的痛苦,但对于冠心病的疾病后期恢复和预防则缺少公认、安全、有效、具体的治疗方法。基于中医“津血同源”、“痰瘀互结”以及“痰瘀同治”等理论,中医中药复方在防治冠心病复发和预防方面存在一定特色和优势,体现出整体优势,与现代西药合用起到协同增效的作用,特别是针对血脂异常和动脉粥样硬化的改善疗效明显。通过辨证组方,中药复方能够达到燥湿泄浊、健脾化痰、通脉行气、活血化瘀等作用,培固正气、祛除邪气,避免疾病发病的高危因素,调节血脂,延缓动脉粥样硬化,减少冠心病发作次数、减轻症状,提高患者生活质量。该治疗措施易于患者及家属接受,价格低廉,服用方便安全,依从性好,且医疗资源消耗较少,正越来越成为医患双方选择治疗冠心病提高其临床疗效的新方法。
发明内容
针对上述问题,本发明提供一种治疗血脂异常和冠心病的中药制剂及其制备方法,以“津血同源”、“痰瘀互结”理论为指导,基于“痰瘀同治”的组方原则,调配方药以燥湿泄浊、健脾化痰、通脉行气、活血化瘀,进而防治血脂异常和冠状动脉粥样硬化性心脏病。
为实现本发明的上述目的,本发明提供一种治疗血脂异常和冠心病的中药制剂,是由如下重量份数的中草药原料组成的:丹参15~30份、清半夏9~15份、藏红花9~18份、当归9~15份、瓜蒌15~30份、薤白9~18份、炒白术15~30份、生蒲黄6~12份、焦山楂9~30份、炙黄芪15~30份、桂枝6~15份、橘络6~12份、鸡血藤15~30份、炙甘草9~15份。
本发明还提供一种治疗血脂异常和冠心病的中药制剂的制备方法,包括以下步骤。
步骤1、按配方取瓜蒌、清半夏混和后,放入容器中,采用饮用冷水浸泡30~45min,水超过药材表面2~4cm。
步骤2、按配方取丹参、藏红花、当归、薤白、炒白术、焦山楂、炙黄芪、橘络、鸡血藤、炙甘草,混和后放入容器中,采用饮用冷水浸泡30~45min,水超过药材表面2~4cm。
步骤3、先煎煮步骤1浸泡后的瓜蒌、清半夏,用武火煮沸药液后,放入步骤2容器中浸泡好的药材和水,用武火再次煮沸药液。
步骤4、按配方取桂枝、生蒲黄,以及清酒20ml放入步骤3的药液中,文火慢煎30~45min;煎煮后倒出汤剂100~150ml,保存以备服用。
步骤5、将药渣保存2℃冰箱,留第二日再次煎煮。
步骤6、第二日不用浸泡,熬药前先放入饮用冷水,水超过药渣表面2~4cm;然后,用武火再次煮沸药液,然后放入清酒20ml,文火慢煎30~45min,即得。
所述容器为砂锅或陶罐。
所述生蒲黄为包煎,即把饮片装在纱布袋中,扎紧袋口后,再与群药共同煎煮。
所述治疗血脂异常和冠心病的中药制剂可制成中药汤剂、颗粒剂等。
本发明组方的配伍释义:所述中药制剂以“津血同源”、“痰瘀互结”理论为指导,基于“痰瘀同治”的组方原则而组成。丹参苦、微寒,归心、肝经,为活血化瘀之要药,《妇人明理论》云:“一味丹参,功同四物”,活血而不伤血,既能活血化瘀,又能补血养心。《日华子本草》云:“养神定志,通利关脉。……破宿血,补新生血。”《滇南本草》云:“补心定志,安神宁心。治健忘怔忡,惊悸不寐。”《本草纲目》云:“活血,通心包络,治病痛”。《云南中草药选》云:“活血散瘀,镇静止痛”。清半夏辛、温,有小毒,归脾、胃、肺经,功能燥湿化痰和胃。《药性论》云其可“消痰涎,开胃健脾”。张寿颐曰:“味辛,辛能泄散,而多涎甚滑,则又速降”。丹参、半夏共为君药,共奏活血化瘀、燥湿化痰之功。藏红花辛、微苦、温,归心、肝经,功能活血通经,散瘀止痛,是活血祛瘀之良药。《开宝本草》曰:“主产后血运口嚓,腹内恶血不尽绞痛,胎死腹中,并酒煮服。亦中蛊毒下血”。当归甘、辛、温,归肝、心、脾经。《本草正》:“当归,其味甘而重,故专能补血,其气轻而辛,故又能行血,补中有动,行中有补,诚血中之气药,亦血中之圣药也。大约佐之以补则补,故能养营养血,补气生精,安五脏,强形体,益神志,凡有形虚损之病,无所不宜。”因而,它既能补血,又能活血,既可通经,又能活络。《本草新编》:“当归,味甘辛,气温,可升可降,阳中之阴,无毒。虽有上下之分,而补血则一。入心、脾、肝三脏。但其性甚动,入之补气药中则补气,入之补血药中则补血,无定功也。”鸡血藤性味归经:苦、甘,温。归肝、肾经。主治补血,活血,通络。当归、鸡血藤辅丹参养血行血为臣。瓜蒌降肺气以利膈宽胸为主,薤白通阳气以化浊阴,共辅半夏降逆化饮,通阳行气止痛为臣。炙黄芪、炒白术益气健脾化湿,以助化痰降浊行气祛瘀之力。焦山楂消食化积,行气散瘀。橘络化痰通络、行气活血;生蒲黄功能收涩止血,行血化瘀。止血无留瘀之弊,化瘀无出血之害。诸药相合为臣,共奏化痰降浊、活血化瘀、健脾益气之功效,标本兼治,直切病机。桂枝通阳散寒、通脉止痛,炙甘草缓急止痛,调和诸药,与桂枝共为使药。上述诸药燥湿泄浊、健脾化痰、通脉行气、活血化瘀同施,诸药合用,共奏化痰祛瘀之功,达痰瘀同治之效。
与现有技术相比本发明的有益效果。
本发明提供的治疗血脂异常和冠心病的中药制剂及其制备方法,由中药地道药材组成,以“津血同源”、“痰瘀互结”理论为指导,基于“痰瘀同治”的组方原则,调配方药以燥湿泄浊、健脾化痰、通脉行气、活血化瘀,进而达到防治血脂异常和冠状动脉粥样硬化性心脏病的目的。本发明提供的中药制剂在防治冠心病复发和预防方面存在一定特色和优势,特别是与现代常规西药合用起到协同增效的作用,尤其针对血脂异常和动脉粥样硬化的改善疗效明显。另外,该中药制剂能够调节血脂,延缓动脉粥样硬化,减少冠心病发作次数、减轻症状,提高患者生活质量。同时,该中药制剂具有配伍得当、疗效确切、使用方便、安全性高、无副作用等优点,为防治、改善血脂异常和冠状动脉粥样硬化性心脏病的有效中药复方制剂。
具体实施方式
下面结合具体实施例进一步详细说明本发明。
实施例1。
本实施例提供一种治疗血脂异常和冠心病的中药制剂,是由如下重量份数的中草药原料组成的:丹参18份、清半夏9份、藏红花12份、当归12份、瓜蒌15份、薤白12份、炒白术15份、生蒲黄9份、焦山楂15份、炙黄芪18份、桂枝6份、橘络9份、鸡血藤15份、炙甘草9份。
所述治疗血脂异常和冠心病的中药制剂可制成中药汤剂。
本实施例还提供一种治疗血脂异常和冠心病的中药制剂的制备方法,包括以下步骤。
步骤1、按配方取瓜蒌、清半夏混和后,放入砂锅(陶罐)中,熬药前先用饮用冷水浸泡30~45min,水没过1中指(2~4cm)。
步骤2、按配方取丹参、藏红花、当归、薤白、炒白术、焦山楂、炙黄芪、橘络、鸡血藤、炙甘草,混和后放入砂锅(陶罐)中,熬药前先用饮用冷水浸泡30~45min,水没过1中指(2~4cm)。
步骤3、先煎煮浸泡后的瓜蒌、清半夏,用武火(即大火)煮沸药液后,向瓜蒌、清半夏砂锅(陶罐)中放入浸泡好的丹参、藏红花、当归、薤白、炒白术、焦山楂、炙黄芪、橘络、鸡血藤、炙甘草及水,用武火(即大火)再次煮沸药液。
步骤4、按配方取桂枝、生蒲黄(包煎)(即把饮片装在纱布袋中,扎紧袋口后,再与群药共同煎煮),并取清酒20ml放入步骤3药液中文火(即小火)慢煎30~45min;煎煮后倒出汤剂1碗(100~150ml)保存备服用。
步骤5、将药渣保存2℃冰箱,留第二日再次煎煮。
步骤6、第二日不用浸泡,熬药前先放入饮用冷水,水没过1中指(2~4cm);然后,用武火(即大火)再次煮沸药液,取清酒20ml放入上述药液中予文火(即小火)慢煎30~45min,即可。
注意事项:(1)煎药时要注意搅拌药料,让药液充分煎透;(2)刚开始煎药时须盖紧锅盖,待水沸时可用两根筷子撑起锅盖,留些缝隙让蒸气排出;(3)药液和药渣保存时要放到密闭容器里,置于阴凉处或冰箱冷藏室;(4)按配方每付汤药煎煮2次,分两日煎熬。
所述治疗血脂异常和冠心病的中药制剂的服用方法为:(1)按配方每付汤药服用2天,每天两次,早饭前30min服用(50~75ml),晚饭后半小时服用(50~75ml),服用前将药液加温;(2)与其它中成药、西药隔开半小时以上;(3)服用汤药期间,禁止服用辛辣、鱼腥、发物、生冷、油腻、酸涩的食物和饮料。
为进一步验证本发明的有益效果,提供以下试验案例。
一、中药复方汤剂治疗痰瘀互结型冠心病血脂异常患者的临床疗效观察。
1、临床资料。
1.1一般资料:90例患者均来源于辽宁中医药大学附属医院门诊冠心病患者,检查结果均具有血脂异常,收集时间为2013年5月~2014年5月,按随机数字表随机分为西药组、中药1组(本实施例1用药)、中药2组,三组均30例,各组患者一般资料如下表1,差异无统计学意义(P>0.05),具有可比性。
表1:三组患者一般资料比较。
组别 | 西药组 | 中药1组 | 中药2组 |
男/女(例) | 20/10 | 23/7 | 22/8 |
年龄(岁,均值±标准差) | (62.5±5.6) | 63.2±7.3 | 60.8±6.9 |
病程(年,均值±标准差) | 10.2±6.7 | 11.1±6.2 | 10.6±6.5 |
体重指数(kg/cm2,均值±标准差) | 26.1±3.6 | 28.5±3.9 | 27.7±4.1 |
冠脉积分(分,均值±标准差) | 70.2±2.8 | 71.3±3.1 | 69.8±2.9 |
高血压(例(%)) | 12(0.4) | 10(0.333) | 14(0.467) |
2型糖尿病(例(%)) | 6(0.2) | 5(0.167) | 6(0.2) |
1.2纳入标准:冠心病心绞痛诊断参照“慢性稳定性心绞痛诊疗指南”以及“不稳定性心绞痛诊断和治疗建议”及“血脂异常危险分层方案——《中国成人血脂异常诊治指南》”。中医辨证分型参照《中药新药临床研究指导原则》及《现代中医临床诊断学》。
1.3排除标准:除急性心肌梗死外,另有中度以上高血压、心肺功能不全、重度心律失常及其他心脏疾患,重度神经官能症,更年期综合征,精神病,肝肾功能损害及其他系统严重原发性疾病者。
1.4脱落及剔除标准。
脱落标准:(1)患者在治疗周期因各种原因不愿意继续服用药物主动退出;(2)发生并发症,不宜继续接受治疗。
剔除标准:(1)纳入后发现不符合纳入标准而误纳;(2)中途换药、加药,或者合并使用本研究禁止使用的中西药物,影响疗效或安全性判定。
2、治疗方法。
2.1西药组:消心痛10mg,口服,3次/d;阿司匹林100mg,口服,1次/d;连续4周。
2.2中药1组:在常规西药治疗基础上联合本实施例1的中药汤剂治疗。本实施例1的中药汤剂每日一剂,早晚分两次服,连续4周。
2.3中药2组:在常规西药治疗基础上联合瓜蒌薤白半夏汤合血府逐瘀汤。组方:瓜蒌、薤白、半夏、生地、桃仁、红花、当归、赤芍、桔梗、枳壳、柴胡、川芎、牛膝、甘草组成。水酒并煎,每日一剂,早晚分两次服,连续4周。
2.4检测指标:患者服药4周后,取空腹12h肘静脉血,离心取血清待测,总胆固醇、甘油三酯用酶法,载脂蛋白A1与载脂蛋白B100、ApoB100及脂蛋白α测定采用透射免疫比浊法,高密度脂蛋白、低密度脂蛋白用直接法。
3、疗效观察。
3.1疗效标准:症状疗效与心电图疗效标准参《中医临床病证诊断与疗效标准》拟定。
(1)症状疗效标准。显效:症状消失或基本消失,或由较重到轻度;有效:发作次数明显减少,程度明显减轻,持续时间明显缩短;无效:症状与治疗前基本相同。
(2)心电图疗效标准。痊愈:心电图恢复至“大致正常”(即正常范围)或达到“正常心电图”;显效:ST段的降低,以治疗后回升0.05mV以上,但未达正常水平,在主要导联倒置T波变浅(达25%以上者);或T波由平坦变为直立,房室或室内传导阻滞改善者;有效:心电图基本与治疗前相同;无效:ST段较治疗前降低0.05mV以上,在主要导联倒置T波加深(达25%以上),或直立T波变平坦,平坦T波变倒置,以及出现异位心律、房室传导阻滞或室内传导阻滞。
3.2统计学方法:分析计数资料采用方差分析检验。以P<0.05差异有统计学意义,应用SPSS15.0软件进行分析。
3.3结果。
3.3.1病例脱落及剔除情况:西药组剔除2例(中途调药),中药1组脱落2例、中药2组脱落3例(均为违反试验用药原则)。
3.3.2心绞痛疗效比较结果,见表2。
西药组总有效率为78.5%,中药1组总有效率为92.8%,中药2组总有效率为85.1%,中药1组、2组心绞痛疗效显著优于对照组(P<0.05),且中药1组心绞痛疗效显著优于中药2组。
表2:三组治疗后心绞痛症状改善结果比较(例(%))。
组别 | 例数 | 显著 | 有效 | 无效 | 总有效率 |
西药组 | 28 | 10(35.7) | 12(42.8) | 6(21.5) | 22(78.5) |
中药1组 | 28 | 13(46.4) | 13(46.4) | 2(7.2) | 26(92.8)*△ |
中药2组 | 27 | 11(40.7) | 12(44.4) | 6(14.9) | 23(85.1)* |
注:与西药组比较:* P<0.05,△与中药2组比较* P<0.05。
3.3.3心电图疗效比较结果,见表3。西药组总有效率为71.4%,中药1组总有效率为82.1%,中药2组总有效率为81.5%,中药1组、2组心绞痛疗效显著优于对照组(P<0.05),两中药组间无统计学差异。
表3:三组治疗后心电图疗效比较(例(%))。
组别 | 例数 | 显著 | 有效 | 无效 | 总有效率 |
西药组 | 28 | 9(32.1) | 11(39.3) | 8(28.6) | 20(71.4) |
中药1组 | 28 | 11(39.3) | 12(42.8) | 5(17.9) | 23(82.1)* |
中药2组 | 27 | 10(37.1) | 12(44.4) | 6(18.5) | 22(81.5)* |
注:与西药组比较:* P<0.05。
3.3.4三组治疗后血脂改善情况比较结果,见表4。中药1组和中药2组的TC,LDL-C,ApoB100,LP(α)均明显低于西药组(P<0.05),但两组间比较无差异(P>0.05)。中药1组和中药2组的HDL-C,ApoA1均明显高于西药组(P<0.05),但两组间比较无差异(P>0.05)。
表4:三组治疗后血脂改善情况比较(均值±标准差)。
西药组/28 | 中药1组/28 | 中药2组/27 | |
TC(mmol/l) | 5.36±0.63 | 4.52±0.13*△ | 5.12±0.56* |
LDL-C(mmol/l) | 3.72±0.79 | 3.21±0.64* | 3.27±0.73* |
HDL-C(mmol/l) | 1.22±0.35 | 1.42±0.26* | 1.35±0.44* |
ApoA1(g/l) | 1.36±0.46 | 1.46±0.37* | 1.42±0.35* |
ApoB100(g/l) | 1.66±0.25 | 1.10±0.32* | 1.12±0.29* |
LP(α)(mg/l) | 465.3±112.5 | 278.6±123.3*△ | 315.4±142.6* |
注:与西药组比较:*P<0.05,△与中药2组比较* P<0.05。
5、结论。
冠心病的发生主要与脂质代谢异常有关,定期检查冠心病患者血脂指标水平,可动态掌握其病情的发展及严重程度,对临床预防及治疗冠心病均可产生指导性意义。冠心病的形成起始于动脉内皮损伤,在长期高脂血症的情况下,TC和氧化修饰的低密度脂蛋白(oxLDL)损伤动脉内膜,从而造成TC、LDL及泡沫细胞等在血管内皮下沉积,形成动脉硬化,造成动脉狭窄,大量研究表明,LDL-C水平越高,HDL-C水平越低,患AS的风险性越大。另外,载脂蛋白作为脂蛋白的主要组成部分参与了血脂的代谢和调节。目前,已知ApoA1约占HDL-C60%~70%,可激活卵磷脂胆固醇酰基转移酶,促进主动脉成纤维细胞中游离胆固醇的清除,酯化周围组织游离胆固醇并将其转入肝内代谢,对防止外周组织脂质沉积有重要意义,ApoA1与动脉粥样硬化呈负相关。ApoB100的含量能精确地反映LDL-C的水平,约占LDL-C的90%以上,ApoB100能将胆固醇导向外周组织引起动脉粥样硬化,因此,ApoB100的升高与动脉粥样硬化呈正相关。
本实施例提供的该中药汤剂在改善冠心病患者的临床症状、心电图改变方面都有明显的疗效,可通过降低血清TC、LDL-C、ApoB100、LP(α)水平,升高HDL-C、ApoA1水平而调脂,可能通过保护血管内皮细胞、稳定粥样斑块、改善心肌血供而减轻心肌缺血缺氧状态,从而达到防治冠心病的目的。
二、本实施例中药汤剂治疗痰瘀互结型冠心病心绞痛患者临床疗效观察。
1、临床资料。
1.1一般资料:90例痰瘀互结型冠心病心绞痛患者来自于辽宁中医药大学附属二院门诊收集,收集时间为2014年5月~2015年5月,按随机数字表法分为试验组及对照组,两组均45例。两组患者一般资料比较,见表5,差异无统计学意义(P>Q05)。
表5:两组患者一般资料比较。
组别 | 试验组 | 对照组 |
男/女(例) | 30/15 | 32/13 |
年龄(岁,均值±标准差) | 63.2±7.5 | 64.5±6.3 |
病程(月,均值±标准差) | 18±5.2 | 19±4.3 |
体重指数(kg/cm2,均值±标准差) | 27.8±5.6 | 25.9±4.7 |
冠脉积分(分,均值±标准差) | 78.6±4.3 | 77.6±5.1 |
高血压(例(%)) | 12(0.27) | 13(0.29) |
血脂异常(例(%)) | 30(0.67) | 32(0.71) |
2型糖尿病(例(%)) | 5(0.11) | 4(0.08) |
1.2诊断标准及辨证分型标准:冠心病心绞痛诊断参照“慢性稳定性心绞痛诊疗指南”以及“不稳定性心绞痛诊断和治疗建议”。中医辨证分型参照《中药新药临床研究指导原则》及《现代中医临床诊断学》。
1.3纳入及排除标准纳入标准:符合诊断标准,符合中医痰瘀互阻证标准;年龄40~75岁;签署知情同意书。排除标准:ST段抬高的急性心肌梗死;低血压(<90/60mmHg)或合并高血压,经药物治疗后效果不明显(收缩压>160mmHg,舒张压>100mmHg);有出血倾向者;充血性心力衰竭及肺动脉高压所致的右心衰竭;重度心律失常;妊娠期或哺乳期妇女;肝肾功能严重异常;伴有肿瘤患者;重度神经官能症,更年期综合症;精神病;其他系统原发性疾病。
1.4脱落及剔除标准。
脱落标准:(1)患者在治疗周期因各种原因不愿意继续服用药物主动退出;(2)发生并发症,不宜继续接受治疗。
剔除标准:(1)纳入后发现不符合纳入标准而误纳;(2)试验中因各种原因破盲;(3)中途换药、加药,或者合并使用本研究禁止使用的中西药物,影响疗效或安全性判定。
2、治疗方法。
两组患者均接受西医常规治疗:阿司匹林100mg,每天1次。试验组在西药常规治疗基础上加服本实施例1的中药汤剂,每日一剂,早晚分两次服,连续4周;对照组在常规西药治疗,疗程均为4周。试验组、对照组中高血压患者常规服用降压药,糖尿病患者常规服用降糖药或应用胰岛素。试验组、对照组患者硝酸甘油备用应急使用。
3、观察指标及方法。
3.1心绞痛疗效:观察治疗前后心绞痛发作情况及心电图变化,参照心绞痛分级,参照《全国中西医结合治疗冠心病、心绞痛及心律失常研究座谈会修订》(1979年9月,上海)。显效:心绞痛发作次数或硝酸甘油用量减少>80%,心绞痛分级改善2级,或静息心电图正常。有效:心绞痛发作次数或硝酸甘油用量减少50%~80%,心绞痛分级改善l级,或静息心电图sT段回升≥0.5mm。无效:心绞痛发作次数或硝酸甘油用量减少<50%,心绞痛分级不变或恶化,静息心电图无改善。
3.2心绞痛发作情况:观察两组治疗前后2周内心绞痛发作情况,包括心绞痛发作频率、持续时间及心绞痛积分。
3.3心电图:观察两组治疗前后心电图ST段下移导联数、T波低平导联数、T波倒置导联数。
3.4中医证候疗效判定标准:根据尼莫地平法积分法判定,计算方法:疗效指数=(疗前积分-疗后积分)/疗前积分×100%。(①临床控制:症状、体征消失或基本消失,证候积分减少≥95%;②显效:症状、体征明显改善,95%>证候积分减少≥70%;③有效:症状、体征均有好转,70%>证候积分减少≥30%;④无效:症状、体征均无明显改善,甚或加重,证候积分减少<30%)。
4、统计学方法:采用SPSS13.0软件,计数资料以%表示,用卡方检验,计量资料多组之间比较用单因素方差分析。
5、结果。
5.1病例脱落及剔除情况:试验组剔除3例(依从性差),对照组脱落2例(中途急性发作)。
5.2心绞痛疗效比较结果,见表6。试验组总有效率为90.5%,对照组总有效率为76.8%,试验组疗效显著优于对照组(P<0.05)。
表6:试验组和对照组心绞痛疗效比较(例(%))。
组别 | 例数(N) | 显效 | 有效 | 无效 | 总有效率 |
试验组 | 42 | 10(23.8%) | 28(66.7%) | 4(9.5%) | 90.5%* |
对照组 | 43 | 7(16.3%) | 26(60.5%) | 10(23.2%) | 76.8% |
注:与对照组比较:* P<0.05。
5.3心绞痛发作情况比较结果,见表7。与本组治疗前比较,两组患者心绞痛发作频率、持续时间及心绞痛积分均显著降低(P<0.01)。与对照组治疗后比较,试验组心绞痛发作频率、疼痛持续时间及心绞痛积分显著降低(P<0.05)。
表7:试验组和对照组治疗前后心绞痛发作情况比较(均值±标准差)。
组别 | 发作频率(次/周) | 持续时间(min/次) | 心绞痛积分(分) |
试验组(42例)治疗前 | 12.5±3.2 | 9.5±2.1 | 22.1±4.5 |
试验组(42例)治疗后 | 7.3±2.1*△ | 4.8±1.2*△ | 13.6±3.3*△ |
对照组(43例)治疗前 | 13.2±4.3 | 9.8±1.6 | 23.6±3.9 |
对照组(43例)治疗后 | 8.8±3.1* | 5.7±1.4* | 15.4±3.6* |
注:与本组治疗前比较,* P<0.01;与对照组同期比较,△ P<O.05。
3、心电图改变比较结果,见表8。与本组治疗前比较,两组治疗后ST段下移导联数、T波低平导联数、T波倒置导联数均减少(P<0.01)。与对照组治疗后比较,试验组T波倒置导联数显著降低(P<0.05),T波低平导联数、ST下移导联数无显著变化(P>0.05)。
表8:试验组和对照组治疗前后心电图结果比较(均值±标准差)。
组别 | ST段下移(个) | T波低平(个) | T波倒置(个) |
试验组(42例)治疗前 | 4.4±0.8 | 6.5±0.8 | 7.3±0.6 |
试验组(42例)治疗后 | 2.4±0.6*△ | 3.2±0.3*△ | 4.2±0.8*△ |
对照组(43例)治疗前 | 4.7±0.6 | 6.2±0.7 | 7.2±0.7 |
对照组(43例)治疗后 | 2.5±0.4 | 3.3±0.7*△ | 4.9±0.2*△ |
注:与本组治疗前比较,* P<0.01;与对照组同期比较, △ P<O.05。
4、中医症状总体评价疗效统计结果,见表9。试验组总有效率为92.8%,对照组总有效率为81.4%,试验组疗效显著优于对照组(P<0.05)。
表9:试验组和对照组中医症状总体评价疗效(例(%))。
组别 | 例数(N) | 显效 | 有效 | 无效 | 总有效率 |
试验组 | 42 | 15(35.7%) | 24(57.1%) | 3(7.2%) | 92.8%* |
对照组 | 43 | 12(27.9%) | 23(53.5%) | 8(18.6%) | 81.4% |
注:与对照组比较:*P<0.05。
6、结论。
本试验运用中药汤剂治疗冠心病心绞痛痰瘀互结证的临床观察表明,用药4周后,试验组临床总体疗效、心绞痛疗效、心电图改善情况及中医证候改善均显著优于对照组;提示通脉化浊汤可以改善痰瘀互结型冠心病心绞痛患者的临床症状,改善患者心肌供血的水平,改善病情的加重,提高患者的生活质量。
综上所述,本实施例提供的中药制剂在改善冠心病心绞痛患者的临床症状、心绞痛及心电图方面有效都有明显的疗效。
实施例2。
本实施例提供一种治疗血脂异常和冠心病的中药制剂,是由如下重量份数的中草药原料组成的:丹参24份、清半夏12份、藏红花15份、当归9份、瓜蒌18份、薤白9份、炒白术18份、生蒲黄6份、焦山楂24份、炙黄芪21份、桂枝9份、橘络12份、鸡血藤18份、炙甘草12份。
所述治疗血脂异常和冠心病的中药制剂可制成颗粒剂。
Claims (8)
1.一种治疗血脂异常和冠心病的中药制剂,其特征在于,是由如下重量份数的中草药原料组成的:丹参15~30份、清半夏9~15份、藏红花9~18份、当归9~15份、瓜蒌15~30份、薤白9~18份、炒白术15~30份、生蒲黄6~12份、焦山楂9~30份、炙黄芪15~30份、桂枝6~15份、橘络6~12份、鸡血藤15~30份、炙甘草9~15份。
2.如权利要求1所述的治疗血脂异常和冠心病的中药制剂,其特征在于,是由如下中草药原料组成的:丹参18份、清半夏9份、藏红花12份、当归12份、瓜蒌15份、薤白12份、炒白术15份、生蒲黄9份、焦山楂15份、炙黄芪18份、桂枝6份、橘络9份、鸡血藤15份、炙甘草9份。
3.如权利要求1所述的治疗血脂异常和冠心病的中药制剂,其特征在于,是由如下中草药原料组成的:丹参24份、清半夏12份、藏红花15份、当归9份、瓜蒌18份、薤白9份、炒白术18份、生蒲黄6份、焦山楂24份、炙黄芪21份、桂枝9份、橘络12份、鸡血藤18份、炙甘草12份。
4.如权利要求1-3所述的治疗血脂异常和冠心病的中药制剂,其特征在于,所述治疗血脂异常和冠心病的中药制剂可制成中药汤剂、颗粒剂等。
5.如权利要求1所述的治疗血脂异常和冠心病的中药制剂的制备方法,其特征在于,包括以下步骤:
步骤1、按配方取瓜蒌、清半夏混和后,放入容器中,采用饮用冷水浸泡30~45min,水超过药材表面2~4cm;
步骤2、按配方取丹参、藏红花、当归、薤白、炒白术、焦山楂、炙黄芪、橘络、鸡血藤、炙甘草,混和后放入容器中,采用饮用冷水浸泡30~45min,水超过药材表面2~4cm;
步骤3、先煎煮步骤1浸泡后的瓜蒌、清半夏,用武火煮沸药液后,放入步骤2容器中浸泡好的药材和水,用武火再次煮沸药液;
步骤4、按配方取桂枝、生蒲黄,以及清酒20ml放入步骤3的药液中,文火慢煎30~45min;煎煮后倒出汤剂100~150ml,保存以备服用;
步骤5、将药渣保存2℃冰箱,留第二日再次煎煮;
步骤6、第二日不用浸泡,熬药前先放入饮用冷水,水超过药渣表面2~4cm;然后,用武火再次煮沸药液,然后放入清酒20ml,文火慢煎30~45min,即得。
6.如权利要求5所述的治疗血脂异常和冠心病的中药制剂,其特征在于,所述容器为砂锅或陶罐等。
7.如权利要求5所述的治疗血脂异常和冠心病的中药制剂,其特征在于,所述生蒲黄为包煎,即把饮片装在纱布袋中,扎紧袋口后,再与群药共同煎煮。
8.如权利要求1所述的治疗血脂异常和冠心病的中药制剂的服用方法,其特征在于:(1)按配方每付汤药服用2天,每天两次,早饭前30min服用(50~75ml),晚饭后半小时服用(50~75ml),服用前将药液加温;(2)与其它中成药、西药隔开半小时以上;(3)服用汤药期间,禁止服用辛辣、鱼腥、发物、生冷、油腻、酸涩的食物和饮料。
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