Qiu Sheng-lei, Jin Mei, Yi Jing-hong, Zhu Tian-gang, Quan Xin, Liang Yan
Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine, Capital University of Medical Sciences, Beijing 100010, China.
Zhong Xi Yi Jie He Xue Bao. 2009 Jul;7(7):616-21. doi: 10.3736/jcim20090704.
No-reflow phenomenon after reperfusion treatment of acute myocardial infarction (AMI) is becoming more recognized today. The effective treatment for no-reflow has not been reported.
To observe the effects of traditional Chinese medicine (TCM) therapy for replenishing qi, nourishing yin, and promoting blood circulation on AMI patients undergoing percutaneous coronary intervention (PCI).
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This study was conducted from January 2005 to March 2006 using a double-blinded, randomized method. Thirty-five AMI patients (Killip I-II) were first diagnosed as ST segment elevation AMI and obtained primary PCI. They were recruited from People's Hospital, Peking University. All patients' symptoms accorded with qi-yin deficiency syndrome and blood stasis syndrome. They were randomly and double blindly divided into control group (18 cases) and treatment group (17 cases). The patients in the control group received Western medicine treatment, and the patients in the treatment group were treated with Western medicine plus American ginseng and Salviae miltiorrhizae preparations. They were all treated for 3 months.
Before and after 3-month treatment, the TCM symptoms were observed and scored. At the state of baseline and dobutamine stress, left ventricular ejection fraction (LVEF), wall motion score (WMS), WMS index and normal cardiac muscle percentage (NCMP), and the myocardial contrast echocardiography index k, which reflects myocardium microcirculation perfusion, were detected.
After 3-month treatment, the TCM symptoms in the treatment group were improved as compared with the control group (X(2)=4.118, P=0.042). At the state of dobutamine stress, LVEF in the treatment group after treatment was higher than those in the control group (t=2.130, P=0.041) and before treatment (t=2.345, P=0.032). Although the number of the segments with increased k value was more than that in the control group, there was no significant difference.
TCM therapy for replenishing qi, nourishing yin and promoting blood circulation can improve the clinical symptoms and quality of life of the AMI patients undergoing PCI, and is beneficial to myocardium microcirculation. Thus, it may be an alternative cardioprotective treatment strategy for successful myocardial microcirculation in AMI patients after reperfusion.
急性心肌梗死（AMI）再灌注治疗后的无复流现象如今越来越受到关注。目前尚未见针对无复流有效治疗方法的报道。
观察益气养阴活血法中药治疗对接受经皮冠状动脉介入治疗（PCI）的AMI患者的影响。
设计、地点、参与者和干预措施：本研究于2005年1月至2006年3月采用双盲随机方法进行。35例AMI患者（Killip I-II级）首次诊断为ST段抬高型AMI并接受了直接PCI治疗。患者来自北京大学人民医院。所有患者症状均符合气阴两虚兼血瘀证。将患者随机双盲分为对照组（18例）和治疗组（17例）。对照组患者接受西医治疗，治疗组患者在西医治疗基础上加用人参及丹参制剂治疗。两组均治疗3个月。
治疗3个月前后观察并记录中医症状及评分。于基线及多巴酚丁胺负荷状态下检测左心室射血分数（LVEF）、室壁运动评分（WMS）、WMS指数、正常心肌百分比（NCMP）以及反映心肌微循环灌注的心肌对比超声心动图指标k。
治疗3个月后，治疗组中医症状较对照组改善（X(2)=4.118，P=0.042）。在多巴酚丁胺负荷状态下，治疗组治疗后LVEF高于对照组（t=2.130，P=0.041）及治疗前（t=2.345，P=0.032）。治疗组k值升高节段数虽多于对照组，但差异无统计学意义。
益气养阴活血法中药治疗可改善接受PCI的AMI患者的临床症状及生活质量，有利于心肌微循环，可能是AMI患者再灌注后成功实现心肌微循环的一种替代性心脏保护治疗策略。
