世界中医药

目的：探讨参麦注射液在气阴两虚型急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗（PCI）患者治疗中的应用价值，观察其对患者脂蛋白磷脂酶A2(Lipoprotein Phospholipase A2，Lp-PLA2)、白细胞介素-1β（Interleukin-1β，IL-1β）和心功能的影响，旨在为本病提供有效的治疗手段。方法：选取2016年11月至2018年9月陕西中医药大学附属医院气阴两虚型STEMI患者89例作为研究对象，按照随机数字表法分为对照组（n=45）和观察组（n=44）。对照组单纯采用经皮冠状动脉介入治疗，观察组则联合参麦注射液静滴治疗，治疗4周后比较临床疗效。结果：治疗前后抽取患者肘部静脉血检测，治疗48 h后观察组肌钙蛋白（Troponin，cTnT）、肌酸激酶同工酶-MB（Creatine Kinase Isoenzyme，CK-MB）水平低于对照组，差异有统计学意义（P<0.05）；治疗4周后观察组氨基末端脑钠肽前体（Amino Terminal Brain Natriuretic Peptide Precursor，NT-ProBNP）、Lp-PLA2、IL-1β水平低于对照组，差异有统计学意义（P<0.05）；治疗后观察组心脏舒张早期与晚期流速比值(E/A)、左室射血分数(LVEF)均大于对照组，左室舒张末内径(LVEDD)水平低于对照组，差异有统计学意义（P<0.05）；治疗后观察组乏力，胃纳差，五心烦热等症状积分均低于对照组（P<0.05）；观察组心电图总有效率95.45%（42/44），高于对照组的75.56%（34/45），差异有统计学意义（P<0.05）；观察组治疗4周内死亡、严重心律失常、心力衰竭、心绞痛等并发症的总发生率低于对照组（P<0.05）。结论：对于STEMI（气阴两虚型）经皮冠状动脉介入治疗的患者而言联合参麦注射液治疗有重要意义，可降低缺血再灌注伤，改善心肌梗死后预后，值得推广。

English Summary:

To explore the application value of Shenmai Injection in the treatment of patients with acute ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) with deficiency of both qi and yin,and to observe its effect on lipoprotein phospholipase in patients A2 (Lipoprotein phospholipase A2,Lp-PLA2),Interleukin-1β (IL-1β) and the influence of heart function,to provide effective treatment for this disease.Methods:From November 2016 to September 2018,a total of 89 patients with the deficiency of both qi and yin due to STEMI admitted to Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were selected as the research objects and were divided into a control group (n=45) and an observation group (n=44) according to the random number table.The control group was treated with percutaneous coronary intervention alone,and the observation group was treated with Shenmai Injection intravenously.The clinical efficacy was compared after 4 weeks of treatment.Results:The venous blood was collected from the elbow before and after treatment.After 48 hours of treatment,the levels of troponin (cTnT) and creatine kinase isoenzyme (CK-MB) in the observation group were lower than those in the control group,the difference was statistically significant (P<0.05).After 4 weeks of treatment,the levels of Amino terminal brain natriuretic peptide precursor (NT-proBNP),LP-PLA2 and IL-1β in the observation group were lower than those in the control group,the differences were statistically significant (P<0.05).After treatment,the ratio of early to late diastolic flow velocity (E/A) and left ventricular ejection fraction (LVEF) of the observation group were greater than those of the control group,and the left ventricular end diastolic diameter (LVEDD) level was lower than the control group,the difference between statistical significance (P<0.05); After treatment,the scores of symptoms such as fatigue,poor stomach appetite and five upset fever in the observation group were all lower than those in the control group (P<0.05).The total effective rate of electrocardiogram in the observation group was 95.45% (42/44),which was higher than the control group 75.56% (34/45),the difference was statistically significant (P<0.05).The total incidence of death,severe arrhythmia,heart failure,angina and other complications within 4 weeks of treatment in the observation group was lower than that in the control group (P<0.05).Conclusion:For patients with STEMI (deficiency of both qi and yin) treated with percutaneous coronary intervention therapy,the combination of Shenmai Injection is of great significance,which can reduce ischemia reperfusion injury and improve the prognosis of myocardial infarction,and is worthy of promotion.

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