目的 观察曲美他嗪治疗冠心病心功能不全的临床疗效.方法 选取2011年2月—2014年1月攀枝花市第二人民医院收治的冠心病心功能不全患者92例,随机分为对照组(46例)和治疗组(46例).对照组给予常规治疗方案,治疗组在对照组基础上口服盐酸曲美他嗪片,20 mg/次,3次/d.两组均治疗4个月.治疗后,评价两组的临床疗效,同时比较两组患者心肌酶谱和心功能指标的变化.结果 治疗组和对照组的显效率分别为58.70%、34.78%,两组比较差异有统计学意义(P<0.05).治疗3 d后,两组患者肌钙蛋白I(cTnI)、肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)及肌红蛋白(Mb)均较同组治疗前显著下降,同组治疗前后差异有统计学意义(P<0.05);治疗后治疗组这些指标低于对照组,两组比较差异有统计学意义(P<0.05).治疗后,两组患者的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、平均动脉压(MAP)均较治疗前显著降低,左室射血分数(LVEF)较治疗前升高,同组治疗前后差异有统计学意义(P<0.05),治疗后治疗组这些指标的改善程度优于对照组,两组比较差异有统计学意义(P<0.05).结论 曲美他嗪治疗冠心病心功能不全具有较好的临床疗效,可改善患者心肌损害状况,促进心功能恢复,建议临床推广应用.

Objective To explore the efficacy of trimetazidine in treatment of coronary heart disease complicated with cardiac insufficiency. Methods Patients (92 cases) with coronary heart disease complicated with cardiac insufficiency from February 2011 to January 2014 were randomly divided into treatment (46 cases) and control (46 cases) groups. The patients in the control group were given conventional treatment. The patients in the treatment group were po administered with Trimetazidine Tablets, 20 mg/time, three times daily. The patients in the two groups were treated for 4 months. After the treatment, the treatment efficacy was evaluated, while the changes of myocardial enzyme spectrum and indexes of cardiac function were compared. Results The significant efficiency in the treatment and control groups were 58.70% and 34.78%, respectively, and there were differences between the two groups (P < 0.05). After treatment, cTnI, cTnT, CK-MB, and Mb were decreased significantly in two groups on day 3 of treatment, and the difference was statistically significant in the same group (P < 0.05). After treatment, these indexes in treatment group were lower than those in the control group, with the significant difference between two groups (P < 0.05). After treatment, LVEDD, LVESD, and MAP in two groups were decreased significantly, and LVEF was elevated, and the differences were statistically significant in the same group (P < 0.05). After treatment, these indicators in the treatment group improved better than those of control group, with the significant difference between two groups (P < 0.05). Conclusion Trimetazidine has good clinical effect in treatment of coronary heart disease complicated with cardiac insufficiency, and can improve situation of myocardial damage and promote recovery of heart function, which is worthy of clinical application.

国家自然科学基金资助项目(30900626)