目的 研究冠心舒通胶囊预防急性心肌梗死经皮冠状动脉介入治疗(PCI)术后再狭窄的临床疗效.方法 选取2009年4月—2014年4月在西安医学院第二附属医院接受PCI手术的156例患者,随机分为对照组和治疗组,每组78例.对照组采用西药常规治疗,治疗组在对照组基础上加服冠心舒通胶囊,3粒/次,3次/d.两组均连续治疗6个月.观察两组患者心绞痛复发率,比较两组术前,治疗1、6个月时气虚血瘀证积分变化,同时比较两组患者高敏C反应蛋白(hs-CPR)和血清淀粉样蛋白A(SAA)的水平变化.结果 对照组和治疗组心绞痛复发率分别为4.35%、17.65%,两组比较差异有统计学意义(P< 0.05).两组患者在治疗第1、6个月时肌酸激酶(CK)下降,在治疗第1个月时,治疗组CK低于对照组(P< 0.05);治疗组气虚血瘀积分在治疗第1、6个月时显著下降且低于对照组,对照组在治疗第6个月时下降.与手术前相比,术后前3 d两组患者hs-CPR和SAA水平均明显升高(P< 0.05);术后第7天开始下降,且术后7 d、1个月时治疗组hs-CPR和SAA水平显著低于对照组,两组比较差异有统计学意义(P< 0.05).结论 冠心舒通胶囊对预防急性心肌梗死PCI术后再狭窄的发生有较好的疗效,可改善患者的气虚血瘀证,其作用机制可能是抑制血管内皮的炎症反应,改善心肌缺血.

Objective To investigate the clinical effect of Guanxin Shutong Capsules in prevention of acute myocardial infarction with PCI postoperative restenosis. Methods The patients with acute myocardial infarction with PCI (156 cases) of the Second Affiliated Hospital of Xi'an Medical University from March 2009 to March 2014 were randomly divided into control and treatment groups, and each group had 78 cases. The patients in the control group were accepted routine western medicine. The patients in treatment group were po administered with Guanxin Shutong Capsules, 3 grains/time, three times daily. Two groups were treated for six months. Angina recurrence rates in two groups were observed, and scores of Qixu Xueyu symptoms in two groups were compared before surgery and treatment of 1, 6 months. At the same time, the changes of hs-CPR and SAA were compared. Results The angina recurrence rates in the control and treatment groups were 4.35% and 17.65%, respectively, and there were differences between two groups (P <0.05). The level of creatine kinase (CK) in the treatment fell in the treatment of first, sixth months, and CK was lower than that in the control group in the treatment of one month (P <0.05). The score of Qixu Xueyu symptoms in the treatment group was reduced in the treatment of first, sixth months and lower than that in the control group (P <0.05), while the score of Qixu Xueyu symptoms in the control group reduced in the treatment of sixth month. The levels of hs-CPR and SAA in two groups were significantly higher first three days after operation, while they declined from the seventh day after operation. And 7 d and one month after operation, the levels of hs-CPR and SAA in treatment group were significantly lower than those in the control group, with significant difference between two groups (P <0.05). Conclusion Guanxin Shutong Capsules has the good clinical effect in prevention of acute myocardial infarction with PCI postoperative restenosis, and can improve Qixu Xueyu symptoms, while its mechanism may be inhibiting vascular endothelial inflammation and improve myocardial ischemia.