目的 探讨芪参益气滴丸联合盐酸替罗非班氯化钠注射液治疗急性心肌梗死的临床疗效。方法 选取2020年1月—2022年6月天津市第一中心医院收治的117例急性心肌梗死患者，按照随机数字表法将所有患者分为对照组（58例）和治疗组（59例）。对照组静脉滴注盐酸替罗非班氯化钠注射液，开始30 min给药速度为0.4 μg/(kg∙min)，然后减为维持量0.1 μg/(kg∙min)，1次/d。治疗组在对照组的基础上餐后0.5 h服用芪参益气滴丸，1袋/次，3次/d。两组患者均治疗4周。对比两组患者的临床疗效、心绞痛发作次数、持续时间、血液流变学指标、炎症因子指标、氧化应激指标和复发率。结果 治疗后，与对照组的总有效率（82.76%）相比，治疗组的总有效率（94.92%）更高（P＜0.05）。治疗后，两组心绞痛发作次数均显著减少，持续时间均显著缩短（P＜0.05）；治疗组心绞痛发作次数少于对照组，持续时间短于对照组（P＜0.05）。治疗后，两组纤维蛋白原、红细胞压积、血浆黏度、全血高切黏度、全血低切黏度、血沉均显著下降（P＜0.05），且治疗组血液流变学指标低于对照组（P＜0.05）。治疗后，两组血清肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-1β水平均显著下降，血清IL-10水平显著升高（P＜0.05），且治疗组血清TNF-α、IL-6、IL-1β水平均低于对照组，血清IL-10水平均高于对照组（P＜0.05）。治疗后，两组血清还原型谷胱甘肽（GSH）、超氧化物歧化酶（SOD）水平均显著升高，血清丙二醛（MDA）水平显著下降（P＜0.05），且治疗组血清GSH、SOD水平高于对照组，血清MDA水平低于对照组（P＜0.05）。治疗组的复发率为3.39%，显著低于对照组的复发率13.79%（P＜0.05）。结论 芪参益气滴丸联合盐酸替罗非班氯化钠注射液治疗急性心肌梗死可提高临床疗效，改善患者的临床症状，降低复发率，可能与改善血液流变学、减轻氧化应激、降低炎症因子水平有关。

Objective To explore the clinical efficacy of Qishen Yiqi Dropping Pills combine with Tirofiban Hydrochloride and Sodium Chloride Injection in treatment of acute myocardial infarction. Methods According to the random number table method, 117 acute myocardial infarction patients who were admitted to Tianjin First Central Hospital from January 2020 to June 2022 were divided into control group (58 cases) and treatment group (59 cases). The control group received intravenous infusion of Tirofiban Hydrochloride and Sodium Chloride Injection. The initial 30 min administration rate was 0.4 μg/(kg∙min), followed by a maintenance dose of 0.1 μg/(kg∙min), once daily. The treatment group takes Qishen Yiqi Dropping Pills half an hour after meals on the basis of the control group, 1 bag/time, 3 times daily. Both groups of patients were treated for 4 weeks. The efficacy, number of angina pectoris attacks, duration, hemorheology index, inflammatory factor index, oxidative stress index, and recurrence rate were compared between two groups. Results After treatment, compared with the total effective rate of 82.76% in control group, the total effective rate of 94.92% in treatment group was higher (P < 0.05). After treatment, the frequency and duration of angina attacks in both groups were significantly reduced (P < 0.05). The number of angina attacks in the treatment group was less than that in the control group, and the duration was shorter than that in the control group (P < 0.05). After treatment, fibrinogen, hematocrit, plasma viscosity, whole blood high shear viscosity, whole blood low shear viscosity, and erythrocyte sedimentation rate significantly decreased in both groups (P < 0.05), and the hemorheological indicators in the treatment group were lower than those in the control group (P < 0.05). After treatment, the serum levels of TNF-α, IL-6, and IL-1β in both groups significantly decreased, while the levels of serum IL-10 significantly increased (P < 0.05). Moreover, the levels of TNF-α, IL-6, and IL-1β in treatment group were lower than those in control group, but the levels of serum IL-10 were higher than those in the control group (P < 0.05. After treatment, the serum levels of GSH and SOD were significantly increased in both groups, while the serum levels of MDA were significantly decreased (P < 0.05). Moreover, the serum levels of GSH and SOD in the treatment group were higher than those in the control group, while the serum MDA levels were lower than those in the control group (P < 0.05). Conclusion The combination of Qishen Yiqi Dropping Pills and Tirofiban Hydrochloride Sodium Chloride Injection in treatment of acute myocardial infarction can improve clinical efficacy, improve clinical symptoms of patients, reduce recurrence rate, and may be related to improving hemorheology, reducing oxidative stress, and lowering levels of inflammatory factors.

R972

国家卫生健康委医药卫生科技发展研究中心课题（W2022ZT382）