目的 观察行血养心中药治疗心瓣膜置换术后气虚血瘀证疗效及对血液流变学、凝血功能的影响.方法 将120例心瓣膜置换术后患者随机分为2组,对照组60例给予西药治疗,观察组60例在此基础上加用行血养心中药治疗,观察2组治疗前后中医证候积分、左室射血分数(LVEF)、左室每搏量(C0)、血浆黏度、全血低切黏度、全血中切黏度、全血高切黏度、凝血酶时间(TT)、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)及血浆纤维蛋白原(FIB)水平变化情况,统计2组近期疗效和并发症发生情况.结果 2组治疗后气短、神疲、乏力、自汗懒言、舌质紫暗或见瘀点及脉涩或沉弦积分均显著低于治疗前(P均＜0.05),且观察组治疗后各项积分均显著低于对照组(P均＜0.05);2组治疗后LVEF、CO及TT、APTT、PT均显著提高(P均＜0.05),血浆黏度、全血低切黏度、全血中切黏度、全血高切黏度及FIB水平显著降低(P均＜0.05),且观察组治疗后备项指标改善情况均显著优于对照组(P均＜0.05);观察组近期治疗总有效率显著高于对照组(P＜0.05),不良反应发生率显著低于对照组(P＜0.05).结论 行血养心中药治疗心瓣膜置换术后气虚血瘀证可有效减轻临床症状体征,促进心脏功能恢复,降低血液黏稠度,改善凝血功能,且有助于降低并发症发生风险.%Objective It is to observe the effect of Xingxue Yangxin Chinese medicine on Qi deficiency and blood stasis syndrome after heart valve replacement and influence on hemorheology and blood coagulation function.Methods 120 patients after heart valve replacement were randomly divided into 2 groups,the control group (n =60) were treated with western medicine,the observation group (n =60) was added with Xingxue Yangxin Chinese medicine on the basis of treatment in control group.The changes of TCM syndrome scores,left ventricular ejection fraction (LVEF),left ventricular stroke volume (CO),levels of plasma viscosity,whole blood low shear viscosity,whole blood viscosity,whole blood high shear viscosity,thrombin time (TT),activated partial thrombin time (APTT),prothrombin time (PT) and plasma fibrinogen (FIB) before and after treatment in both groups were observed,the recent curative effect and occurrence of side effect was compared.Results The scores of shortness of breath,weakness,fatigue,spontaneous perspiration lazy words,petechiae or dark purple tongue and pulse astringent or sink string after treatment were significantly lower than that before treatment (P ＜ 0.05),and the scores of these indexes in observation group were significantly lower than that in control group (P ＜ 0.05);After treatment LVEF,CO and TT and APTT and PT were significantly increased (P ＜ 0.05),plasma viscosity,whole blood low shear viscosity,whole blood viscosity,whole blood high shear viscosity and FIB were significantly reduced in both groups (P ＜ 0.05),and the improvement of these indexes in observation group were significantly better than that in the control group (P ＜ 0.05);The recent total effective rate in treatment group was significantly higher while the incidence of adverse reactions was significantly lower than that in the control group (P ＜ 0.05).Conclusion Xingxue Yangxin Chinese medicine can effectively relieve the clinical symptoms and signs,promote heart function recovery,reduce blood viscosity,improve blood coagulation function,and is helpful for reducing the risk of complications in the treatment of Qi deficiency and blood stasis syndrome after heart valve replacement.
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