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題 名 | 預防「冠狀動脈氣球擴張術」後再生狹窄之中醫治療臨床研究=Herb Medicine in Prevention of Restenosis after Percutaneous Transluminal Coronary Angioplasty |
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作 者 | 陳建仲; | 書刊名 | 中醫藥年報 |
卷 期 | 15:1 1997.05[民86.05] |
頁 次 | 頁581-611 |
分類號 | 413.34 |
關鍵詞 | 冠狀動脈疾病; 冠狀動脈氣球擴張術; 再生狹窄; 胸痺; 益氣活血法; 黃耆; 水蛭; 水蛭素; Corondry artery disease; Percutaneous transluminal coronary angioplasty; PTCA; Restenosis; Radix astragali; Hirudo medicnalis; Hirudin; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究之目 的在於探討中醫"益氣活血法"對於冠狀動脈疾病(胸痺)患者接受"冠 狀動脈氣球擴張術 " 後預防再生狹窄之療效。 臨床實驗針對二十名診斷為單一或兩條冠狀 動脈狹窄 (共 38 處狹窄病灶 ) 且無心肌梗塞患者,區分為兩組 (各十五人 ) 一為實驗組 (男 l2 人,女 3 人 ),一為對照組 (男 9 人,女 6 人 ),各組平均年齡分別為 65.5 土 6.7 歲及 61.9 土 13.8 歲 (P= NS)。 追蹤期間分別為 3.7 土 1.0 月及 3.5 土 1.2 月 (P=NS),冠脈動脈氣球擴張術成功後實驗組接受黃耆 (8 公克 / 日 ) 及水蛭粉 (2 公克 / 日 ) 口服治療,對照組服用安慰劑,兩組服用西藥不受限,服藥期間共三個月。 術前及術 後追蹤期間全部患者均接受血液學 (血球計數、凝血時間 )、生化、運動心電圖、二十四小 時心電圖記錄、心臟超音波檢查 (術後二週及三個月或任何心絞痛再發戶且於任何心絞痛再 發或術後三個月接受冠狀動脈血管攝影檢查。結果顯示危險因子中實驗組比對照組患有高血 壓 (11:2,P =0.0009),糖尿病 (6: 1,P=0.031) 較多,其餘危險因子則無差別。 服用抗 心絞痛藥物實驗組服用 b-blocker 較少 (2:7,P=0.046),其餘則無差別。兩組患者之冠狀 動脈血管攝影結果,包括侵犯血管數、病灶部位、病灶特徵之間並無差異。實驗組術前與術 後 2 週運動心電圖運動時間 (實驗組 307 土 9O vs 394 土 85 秒, P=O . 027; 對照組 365 土 99 vs 504 土 123 秒, P=0.083) 及 ST 波段變化 (1.4 土 0.8 vs O.5 土 1.l, P=0.021; 1.6 土 1. 3 vs 0.6 土 0.7,P=O.108) 有明顯改善, 而術後二個月之結果及左 心室射出分率與二十四小時心電圖記錄,兩組間無甚差異。第二次冠狀動脈血管攝影檢查發 現再生狹窄人數實驗組為 lO 人 (67%),對照組 9 人 (60%) (P=NS),依狹窄病灶數區分則 為 l2/18(67%)vs l0/20(50%)(P=NS),中醫辯證依全部患者、實驗組、對照組次序分析再生 狹窄結果,陽虛血瘀型為 9/12(75%)、4/5(80%)、5/7(71%); 氣虛血瘀型 6/1l(55%)、4 /8 (50%)、2/3(67%); 痰熱型 4/7(57%)、2/2(100%)、2/5(40%), 其中以陽虛血瘀型患者較多 ,且再生狹窄機會較高。血液學及生化檢查無論在術前或術後追蹤比較並無甚差異,顯示該 藥並無造成不良副作用。結論以益氣活血採用黃耆、水蛭預防冠狀動脈氣球擴張術後再生狹 窄,可能因冠狀動脈疾病多重致病因素及樣本數較少影響下,目前無明顯療效,宜再進一步 研究。 |
英文摘要 | This study is aimed to evaluate the effect of "method of Yih Chih Hwo Shiee" to prevent the restenosis after percutaneous transluminal coronary angioplasty (PTCA) in patients with coronary artery disease. Thirty subjects were enrolled with single or double vessel diseases (38 lesions) and without myocardial infarction; and seperated into study group and control group, each consist of 15 patients. The sex ratio was male to female 12/3 for study group and 9/6 for control group. The mean ape was 65.5±6.7 years and 61.9+13.8 years; and the follow up interval was 3.7 ± 1.0 months and 3.5 ± 1.2 months (p-NS). After PTCA the study group received Radix Astragali (8 gm/day) and leech powder (2 gm/day) and the control group received placebo; without restriction in use of other usual antianginal medication for ecah group. All the subjects received hematologic, biochemical, treatmill exercise, holter ECG and echocardiogram studies before and after PTCA 2 weeks and 3 months or any cardiac event developed. The second coronary angiography was performed 3 months after PTCA or any cardiac event developed. The result showed in coronary risk factors the hypertension (11:2, p=0.0009) and diabetes (6:1, p=0.031) was more in study group. In use of antianginal medication, the beta-blocker was less used in study group (2:7, p=0.046), The vessel involved, number of lesions, the site of lesions, and character of lesions was no significant difference between two groups.The duration and ST-segment change of treadmill exercise test were much improved in 2 weeks after PTCA as compared with those before PTCA (394f 85 vs 307 ± 90 seconds, p=0.027; 0.5 ± 1.1 vs 1.4 ± 0.8 mm, p=0.021) in study group. But there was no significant difference for other comparisons in treadmill exercise test, holter ECG and left ventricular ejection fraction. The second coronary angiography showed restenosis (stenosis rate > 50%) 10 (67%) in study group and 9 (60%) in control group; the number of lesions restenosis was 12/18 (67%) and 10!20 (50%) (p=NS). The patients number was subjected to whole, study group, and control group to analyze the restenosis in Chinese Medicine. Those are "Yang Shiu Shiee Iu" 9/12 (75%), 4/5 (80%), 5/7 (71%); "Chih shiu Shiee Iu" 6/11 (55%), 4/8 (50%), 2/3 (67%); "Tarn Reh" 4/7 (57%), 2/2 (100%), 2/5 (40%). The restenosis was more common in "Yang Shiu Shiee Iu". The results of hematology, biochemisty were no significant difference between two groups, and also no side effect was noted in administration of herb drug. In cnoclusion, there was no substantial benefit in prevention of restenosis after PTCA by use of Radix Astragali and leech powder based on the theory of "Yih Chih Hwo Shiee" because of the multiple factors precipitated coronary artery disease and small sample size in this study. Further investigation is necessary. |
本系統中英文摘要資訊取自各篇刊載內容。