| Coronary heart disease is a serious threat to human life and health.At present,China’s coronary heart disease morbidity and mortality increase year after year,there are over 70 million people died of coronary heart disease,bringing a greatly burden to the state’s financial and people’s lives year.Clinical treatment of myocardial ischemia and effective measures are mainly PCI,CABGand thrombolytic reperfusion therapy,But they often due to re-perfusion of blood vessels,which results in myocardial ultrastructural changes and myocardial systolic and diastolic dysfunction,causing cardiac function and metabolic abnormalities,seriously affecting the patient’s cardiac infarct size,heart function and prognosis,that proposed in recent years myocardial ischemia-reperfusion injury.In order to reduce myocardial ischemia-reperfusion injury,researchers know who experienced ischemic preconditioning from,drugs to ischemic preconditioning after adaptation,after the drug development process adaptation.However,due to the time of clinical myocardial infarction unpredictable,ischemic preconditioning,the clinical application of drugs preconditioning has been extremely limited.The ischemic adaptation is a mechanical approach,so that will cause inevitably vessel wall injury,loss and other risk plaque,making clinical applications are subject to certain restrictions;After the drug has to adapt its security can be implemented,controllability,etc.,with a wider range of clinical applications in cardiac protection.A variety of Western medicine(eg:isoflurane,fasudil Haier)animal studies found that adaptation through different mechanisms play a role in myocardial protection after drugs.Chinese medicine for thousands of years in the protection of people’s lives and health has been playing an important role,in addition due to its multi-target,multi-link interference and relatively good safety and other advantages,more and more attention.Angina is kind of Thoracic Obstruction.The disease is usually caused by old and feeble,weary injuries,chronic illness resulting in weak stomach,unable to transport blood,systolic blood stagnation,mostly internal qi,yang.The invasion of external pathogenic cold heart is,too thick and greasy food fatness,so mind yang Blockage,systolic barrier,made of qi stagnation,blood stasis,phlegm,Hanning.Therefore,the treatment of this disease should be closely linked to the deficiency,blood stasis,through supplementation and.Qi and blood circulation as to complement rather than obstruct,pass without injury is.Qishenyiqi dropping pills prescription main components of Astragalus,Panax,Salvia,drop sesame oil.Its main function is Yiqihuoxuetongmai pain is clinically effective prescription treatment of angina pectoris.After this study,a randomized,controlled,double-blind study,in order to represent Qishenyiqi drop pills drugs,Chinese medicines Yiqihuoxue observed after myocardial protective effect of adaptation to ischemia-reperfusion injury and interventional treatment of patients QDBS syndrome,improvement of quality of life.Research is divided into two parts.Clinical studies of ischemia-reperfusion injury after myocardial adaptation literature was the first part of the Chinese intervention myocardial ischemia-reperfusion injury in the second part of Yiqihuoxue Chinese medicines.Literature mainly Chinese medicines after adaptation to PCI in patients with acute myocardial infarction reperfusion injury in myocardial Meta-analysis.Methods:AWeb-based search was performed for relevant studies,CNKI,CBM,VIP,the Cochrane library,Pubmed,EMbase were searched using"pharmacological postconditioning","myocardial infarction ";"ischemia reperfusion injury","PCI","angiography"as the keywords from the inception to February,2012.Randomized controlled trials(RCT)to evaluate the herbal medicine effect on ischemia-reperfusion injury were collected and meta-analysis were conducted,Domain-based evaluation analysis were conducted further.Results:Nine studies were identified.Pooled analysis of 2 studies demonstrated a significant reduction of peak creatine kinase with TCM relative to standard care[MD = 63.91,95%CI(46.74,81.08),P<0.00001].The analysis of 3 of the studies showed the rate of reperfusion arrhythmias of the TCM group was lower than the control group[(OR = 0.5,95%CI(0.29,0.87),P=0.01].The meta-analysis of the rate of ST-Segment fell back after 2 hours、24 hours、7 days of PCI showed:2 hours after PCI[OR = 1.22,95%CI(0.75-1.96),P=0.42];24 hours after PCI[OR = 2.32,95%Cl(1.50-3.58),P=0.002];7 days after PCI[OR = 3.54,95%CI(1.53-8.20),P=0.03].A analysis of 2 of the studies showed an improvement of left ventricular ejection fraction with TCM[MD=-4.26,95%CI(-7.38,-1.15),P=0.007].About adverse events,two groups was not significant(OR = 1.46,95%CI(0.54,3.91)].Conclusion:Herbal medicine intervention before PCI for acute myocardial infarction patients may help reduce CK-MB peak and reperfusion arrhythmias incidence,may improve the ST segment fall-back rate and left ventricular ejection fraction.For the limits of included research’s quality and quantity,the effects of outcomes remain to be determined.Clinical research data and methods:The study is the first to receive acute coronary syndrome in 60 patients with coronary intervention in patients strictly follow the development of inclusion and exclusion criteria.Diagnosis and treatment guidelines are consistent with the diagnosis of acute coronary syndrome China.Were randomly divided into a treatment group of 30 patients(oral Qishenyiqi drop pills),the control group of 30 patients(the same amount of oral placebo),two Western medicine treatment guidelines are strictly routine.All enrolled patients during the observation period without the application of other traditional Chinese medicines,treatment for four weeks.Basic data collection selected clinical cases,the main evaluation indicators are:oxygen free radicals Detection,Evaluation,and reperfusion injury;inflammatory cytokines detection,impact assessment of coronary syndrome pathology of atherosclerosis;electrocardiographic and echocardiographic evaluation of cardiac function;after 2 weeks and 4 weeks Seattle angina questionnaire scale,quality of Life assessment Scale condensed and blood stasis syndrome score in the survey(see Appendix),were evaluated cases of angina and quality of life;after 4 weeks inspection coagulation parameters were observed in patients clotting mechanism;in blood,urine,stool routine,liver and kidney function tests as a safety indicator.Results:1、Angina,as well as evaluation of quality of life:Seattle Angina Scale(SAQ)showed two groups of patients before and 4 weeks after PCI patients were tested in this scale,will answer questions recorded on the CRF tables,will the scoring.Two groups of patients before treatment,AF,AS,TS、DP scored four indicators showed no significant difference(P>0.05);After treatment,AF,AS,TS、DPscore four indicators were higher than before treatment,the difference was statistically these two groups of patients after two;significance(P<0.05);while the treatment group was significantly better results than the control group,a statistically significant difference between the two groups of patients before treatment.The results for the treatment group compared with the control group before treatment,quality of life of two groups of patients without condensed scale evaluation of quality of life(SF-12)significant difference,P>0.05,no statistical difference.After treatment,the treatment group compared with the control group,the quality of life of treated patients improved,P<0.05,statistically significant.2、Before and after the treatment of angina and blood stasis symptom scoring results:Treatment group and the control group in each patient before treatment of angina,clinical symptoms,tongue and pulse points no significant difference between comparable,each angina,clinical symptoms,tongue and pulse points are different groups of patients after treatment,the treatment group than the control group,indicating the degree of Qishenyiqi drop pills reduce angina and improve the symptoms of blood stasis.3、Cardiac function:ECG the treatment group and the control group,the results showed:For NSTEMI,USAP type ECG compare two groups of patients,treatment group,respectively(10%、6.6%),the efficiency of the control group(13.3%,0%),for the two types of ECG STEMI patients,the treatment group was 43.3%,the control group was 40%.After treatment the total efficiency of 60%and 53.3%,respectively,the treatment group than the control group.Preoperative echocardiographic left atrial diameter aspect,left ventricular end-diastolic diameter,left ventricular ejection fraction was no difference between the two groups were statistically significant(P>0.05);two groups of patients after four weeks left atrial diameter comparison,left ventricular end-diastolic diameter was no significant difference(P>0.05);after treatment than before treatment significantly increased left ventricular ejection fraction 4 weeks,the difference was statistically significant(P=0.005).4、Comparison of myocardial enzyme markers results:Treatment group and the control group,serum myocardial enzyme markers before treatment groups were compared,P>0.05,no significant difference compared two groups of patients with myocardial enzyme serum markers after treatment,P>0.05,no statistical learning differences.5、Oxygen radicals detection:Two groups of patients before treatment serum MDA,SOD results compared,P>0.05,no significant difference.In serum MDA,SODafter treatment compared to the results of the two groups of patients,P<0.05,statistically significant.6、Inflammatory cytokines detection:The treatment group compared with the control group,the two groups before treatment,serum MMP-9,endothelin-1,hs-CRP,adiponectin,IL-10 results compared,P>0.05,no significant difference,the two treatment patients with serum MMP-9,endothelin-1,IL-10 results compared,P>0.05,no significant difference in serum hs-CRP,adiponectin results compared.But the treatment group,serum hs-CRP levels than the control group,the treatment group serum adiponectin levels higher in the treatment group compared with the control group results,P<0.05,statistically significant.7、Hemagglutination index test results before and after treatment:Before treatment,Fib between the treatment group and the control group no difference(P>0.05).After treatment,Fib lower than before treatment,but there was no significant difference(P>0.05).8、Safety index of detection:Clinical trials for all enrolled patients before and after treatment were detected in blood,urine,feces,liver function(ALT,AST),renal function(Cr,BUN),before and after treatment showed no obvious abnormalities,suggesting that Astragalus Danshen Pill good safety.Conclusion:1、Meta analysis of acute myocardial infarction underwent emergency surgery patients before PCI,patients given traditional Chinese medicine,helps reduce peak CK-MB and reperfusion arrhythmia and ST segment can improve the rate and left ventricular ejection fraction.2、Before surgery Yiqihuoxue class medicine treatment,4 weeks after the first Seattle Angina Questionnaire Scale,Quality of Life Assessment Scale condensed and blood stasis syndrome score after investigation found cases of angina and improve the quality of life has improved;ECG and echocardiography showed some changes in cardiac function;3、No myocardial enzyme markers results statistically significant,indicating myocardial damage is not obvious,so improvement of Qishenyiqi Dripping Pill for myocardial necrosis is not obvious.oxygen radical detection MDA,SOD levels,Two groups of patients before treatment serum MDA,SOD results compared,P>0.05,no significant difference.In serum MDA,SODafter treatment compared to the results of the two groups of patients,P<0.05,statistically significant,indicating Qishenyiqi drop pills have some anti-oxidative stress,its anti-oxidative stress is mainly achieved by improving serum SOD and decreasing serum MDA;inflammatory cytokines detection,treatment group and compared to the control group,two groups of patients after treatment serum MMP-9,endothelin-1,IL-10 results compared,P>0.05,no significant difference.But the treatment group,serum hs-CRP levels than the control group,the treatment group serum adiponectin levels higher than the treatment group and the control group,serum hs-CRP,adiponectin results,P<0.05,statistically significant,indicating Qishenyiqi drop pills have some anti-inflammatory effects,mainly by improving its anti-inflammatory effects of serum hs-CRP,adiponectin achieved;4、clinical trials for all enrolled patients before and after treatment were detected in blood,urine,stool routine,coagulation,liver function(ALT,AST),renal function(Cr,BUN),before and after treatment showed no obvious abnormalities,Tip Astragalus Danshen Diwan good safety.In summary,for patients with acute coronary syndrome,reperfusion therapy,based on conventional western medicine,traditional Chinese medicine combined with Qishenyiqi pills,can effectively scavenge oxygen free radicals,inhibiting the inflammatory response,improve heart function relieve symptoms and improve quality of life of patients,can serve as a good adjuvant therapy in patients with acute coronary syndrome PCI surgery. |
