| Purpose:Through the summary of previous theoretical basis and relevant clinical research,this thesis discusses the concept of coronary homeostasis and syndrome differentiation scheme of "Blood-Vessel-Heart-Spirit" in the intervention of patients with coronary heart disease after percutaneous coronary intervention,and further explores the clinical efficacy and mechanism of representative prescriptions in the vulnerable period to guide the intervention of patients with ACS after percutaneous coronary intervention,so as to enrich and improve the systematic concept of coronary homeostasis of "Blood-Vessel-Heart-Spirit",To provide more ideas and basis for clinical intervention in patients with coronary heart disease.Method:1.Summarize the current situation of angina pectoris after intervention in patients with acute coronary syndrome,explore the team’s hypothesis of "Blood-Vessel-Heart-Spirit" integration,guide the understanding of vascular homeostasis in patients with coronary heart disease,and analyze the pathogenesis and treatment plan of patients after intervention from blood,pulse,heart and spirit.2.A total of 131 eligible patients after interventional surgery were included,including 65 cases in the experimental group and 66 cases in the control group.On this basis,the experimental group superimposed and intervened the prescriptions of eliminating phlegm and removing blood stasis,promoting blood circulation and detoxification guided by the concept of "Blood-Vessel-Heart-Spirit".The scale and serum data of the two groups were collected at week 0 and week 4 respectively.Different integral scales were used to evaluate the improvement of angina pectoris attack,TCM syndrome and quality of life,and to explore the possible mechanism of the prescription from the perspective of oxidative stress and vascular endothelium.Result:1.There was no significant difference between the experimental group and the control group in the baseline data(age,gender,family history,tobacco and alcohol history,comorbidity,number of lesions,four items of blood lipids and glycosylated hemoglobin)before intervention.The distribution of the two groups was balanced and comparable.2.In terms of curative effect evaluation,the angina pectoris score and TCM syndrome score of the experimental group and the control group increased after the intervention.Compared with the control group,the experimental group can significantly improve the angina pectoris score,TCM main symptom score(chest tightness,chest pain)and TCM total symptom score(P < 0.05).3.In terms of angina pectoris related quality of life,the scores of all scales in the experimental group and the control group were improved after the intervention.Compared with the control group,the experimental group improved significantly in physical activity restriction,angina pectoris attack,angina pectoris stability,treatment satisfaction and disease cognition(P < 0.05).In terms of concise life scale,the experimental group and the control group improved in all aspects after intervention.Compared with the control group,the experimental group improved significantly in physiological function,physical pain,mental health and health changes(P < 0.05).4.During the treatment period and 6-month follow-up period,5 patients in the control group were readmitted due to cardiovascular adverse events such as recurrence of angina pectoris and acute coronary syndrome.There were no cardiovascular adverse events in the experimental group,suggesting that the experimental group was better than the control group in improving cardiovascular adverse events(P < 0.05).5.In terms of serological test,both the experimental group and the control group could improve the levels of protective factors of oxidative stress such as Nrf2,Klf2 and HO-1,and the levels of e NOS endothelial related factors.Compared with the control group,the experimental group improved significantly in e NOS and HO-1(P < 0.05).Conclusion:1.The prevention and treatment system to maintain the steady state of coronary artery system under the concept of " Blood-Vessel-Heart-Spirit " has rich scientific connotation and clinical guiding value.The scheme of syndrome differentiation and treatment of patients after interventional surgery from the four dimensions of blood,pulse,heart and spirit is feasible and scientific.2.Changmai Wenban decoction,the representative of the method of eliminating phlegm and removing blood stasis and promoting blood circulation and detoxification under the guidance of the " Blood-Vessel-Heart-Spirit " integration concept,is better than the control group in angina pectoris score and TCM syndrome score,and better than the control group in quality of life to a certain extent.3.The mechanism of changmai Wenban decoction,a representative of the methods of eliminating phlegm and removing blood stasis,promoting blood circulation and detoxification,in intervening patients after intervention may be related to regulating Nrf2 /KLF2 / HO-1 axis and reducing e NOS,which can reduce oxidative damage,inhibit endothelial damage and inflammation. |
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