目的 探討芪參益氣滴丸聯(lián)合鹽酸替羅非班氯化鈉注射液治療急性心肌梗死的臨床療效。方法 選取2020年1月—2022年6月天津市第一中心醫(yī)院收治的117例急性心肌梗死患者，按照隨機(jī)數(shù)字表法將所有患者分為對照組（58例）和治療組（59例）。對照組靜脈滴注鹽酸替羅非班氯化鈉注射液，開始30 min給藥速度為0.4 μg/(kg∙min)，然后減為維持量0.1 μg/(kg∙min)，1次/d。治療組在對照組的基礎(chǔ)上餐后0.5 h服用芪參益氣滴丸，1袋/次，3次/d。兩組患者均治療4周。對比兩組患者的臨床療效、心絞痛發(fā)作次數(shù)、持續(xù)時間、血液流變學(xué)指標(biāo)、炎癥因子指標(biāo)、氧化應(yīng)激指標(biāo)和復(fù)發(fā)率。結(jié)果 治療后，與對照組的總有效率（82.76%）相比，治療組的總有效率（94.92%）更高（P＜0.05）。治療后，兩組心絞痛發(fā)作次數(shù)均顯著減少，持續(xù)時間均顯著縮短（P＜0.05）；治療組心絞痛發(fā)作次數(shù)少于對照組，持續(xù)時間短于對照組（P＜0.05）。治療后，兩組纖維蛋白原、紅細(xì)胞壓積、血漿黏度、全血高切黏度、全血低切黏度、血沉均顯著下降（P＜0.05），且治療組血液流變學(xué)指標(biāo)低于對照組（P＜0.05）。治療后，兩組血清腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素（IL）-6、IL-1β水平均顯著下降，血清IL-10水平顯著升高（P＜0.05），且治療組血清TNF-α、IL-6、IL-1β水平均低于對照組，血清IL-10水平均高于對照組（P＜0.05）。治療后，兩組血清還原型谷胱甘肽（GSH）、超氧化物歧化酶（SOD）水平均顯著升高，血清丙二醛（MDA）水平顯著下降（P＜0.05），且治療組血清GSH、SOD水平高于對照組，血清MDA水平低于對照組（P＜0.05）。治療組的復(fù)發(fā)率為3.39%，顯著低于對照組的復(fù)發(fā)率13.79%（P＜0.05）。結(jié)論 芪參益氣滴丸聯(lián)合鹽酸替羅非班氯化鈉注射液治療急性心肌梗死可提高臨床療效，改善患者的臨床癥狀，降低復(fù)發(fā)率，可能與改善血液流變學(xué)、減輕氧化應(yīng)激、降低炎癥因子水平有關(guān)。

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

國家衛(wèi)生健康委醫(yī)藥衛(wèi)生科技發(fā)展研究中心課題（W2022ZT382）