目的 探討冠心丹參滴丸聯(lián)合維拉帕米治療非阻塞性冠狀動脈微血管型心絞痛（CMVD-AP）的臨床療效及對心血管預(yù)后的影響。方法 選取2024年6月—2024年12月滄州市人民醫(yī)院確診的CMVD-AP患者104例，隨機(jī)分為對照組（52例）和治療組（52例）。對照組口服鹽酸維拉帕米片，80 mg/次，3次/d。治療組在對照組基礎(chǔ)上舌下含服冠心丹參滴丸，10粒/次，3次/d。兩組患者均接受4周的治療。觀察兩組患者臨床療效，比較治療前后兩組患者收縮壓心率比值（PRQ）和冠狀動脈血流儲備（CFR）水平，ST段壓低最大幅度、運(yùn)動平板試驗(yàn)終止率和總運(yùn)動時(shí)間，血清內(nèi)皮素-1（ET-1）和一氧化氮（NO）水平，及不良反應(yīng)情況。結(jié)果 治療后，治療組總有效率為94.23%，顯著高于對照組的78.85%（P＜0.05）。治療后，兩組患者PRQ和CFR水平均明顯高于治療前，且治療組患者上升幅度顯著高于對照組（P＜0.05）。治療后，兩組患者ST段壓低最大幅度和運(yùn)動平板試驗(yàn)終止率較治療前明顯降低，而總運(yùn)動時(shí)間明顯增加（P＜0.05），且治療組運(yùn)動平板試驗(yàn)結(jié)果改善幅度顯著高于對照組（P＜0.05）。治療后，兩組患者血清ET-1水平較治療前明顯下降，而NO水平明顯升高（P＜0.05），且治療組血清ET-1和NO水平改善幅度均明顯優(yōu)于對照組（P＜0.05）。治療期間，治療組與對照組不良反應(yīng)發(fā)生率（3.85% vs 15.38%）比較差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論 冠心丹參滴丸聯(lián)合維拉帕米可有效改善CMVD-AP患者心肌耗氧量、冠狀動脈血流儲備及運(yùn)動耐量，調(diào)節(jié)血管內(nèi)皮功能并降低不良反應(yīng)發(fā)生率風(fēng)險(xiǎn)。

Objective To investigate the clinical efficacy of Guanxin Danshen Dropping Pills combined with verapamil in treatment of non-obstructive coronary microvascular angina (CMVD-AP) and its impact on cardiovascular prognosis. Methods Patients (104 cases) with non-obstructive coronary microvascular angina in Cangzhou People’s Hospital from June 2024 to December 2024 were randomly divided into control (52 cases) and treatment (52 cases) group. Patients in the control group were po administered with Verapamil Hydrochloride Tablets, 80 mg/time, three times daily. Patients in the treatment group were po sublingually administered with Guanxin Danshen Dropping Pills on the basis of the control group, 10 pills/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical evaluations were evaluated, and the levels of PRQ and CFR, the maximum ST segment depression, treadmill test termination rate, and total exercise time, the levels of serum ET-1 and NO, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was 94.23%, which was significantly higher than 78.85% in the control group (P < 0.05). After treatment, the levels of PRQ and CFR in two groups were significantly higher than before treatment, and the increase in the treatment group was significantly higher than that in the control group (P < 0.05). After treatment, the maximum ST-segment depression and the termination rate of treadmill test in two groups were significantly reduced compared with before treatment, while the total exercise time was significantly increased (P < 0.05), and the improvement in treadmill test results in the treatment group was significantly higher than that in the control group (P < 0.05). After treatment, the serum ET-1 levels in two groups were significantly decreased compared with those before treatment, while the NO levels were significantly increased (P < 0.05). The improvement of serum ET-1 and NO levels in the treatment group was significantly better than that in the control group (P < 0.05). During the treatment period, there was a statistically significant difference in the incidence of adverse reactions between the treatment group and the control group (3.85% vs 15.38%, P < 0.05). Conclusion The combination of Guanxin Danshen Dripping Pills and verapamil can effectively improve myocardial oxygen consumption, coronary flow reserve, and exercise tolerance in patients with CMVD-AP, regulate endothelial function, and reduce the risk of adverse reactions.

R914

河北省衛(wèi)生健康委員會醫(yī)學(xué)科學(xué)研究計(jì)劃項(xiàng)目（20251499）