Study Of Gualou Xiebai Banxia Decoction Combined With Alprostadil On Improving Microcirculation Of Coronary Heart Disease After PCI

Objective:The aim of this study was to evaluate the effect of modified Gualou Xiebai Banxia Decoction combined with alprostadil on myocardial microcirculation in patients with coronary heart disease after coronary intervention and to provide theoretical basis for traditional Chinese medicine treatment of coronary heart disease after interventional therapy.Methods:This study is a prospective clinical trial of randomized controls.According to the random number table method,the patients who were diagnosed as acute myocardial infarction and treated with PCI in the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine were selected as subjects.According to different treatment schemes,the subjects were divided into three groups: GQZ group,GLZ group,QLZ group.All the three groups were given routine treatment such as anticoagulation,antiplatelet,lipid regulation,myocardial nutrition and inhibition of myocardial remodeling.On the basis of routine treatment,patients in GQZ group received intravenous injection of alprostadil 20ug+100ml saline slowly,twice a day,continuously until the seventh day after operation,and were treated with Gualou Xiebai Banxia Decoction for 3 months after operation(Gualou fruit 20 g,Xiebai 10 g,Pinellia ternata 10 g,Poria Cocos 10 g,Salvia miltiorrhiza 15 g,Dangshen 15 g,Chuanxiong 15 g,Chishao 10 g,Taoren 10 g,roasted licorice 10g).QLZ group received intravenous injection of alprostadil 20ug+100ml saline on the basis of routine treatment,twice a day for 7 days after operation.And GLZ group received Gualou Xiebai Banxia Decoction for three months after PCI.The general data of three groups of subjects were recorded.The therapeutic effects were evaluated by cardiac function,three-month health questionnaire(SF-36),TCM syndromes,ST-segment regression of ECG,TIMI blood flow grading and corrected TIMI frame count,myocardial perfusion evaluation,troponin and creatine kinase isozyme peak.Finally,the data are summarized and analyzed.Results:A total of 90 cases were included in the study,including 1 case of termination of the experiment,2 cases of experimental abscission.A total of 87 cases were finally included in the study,29 cases in GQZ group,28 cases in QLZ group and 30 cases in GLZ group.There were 60 males and 27 females in the study.General data of patients showed no significant difference among the three groups.The echocardiographic results showed that there was significant difference in left ventricular ejection fraction between the three groups after 3months(57.93±3.68 VS 55.03±4.48 VS 56.29±5.07)%.There was no significant difference between GLZ group and QLZ group(F=0.48,P =0.91).Three months after operation,the results of SF36 scale evaluation showed that there were significant differences in seven aspects of physical pain,physiological function,general health status,emotional function,vitality,social function and mental health among the three groups(P < 0.05).The scores of GQZ group were higher than those of other two groups in general health condition,physical pain,social function,emotional function and mental health.In terms of ST-segment depression,GQZ group had better ST-segment depression after operation.More patients with ST-segment depression > 70% than the other two groups(?~2=6.08,P=0.048).There was no significant difference between QLZ group and GLZ group(?~2=2.01,P=0.16).Myocardial perfusion evaluation showed that the proportion of patients with MBG grade 3 in GQZ group was higher than that in QLZ group and GLZ group.The difference was statistically significant(?~2=3.51,P=0.17).There was no significant difference between QLZ group and GLZ group(?~2=2.42,P=0.12).The time of c Tn I and CK-MB peaking in the three groups was significantly different,but there was no significant difference between QLZ group and GLZ group in the time of c Tn I and CK-MB peaking(P=0.85 VS P=0.21).From the change trend of c Tn I level in each group,the downward trend of GQZ group was significantly faster than that of the other two groups after peaking.Postoperative TIMI grade 3 acquisition rate showed GQZ group was higher than that of the other two groups(P=0.048),but there was no significant difference between QLZ group and GLZ group.Postoperative CTFC evaluation showed that GQZ group was better than the other two groups.Safety analysis showed that 1 case terminated the experiment and 2 cases dropped out during the study,and there were no obvious adverse reactions during the whole experiment.Conclusion:Alprostadil combined with Gualou Xiebai Banxia Decoction is effective in improving myocardial microcirculation in patients with coronary heart disease after PCI.