三级医院-社区联动机制下中西医整合治疗冠心病的对照研究

刘荣 徐卫平 沈艺 金慧宏 张国琛

摘 要 目的：探討社区联动机制下中西医整合治疗冠心病患者的效果。方法：采用系统抽样法，选取2019年11月至2020年10月社区门诊和病区冠心病患者220例，随机分为对照组和试验组各110例。对照组口服阿司匹林肠溶片100 mg/d，单硝酸异山梨酯缓释胶囊50 mg/d，共3个月。试验组在社区联动机制带动下，服用化瘀祛痰中药，采用辨证论治，辅助给予拜阿司匹林片100 mg/d，氯吡格雷片75 mg/d，并进行运动治疗和康复教育，共3个月。治疗后对患者进行血脂、6 min步行距离（6MWD）、左心室射血分数（LVEF）、心绞痛发生次数（西雅图心绞痛量表，SAQ）、生活质量（SF-36评分）、焦虑和抑郁等评分进行评估。结果：试验组血脂、6MWD、LVEF、SAQ、SF-36）评分高于对照组，焦虑量表和抑郁量表评分低于对照组；差异有统计学意义（P<0.05）。结论：联动机制下的中西医整合治疗能明显改善患者生理、心理和生命质量，延长生命指数，值得在社区进一步推广。

关键词 冠心病；联动机制；中西医整合治疗

中图分类号：R541.4 文献标志码：A 文章编号：1006-1533（2021）12-0036-04

A comparative study of integrated traditional Chinese and Western medicine in the treatment of coronary heart disease under the tertiary hospital-community linkage mechanism

LIU Rong1， XU Weiping1， SHEN Yi1， JIN Huihong1， ZHANG Guochen2

（1.Science and Education Department of Qibao Community Health Service Center Affiliated to Shanghai Traditional Chinese Medicine University. Shanghai， 201101， China； 2.Shanghai Electrical Engineering School of University of Applied Technology， Shanghai 201418， China）

ABSTRACT Objective： To explore the effect of integrated Chinese and Western medicine in the treatment of patients with coronary heart disease under the community linkage mechanism. Methods： Using a systematic sampling method， 220 patients with coronary heart disease in the community outpatient clinics and wards from November 2019 to October 2020 were selected and randomly divided into a control group and an experimental group with 110 cases each. The control group took aspirin enteric coated tablets 100 mg/d and isosorbide mononitrate sustained release capsules 50 mg / d for 3 months. Driven by the community linkage mechanism， the experimental group took traditional Chinese medicine for removing blood stasis and phlegm， adopted syndrome differentiation and treatment， and was supplemented with aspirin tablets 100 mg/d， clopidogrel tablets 75 mg/d， exercise therapy and rehabilitation education for a total of 3 months. After treatment， blood lipid， 6-min walking distance（6MWD）， left ventricular ejection fraction（LVEF）， angina frequency（Seattle angina questionnaire， SAQ）， quality of life（SF-36 score）， anxiety and depression， etc were assessed. Results： The scores of blood lipid， 6MWD， left LVEF， SAQ and SF-36 in the experimental group were higher than those in the control group， and the scores of anxiety scale and depression scale in the experimental group were lower than those in the control group； the difference was statistically significant（P<0.05）. Conclusion： The integrated treatment of traditional Chinese and Western medicine under the linkage mechanism can significantly improve the patients physiological， psychological and life quality， and prolong the life index， which is worthy of further promotion in the community.

KEY WORDS coronary heart disease； linkage mechanism； integrated treatment of Chinese and Western medicine

冠心病（CHD）是由冠脉粥样病变引起的血管狭窄或闭塞，从而导致心肌的一系列缺血、缺氧或坏死而引发的心脏病[1]。心脏康复治疗包括健康宣教、营养咨询、体力活动咨询、运动训练、康复评估等手段。另外，通过膳食和心理调整也可达到心脏康复目的，且不仅可以减低医疗成本，还可以达到生理活动和心理活动的协调统一、形神俱一，提高患者对心脏康复治疗的依从性。本研究通过将单纯药物治疗转变为多个手段技术的整合治疗，组成三级医院-社区整合联动康复小组，采用太极拳、八段锦等传统医学，形成中西医优势互补，从而体现医学合力的生命力。……