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目的:探究芪参益气滴丸对老年冠心病骨科大手术后对心肌损伤的保护作用和对心脏GRACE风险评分的影响。方法:选取医院在2013年1月—2016年1月收治的300例老年冠心病并骨性关节炎患者作为本次研究的对象。采用随机分配的方法,将此30例老年冠心病并骨性关节炎患者分为观察组和对照组两个研究小组,每个研究小组均有150例患者。手术结束后,对照组采用4100 U低分子肝素进行治疗;而观察组患者则采用芪参益气滴丸0.5 g进行治疗,3 d后再采用4100 U低分子肝素进行治疗。对比两组患者术前术后血浆肌钙蛋白的变化情况、术中出血量、术后引流血量、冠心病GRACE风险评分(术后15天)、深静脉血栓发生概率以及全因死亡概率(1个月内)。结果:两组患者的术前血浆肌钙蛋白、术中出血量、全因死亡概率(观察组1.33%,对照组2.67%%)以及深静脉血栓发生概率(观察组10.00%,对照组12.00%)数据之间产生的差异无统计学意义(P>0.05),而观察组患者的术后血浆肌钙蛋白明显低于对照组患者的术后血浆肌钙蛋白(观察组4.00%,对照组10.00%),前者的冠心病GRACE风险评分优于后者的冠心病GRACE风险评分,其产生的数据差异具有统计学意义(P<0.05)。结论:芪参益气滴丸对老年冠心病骨科大手术后对心肌损伤有明显的保护作用和,并且对心脏GRACE风险评分有良好的影响,值得在临床中推广即应用。
Objective: To investigate the protective effect of Qishen Yiqi Drops on myocardial injury in elderly patients with orthopedic major orthopedic surgery and its effect on the risk score of cardiac GRACE. Methods: A total of 300 elderly patients with coronary heart disease and osteoarthritis admitted from January 2013 to January 2016 in our hospital were enrolled in this study. The 30 elderly patients with coronary heart disease and osteoarthritis were randomly divided into observation group and control group, with 150 patients in each group. At the end of surgery, the control group was treated with 4100 U low molecular weight heparin; while the observation group was treated with Qishen Yiqi Dripping Pill 0.5 g, and 3 days later 4100 U low molecular weight heparin was used for treatment. Preoperative and postoperative plasma troponin changes, intraoperative blood loss, postoperative drainage, coronary heart disease GRACE risk score (15 days after surgery), deep venous thrombosis and all-cause mortality ( Within 1 month). Results: Preoperative plasma troponin, intraoperative blood loss, all-cause mortality (observation group 1.33%, control group 2.67 %%) and deep vein thrombosis (observation group 10.00%, control group 12.00% (P> 0.05). The postoperative plasma troponin in the observation group was significantly lower than that in the control group (4.00% in the observation group and 10.00 in the control group %), The former coronary heart disease GRACE risk score is superior to the latter’s coronary heart disease GRACE risk score, the data generated by the difference was statistically significant (P <0.05). Conclusion: Qishenyiqi dripping pills have a significant protective effect on myocardial injury after major orthopedic surgery in elderly patients with coronary heart disease, and have a good effect on the risk score of cardiac GRACE. It is worth to be popularized in clinical application.