目的 探討穩(wěn)心顆粒聯(lián)合依諾肝素鈉治療急性心肌梗死的臨床療效。方法 選取2022年3月—2024年3月在首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院治療的急性心肌梗死患者106例，隨機(jī)分為對(duì)照組和治療組，每組各53例。對(duì)照組皮下注射依諾肝素鈉注射液，4 000～6 000 IU/次，1～2次/d。治療組在對(duì)照組基礎(chǔ)上口服穩(wěn)心顆粒，1袋/次，3次/d。兩組療程10 d。觀察兩組患者臨床療效，比較治療前后兩組患者左心室射血分?jǐn)?shù)（LVEF）和血清心臟損傷標(biāo)志物水平，中國(guó)冠心病患者優(yōu)化抗血小板治療（OPT-CAD）和心肌梗死多維度評(píng)估量表（MIDAS）評(píng)分，及血漿D-二聚體（D-D）、凝血酶抗凝血酶復(fù)合物（TAT）和血清白細(xì)胞介素-17（IL-17）、基質(zhì)金屬蛋白酶-9（MMP-9）水平。結(jié)果 治療后，治療組總有效率明顯高于對(duì)照組（92.45% vs 77.36%，P＜0.05）。治療后，兩組LVEF水平明顯高于治療前，而血清心臟損傷標(biāo)志物肌酸激酶同工酶（CK-MB）、心肌肌鈣蛋白Ⅰ（cTnⅠ）和N末端B型利鈉肽原（NT-proBNP）水平均低于組內(nèi)治療前（P＜0.05），且治療組LVEF和血清心臟損傷標(biāo)志物水平明顯好于對(duì)照組（P＜0.05）。治療后，兩組OPT-CAD、MIDAS評(píng)分均低于組內(nèi)治療前（P＜0.05），且治療組評(píng)分明顯低于對(duì)照組（P＜0.05）。治療后，兩組患者血漿D-D、TAT和血清IL-17、MMP-9水平均低于組內(nèi)治療前（P＜0.05），且治療組血漿D-D、TAT和血清IL-17、MMP-9水平明顯低于對(duì)照組（P＜0.05）。結(jié)論 穩(wěn)心顆粒聯(lián)合依諾肝素鈉治療急性心肌梗死患者，可有效降低心臟損傷，調(diào)節(jié)凝血系統(tǒng)活性，抑制炎癥反應(yīng)及心肌重塑，促進(jìn)患者生活質(zhì)量提高和病情減輕。

Objective To investigate the clinical efficacy of Wenxin Granules combined with enoxaparin sodium in treatment of acute myocardial infarction. Methods Patients (106 cases) with acute myocardial infarction in Beijing Friendship Hospital, Capital Medical University from March 2022 to March 2024 were randomly divided into control and treatment group, and each group had 53 cases. Patients in the control group were subcutaneous injection administered with Enoxaparin Sodium Injection, 4 000 — 6 000 IU/time, 1 — 2 times daily. Patients in the treatment group were po administered with Wenxin Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 10 d. After treatment, the clinical evaluations were evaluated, and the LVEF, serum cardiac injury markers, OPT-CAD and MIDAS scores, the plasma D-D, TAT and serum IL-17, MMP-9 levels in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was significantly higher than that in the control group (92.45% vs 77.36%, P < 0.05). After treatment, the LVEF levels in two groups were significantly higher than before treatment, while the levels of serum CK-MB, cTnⅠ, and NT-proBNP were all lower than those before treatment in the group (P < 0.05), and the LVEF and serum cardiac damage marker levels in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the OPT-CAD and MIDAS scores in two groups were lower than those before treatment (P < 0.05), and the scores in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of plasma D-D, TAT and serum IL-17 and MMP-9 in two groups were lower than those before treatment (P < 0.05), and the levels in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion The application of Wenxin Granules combined with enoxaparin sodium in the treatment of patients with acute myocardial infarction can effectively reduce heart injury, regulate the activity of coagulation system, inhibit inflammatory reaction and myocardial remodeling, and promote the improvement of patients' quality of life and disease alleviation.

R972

延安市科學(xué)技術(shù)研究發(fā)展計(jì)劃項(xiàng)目（2017KS-17）