·心血管病临床观察/研究·

“冬病夏治”三伏贴防治冠心病心绞痛的前瞻性队列研究

于美丽1，胡晓美2，徐浩2

摘要：目的评价“冬病夏治”三伏贴预防冠心病患者冬季心绞痛发作、中医证候的临床疗效，分析贴敷有效证型及影响发生冬季再住院事件的因素。方法 采用前瞻性队列研究，收集符合纳入标准的冠心病患者230例，根据患者意愿是否进行贴敷分为贴敷组(116例)和对照组(114例)。半年后随访，进行统计分析。结果贴敷组冬季心绞痛发作、中医证候疗效改善优于对照组，阳虚寒凝证患者的贴敷疗效优于非阳虚寒凝证患者，差异具有统计学意义(P<0.05)；三伏贴是发生冬季因心绞痛再住院事件的保护因素[P<0.01，RR=0.029，95%CI(0.003，0.312)]。结论“冬病夏治”三伏贴是预防冠心病心绞痛冬季发作的有效方法，不良反应较少，患者满意度较高，值得进一步采用多中心随机对照试验加以验证。

关键词：冠心病；心绞痛；冬病夏治；三伏贴

中图分类号：R541R289

基金项目：名老中医独特辨证方法传承研究(No.2013BAI13B01)

通讯作者：徐浩，E-mail：xuhaotcm@gmail.com

收稿日期：(2015-03-02)

Clinical Evaluation on Dog-days Paste Treating Winter Diseases in Summer for the Prevention and Treatment of Angina Pectoris

Yu Meili，Hu Xiaomei，Xu Hao

Beijing University of Chinese Medicine，Beijing 100029，China

Corresponding Author：Xu Hao(China Academy of Chinese Medical Sciences，Beijing 100091，China)

Abstract：ObjectiveTo evaluate the effect of Dog-days paste treating winter diseases in summer for prevention and treatment of angina pectoris.MethodsThis was a prospective cohort study which collected 230 patients with angina pectoris met the inclusion criteria.According to the patient’s will，116 cases was divided into the treatment group and the other 114 as control group，follow-up for half a year for statistical analysis.ResultsThe effects of angina pectoris attacks and TCM symptoms in sticking group was significantly improved compared with the control group.In sticking group，patients with syndrome of yang deficiency and cold coagulated improvement were better than those who without yang deficiency and cold coagulation syndrome in terms of syndrome curative effect.The difference was statistically significant(P<0.05).Dog-days paste was a influencing factor in hospitalized events in winter[P<0.01，RR=0.029，95% CI(0.003，0.312)]. ConciusionThis study has preliminarily verified Dog-days paste is the effective method for prevention of angina pectoris of winter attack.The masses have higher satisfaction and good security on Dog-days paste.It is worth further to verify by multi center randomized controlled trials.

Key words：angina pectoris；Dog-days paste；treating winter diseases in summer

冠心病(CHD)的二级预防是临床防治的重点。中医常以温阳通脉、活血化瘀为法。“冬病夏治”三伏贴是中医学防治多种慢性疾病的重要方法，其根据《黄帝内经》中“春夏养阳”的原则，在夏季人体阳气最旺盛的时机，对患有冬季易发作或加重疾病的患者施以助阳药，从而发挥扶阳祛寒、补益正气、祛除疾病的作用。根据胸痹“阳微阴弦”的病机特点，“冬病夏治”三伏贴是否对冠心病患者冬季心绞痛发作具有预防作用？目前，临床上已开展了一些关于穴位贴敷治疗冠心病心绞痛的小样本观察研究，但采用“冬病夏治”三伏贴防治冠心病心绞痛的系统性临床观察却未见报道，为进一步验证“冬病夏治”三伏贴对冠心病患者冬季心绞痛发作的预防作用，进行此项研究。……