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Article(id=1322926314071662724, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.08.020, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339812056, onlineDateStr=2026-10-30, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339812056, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339812056, creator=13701087609, updateTime=1793339812056, updator=13701087609, issue=Issue{id=1322926217711726961, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='8', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1754755200000', pubDateStr='2025-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339789083, creator='13701087609', updateTime=1793340517761, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929274071679978, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929274071679979, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=92, endPage=95, ext={EN=ArticleExt(id=1322926315854241925, articleId=1322926314071662724, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Short-Term Effect of Shexiang Baoxin Pill（麝香保心丸）Combined with Double Antiplate in Treatment of Elderly Female Patients with Acute Myocardial Infarction, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To systematically evaluate the short-term safety and efficacy of Shexiang Baoxin Pill（麝香保心丸）combined with dual antiplate therapy in the treatment of elderly female patients with acute myocardial infarction.

Methods

90 female patients with acute myocardial infarction were collected.They were divided into observation group（group A，45 cases）and control group（group B，45 cases）by random number table method.The observation group was treated with Shoxiang Baoxin Pill combined with dual antiplate therapy.The control group was treated with conventional dual antiplate therapy.Both groups received routine hospital treatment for 2 weeks and were discharged with symptoms improved.After discharge，they took medicine regularly according to the doctor´s advice.The data before treatment and one month after discharge was recorded respectively.The efficacy indicators were angina pectoris efficacy score，Herth hope scale and QLQ-C30（quality of life survey rating table）.The safety indicators included platelet count，P-D score（PRECISE-DAPT score，or prediction of bleeding complications in patients undergoing coronary stent implantation and subsequent dual antiplatelet therapy），liver function（alanine aminotransferase，aspartate aminotransferase），kidney function（creation），bleeding，recurrence of myocardial infarction，death and other adverse reactions.The clinical efficacy and safety of Shexiang Baoxin Pill combined with dual antiplate therapy in the treatment of elderly female patients with acute myocardial infarction were analyzed.

Results

1.There were no significant differences in the values of alanine aminotransferase，aspartate aminotransferase，platelet or creatinine between the two groups before treatment（P>0.05）.After treatment，the observation group showed a decrease in alanine aminotransferase，while the control group showed a slight increase in alanine aminotransferase，with no statistically significant difference between the two groups（P>0.05）.After treatment，the control group showed a decrease in aspartate aminotransferase，while the observation group showed no significant change in aspartate aminotransferase，and there was no statistical difference between the two groups（P>0.05）.After treatment，the platelet count in both groups decreased，and there was no statistically significant difference between the two groups（P>0.05）.After treatment，the creatinine levels in both groups increased and there was no statistically significant difference between the two groups（P>0.05）.2.There was no statistical significance in QLQ-C30，angina pectoris score or Herth score between the two groups before treatment（P>0.05）.After treatment，the QLQ-C30 scores and angina pectoris scores of the two groups decreased significantly，the Herth scores of the control group decreased，and that of the observation group increased.The angina pectoris score of the observation group was significantly lower than that of the control group after treatment with statistical significance（P<0.05），but the QLQ-C30 score and Herth score after treatment had no statistical significance（P>0.05）.3.There was no statistical significance in PD scores of the two groups before treatment（P>0.05），and PD scores of the two groups after treatment were significantly decreased compared with those before treatment，and the score of the observation group was significantly better than that of the control group（P<0.05）.4.There was no significant difference in adverse events between the two groups（P>0.05）.

Conclusion

Shexiang Baoxin Pill combined with dual antiplate therapy can significantly reduce angina pectoris score and improve angina pectoris symptoms in the treatment of elderly female patients with myocardial infarction，and it is safe and effective，without increasing the risk of bleeding and the burden of liver and kidney.

, authors=Xue DONG1, Haijiao SHI2, Fanyu HE3, authorsList=Xue DONG, Haijiao SHI, Fanyu HE, authorCompany=null, correspAuthors=Haijiao SHI, Fanyu HE, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926320530890894, articleId=1322926314071662724, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=麝香保心丸联合双联抗板治疗高龄急性心肌梗死女性患者近期疗效, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

系统评价麝香保心丸联合双联抗板治疗高龄女性急性心肌梗死患者短期内的安全性和疗效性。

方法

纳入女性急性心肌梗死患者90例，采用随机数字表法将其分为观察组45例和对照组45例，对照组采用常规双联抗板治疗，观察组在对照组基础上，加用麝香保心丸联合治疗，两组均接受常规入院治疗2周症状好转出院，出院后根据医嘱规律服药。分别记录治疗前、出院后1个月的数据，其中疗效指标：心绞痛疗效积分、Herth希望量表、生活质量调查评分表（QLQ-C30）情况。安全指标：血小板计数、PRECISE-DAPT评分（P-D评分），即接受冠状动脉支架植入术及后续双联抗血小板治疗的患者的出血并发症预测）、肝功（谷丙转氨酶、谷草转氨酶）、肾功（肌酐）、出血、再次心梗、死亡及其他不良反应。分析麝香保心丸联合双联抗板治疗高龄女性急性心肌梗死患者的临床有效性及安全性。

结果

①治疗前两组谷丙、谷草、血小板、肌酐等数值差异均无统计学意义（P>0.05）；治疗后观察组谷丙较前下降，对照组谷丙较前略上升，两者差异无统计学意义（P>0.05）；治疗后对照组谷草较前下降，观察组谷草较前未见明显变化，两者差异无统计学意义（P>0.05）；治疗后两组血小板较前下降，两者差异无统计学意义（P>0.05）；治疗后两组肌酐较前升高，两者差异无统计学意义（P>0.05）；②两组QLQ-C30、心绞痛积分、Herth积分在治疗前比较，差异无统计学意义（P>0.05）。治疗后，两组QLQ-C30积分及心绞痛积分明显下降，Herth积分对照组降低，观察组升高。观察组治疗后心绞痛积分明显低于对照组，差异有统计学意义（P<0.05），治疗后QLQ-C30积分及Herth积分无统计学意义（P>0.05）；③两组治疗前P-D积分无统计学意义（P>0.05），治疗后两组P-D积分较治疗前明显下降，观察组明显优于对照组，且P<0.05，存在统计学意义。④两组不良事件差异无统计学意义（P>0.05）。

结论

麝香保心丸联合双联抗板治疗高龄女性心肌梗死患者可以显著降低心绞痛评分，改善心绞痛症状，且安全有效，不增加出血风险，不增加肝肾负担。

, authors=董雪1, 史海蛟2, 何璠玙3, authorsList=董雪, 史海蛟, 何璠玙, authorCompany=null, correspAuthors=史海蛟, 何璠玙, authorNote=

董雪（1991-），女，辽宁锦州人，主治医师，硕士，研究方向：冠心病的中西医结合诊治。

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史海蛟（1981-），男，辽宁沈阳人，主任医师，博士，博士后，研究方向：中医药治疗心血管疾病。E-mail：。
何璠玙（1992-），女，辽宁沈阳人，助理研究员，在站博士后，研究方向：中西医结合防治心血管疾病。E-mail：。
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董雪（1991-），女，辽宁锦州人，主治医师，硕士，研究方向：冠心病的中西医结合诊治。

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董雪（1991-），女，辽宁锦州人，主治医师，硕士，研究方向：冠心病的中西医结合诊治。

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组别例数年龄●吸烟★饮酒★P-D●高血压★糖尿病★肾功能不全★房颤★心衰★贫血★
对照组4582.16±1.9116（35.6）7（15.6）44.73±9.0434（75.6）24（53.3）20（44.4）10（22.2）18（40.0）11（24.4）
观察组4581.49±1.5518（40.0）9（20.0）44.33±8.9936（80.0）23（51.1）19（42.2）9（20.0）18（40.0）9（20.0）
P0.0720.6640.5810.8350.6120.8330.8320.7961.0000.074
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两组女性急性心肌梗死患者基线资料比较

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组别例数年龄●吸烟★饮酒★P-D●高血压★糖尿病★肾功能不全★房颤★心衰★贫血★
对照组4582.16±1.9116（35.6）7（15.6）44.73±9.0434（75.6）24（53.3）20（44.4）10（22.2）18（40.0）11（24.4）
观察组4581.49±1.5518（40.0）9（20.0）44.33±8.9936（80.0）23（51.1）19（42.2）9（20.0）18（40.0）9（20.0）
P0.0720.6640.5810.8350.6120.8330.8320.7961.0000.074
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组别例数谷丙转氨酶/（U/L）谷草转氨酶/（U/L）血小板/（109/L）肌酐/（μmol/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组4539.29±9.6242.69±10.7134.09±11.5234.44±9.31284.60±45.28280.93±45.0497.71±17.81104.19±16.13
观察组4541.11±12.4640.91±9.1131.04±10.8830.80±11.52286.69±44.39283.89±42.8394.51±17.25101.73±15.96
t值-0.7760.8481.2891.651-0.221-0.3190.8640.727
P值0.4400.3990.2010.1020.8260.7500.3900.469
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两组女性急性心肌梗死患者安全指标水平比较（）

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组别例数谷丙转氨酶/（U/L）谷草转氨酶/（U/L）血小板/（109/L）肌酐/（μmol/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组4539.29±9.6242.69±10.7134.09±11.5234.44±9.31284.60±45.28280.93±45.0497.71±17.81104.19±16.13
观察组4541.11±12.4640.91±9.1131.04±10.8830.80±11.52286.69±44.39283.89±42.8394.51±17.25101.73±15.96
t值-0.7760.8481.2891.651-0.221-0.3190.8640.727
P值0.4400.3990.2010.1020.8260.7500.3900.469
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组别例数QLQ-C30心绞痛积分Herth
治疗前治疗后治疗前治疗后治疗前治疗后
对照组4586.00±10.2583.64±10.6212.04±3.9712.04±3.0631.42±4.9330.20±4.91
观察组4585.98±10.0881.29±10.1911.78±2.8010.36±2.49*31.24±4.8832.11±5.13
t值0.011.073-0.3682.869-0.172-1.806
P值0.9920.2860.7130.0050.8640.074
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两组女性急性心肌梗死患者疗效指标比较（）

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组别例数QLQ-C30心绞痛积分Herth
治疗前治疗后治疗前治疗后治疗前治疗后
对照组4586.00±10.2583.64±10.6212.04±3.9712.04±3.0631.42±4.9330.20±4.91
观察组4585.98±10.0881.29±10.1911.78±2.8010.36±2.49*31.24±4.8832.11±5.13
t值0.011.073-0.3682.869-0.172-1.806
P值0.9920.2860.7130.0050.8640.074
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组别例数P-D评分
治疗前治疗后
对照组4544.73±9.0443.20±6.99
观察组4544.33±8.9939.96±7.36
t值0.2102.144
P值0.8340.035
), ArticleFig(id=1322926324947493048, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926314071662724, language=CN, label=表4, caption=

两组女性急性心肌梗死患者P-D评分指标比较（）

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组别例数P-D评分
治疗前治疗后
对照组4544.73±9.0443.20±6.99
观察组4544.33±8.9939.96±7.36
t值0.2102.144
P值0.8340.035
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组别例数出血再次梗死死亡
对照组453（6.67）8（17.78）3（6.67）
观察组452（4.44）7（15.56）2（4.44）
P值1.0000.7771.00
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两组女性急性心肌梗死患者不良事件情况

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组别例数出血再次梗死死亡
对照组453（6.67）8（17.78）3（6.67）
观察组452（4.44）7（15.56）2（4.44）
P值1.0000.7771.00
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麝香保心丸联合双联抗板治疗高龄急性心肌梗死女性患者近期疗效
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董雪 1 , 史海蛟 2 , 何璠玙 3
中华中医药学刊 | 国家项目点击 2025,43(8): 92-95
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中华中医药学刊 |国家项目点击 2025 , 43 (8) : 92 -95
麝香保心丸联合双联抗板治疗高龄急性心肌梗死女性患者近期疗效
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董雪1, 史海蛟2 , 何璠玙3
作者信息
  • 1.锦州医科大学附属第三医院，辽宁 锦州 121000
  • 2.辽宁中医药大学附属医院，辽宁 沈阳 110032
  • 3.辽宁中医药大学，辽宁 沈阳 110847
通讯作者:
史海蛟（1981-），男，辽宁沈阳人，主任医师，博士，博士后，研究方向：中医药治疗心血管疾病。E-mail：。
何璠玙（1992-），女，辽宁沈阳人，助理研究员，在站博士后，研究方向：中西医结合防治心血管疾病。E-mail：。
作者简介:

董雪（1991-），女，辽宁锦州人，主治医师，硕士，研究方向：冠心病的中西医结合诊治。

Short-Term Effect of Shexiang Baoxin Pill（麝香保心丸）Combined with Double Antiplate in Treatment of Elderly Female Patients with Acute Myocardial Infarction
Xue DONG1, Haijiao SHI2 , Fanyu HE3
Affiliations
  • 1.The Third Affiliated Hospital of Jinzhou Medical University，Jinzhou 121000，Liaoning，China
  • 2.Affiliated Hospital of Liaoning University of Traditional Chinese Medicine，Shenyang 110032，Liaoning，China
  • 3.Liaoning University of Traditional Chinese Medicine，Shenyang 110847，Liaoning，China
出版时间: 2025-08-10 doi: 10.13193/j.issn.1673-7717.2025.08.020
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摘要
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目的

系统评价麝香保心丸联合双联抗板治疗高龄女性急性心肌梗死患者短期内的安全性和疗效性。

方法

纳入女性急性心肌梗死患者90例，采用随机数字表法将其分为观察组45例和对照组45例，对照组采用常规双联抗板治疗，观察组在对照组基础上，加用麝香保心丸联合治疗，两组均接受常规入院治疗2周症状好转出院，出院后根据医嘱规律服药。分别记录治疗前、出院后1个月的数据，其中疗效指标：心绞痛疗效积分、Herth希望量表、生活质量调查评分表（QLQ-C30）情况。安全指标：血小板计数、PRECISE-DAPT评分（P-D评分），即接受冠状动脉支架植入术及后续双联抗血小板治疗的患者的出血并发症预测）、肝功（谷丙转氨酶、谷草转氨酶）、肾功（肌酐）、出血、再次心梗、死亡及其他不良反应。分析麝香保心丸联合双联抗板治疗高龄女性急性心肌梗死患者的临床有效性及安全性。

结果

①治疗前两组谷丙、谷草、血小板、肌酐等数值差异均无统计学意义（P>0.05）；治疗后观察组谷丙较前下降，对照组谷丙较前略上升，两者差异无统计学意义（P>0.05）；治疗后对照组谷草较前下降，观察组谷草较前未见明显变化，两者差异无统计学意义（P>0.05）；治疗后两组血小板较前下降，两者差异无统计学意义（P>0.05）；治疗后两组肌酐较前升高，两者差异无统计学意义（P>0.05）；②两组QLQ-C30、心绞痛积分、Herth积分在治疗前比较，差异无统计学意义（P>0.05）。治疗后，两组QLQ-C30积分及心绞痛积分明显下降，Herth积分对照组降低，观察组升高。观察组治疗后心绞痛积分明显低于对照组，差异有统计学意义（P<0.05），治疗后QLQ-C30积分及Herth积分无统计学意义（P>0.05）；③两组治疗前P-D积分无统计学意义（P>0.05），治疗后两组P-D积分较治疗前明显下降，观察组明显优于对照组，且P<0.05，存在统计学意义。④两组不良事件差异无统计学意义（P>0.05）。

结论

麝香保心丸联合双联抗板治疗高龄女性心肌梗死患者可以显著降低心绞痛评分，改善心绞痛症状，且安全有效，不增加出血风险，不增加肝肾负担。

麝香保心丸  /  急性心肌梗死  /  双联抗板  /  老年女性  /  生活质量
Objective

To systematically evaluate the short-term safety and efficacy of Shexiang Baoxin Pill（麝香保心丸）combined with dual antiplate therapy in the treatment of elderly female patients with acute myocardial infarction.

Methods

90 female patients with acute myocardial infarction were collected.They were divided into observation group（group A，45 cases）and control group（group B，45 cases）by random number table method.The observation group was treated with Shoxiang Baoxin Pill combined with dual antiplate therapy.The control group was treated with conventional dual antiplate therapy.Both groups received routine hospital treatment for 2 weeks and were discharged with symptoms improved.After discharge，they took medicine regularly according to the doctor´s advice.The data before treatment and one month after discharge was recorded respectively.The efficacy indicators were angina pectoris efficacy score，Herth hope scale and QLQ-C30（quality of life survey rating table）.The safety indicators included platelet count，P-D score（PRECISE-DAPT score，or prediction of bleeding complications in patients undergoing coronary stent implantation and subsequent dual antiplatelet therapy），liver function（alanine aminotransferase，aspartate aminotransferase），kidney function（creation），bleeding，recurrence of myocardial infarction，death and other adverse reactions.The clinical efficacy and safety of Shexiang Baoxin Pill combined with dual antiplate therapy in the treatment of elderly female patients with acute myocardial infarction were analyzed.

Results

1.There were no significant differences in the values of alanine aminotransferase，aspartate aminotransferase，platelet or creatinine between the two groups before treatment（P>0.05）.After treatment，the observation group showed a decrease in alanine aminotransferase，while the control group showed a slight increase in alanine aminotransferase，with no statistically significant difference between the two groups（P>0.05）.After treatment，the control group showed a decrease in aspartate aminotransferase，while the observation group showed no significant change in aspartate aminotransferase，and there was no statistical difference between the two groups（P>0.05）.After treatment，the platelet count in both groups decreased，and there was no statistically significant difference between the two groups（P>0.05）.After treatment，the creatinine levels in both groups increased and there was no statistically significant difference between the two groups（P>0.05）.2.There was no statistical significance in QLQ-C30，angina pectoris score or Herth score between the two groups before treatment（P>0.05）.After treatment，the QLQ-C30 scores and angina pectoris scores of the two groups decreased significantly，the Herth scores of the control group decreased，and that of the observation group increased.The angina pectoris score of the observation group was significantly lower than that of the control group after treatment with statistical significance（P<0.05），but the QLQ-C30 score and Herth score after treatment had no statistical significance（P>0.05）.3.There was no statistical significance in PD scores of the two groups before treatment（P>0.05），and PD scores of the two groups after treatment were significantly decreased compared with those before treatment，and the score of the observation group was significantly better than that of the control group（P<0.05）.4.There was no significant difference in adverse events between the two groups（P>0.05）.

Conclusion

Shexiang Baoxin Pill combined with dual antiplate therapy can significantly reduce angina pectoris score and improve angina pectoris symptoms in the treatment of elderly female patients with myocardial infarction，and it is safe and effective，without increasing the risk of bleeding and the burden of liver and kidney.

Shexiang Baoxin Pill（麝香保心丸）  /  acute myocardial infarction  /  dual antiplate therapy  /  elderly women  /  quality of life
董雪, 史海蛟, 何璠玙. 麝香保心丸联合双联抗板治疗高龄急性心肌梗死女性患者近期疗效. 中华中医药学刊, 2025 , 43 (8) : 92 -95 . DOI: 10.13193/j.issn.1673-7717.2025.08.020
Xue DONG, Haijiao SHI, Fanyu HE. Short-Term Effect of Shexiang Baoxin Pill（麝香保心丸）Combined with Double Antiplate in Treatment of Elderly Female Patients with Acute Myocardial Infarction[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (8) : 92 -95 . DOI: 10.13193/j.issn.1673-7717.2025.08.020
正文
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急性心肌梗死（AMI）是心内科一种常见的危重症，老年人所占比重大，并发症多、致死率高是其重要的临床特点。中国已经进入深度老龄化阶段，性别间存在死亡差异，高龄女性数量逐年增多，80岁及以上高龄老人每年以5%的速度增加，预计2040年高龄老人将会增加到7400余万人[1]。针对急性心肌梗死临床治疗而言，各大指南均推荐，在无禁忌证情况下均推荐双联抗血小板治疗急性心肌梗死，但是某些大型临床研究经常将高龄患者排除在纳入标准之外，例如：在TRITON-TIMI38和PLATO中，只有13%和15%的患者为75岁及以上，但是登记数据中接近1/3的急性冠脉综合征患者为75岁以上老年患者[2]。
麝香首载于《神农本草经》，具有活血通络功效，主治胸痹心痛等。麝香保心丸来源于宋代名方苏合香丸[3]，组方遵循“君臣佐使”原则，具有活血、益气、强心的作用，为指南推荐的、临床常用治疗冠心病的中成药之一，因其疗效显著、方便携带、颗粒较小、易于服用，很容易被高龄冠心病患者接受。
老龄化已经到来，研究对象也要作出相应调整，这些高龄人群已经成为急性心肌梗死患者的主力军，但是因其自身的特殊性，现临床研究甚少，因此，本文以高龄患者为研究主体，研究麝香保心丸联合双联抗板治疗方案的临床有效性和安全性。
1　资料与方法
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1.1　研究对象
收集2022年9月—2023年9月锦州医科大学附属第三医院心血管内一科就诊的女性急性心肌梗死患者90例，年龄80～87岁，采用随机数字表法将其分为观察组45例、对照组45例。两组临床资料比较差异无统计学意义（P>0.05），见表1。本文经过伦理委员会审核，伦理号：JYDSYKXYZ-ICE-2024-046
1.2　病例选择标准
急性心肌梗死（STEMI/NSTEMI）诊断明确[4]；②病史及用药情况记录完善。排除标准：①外周血栓脱落造成的AMI；②由损伤性诊疗造成的AMI；③住院期间死亡；④院内行手术开通血管。
1.3　治疗方法
对照组为拜阿司匹林（拜耳医药保健有限公司生产，批准文号：国药准字HJ20160685规格：100 mg；100 mg口服，1次/d）联合氯吡格雷［赛诺菲（杭州）制药有限公司生产，批准文号：国药准字H2017237规格：75 mg，75 mg口服，1次/d］，观察组在对照组基础上联合麝香保心丸（上海和黄药业有限公司生产，批准文号：国药准字Z31020068规格：22.5 mg，45 mg/次，3次/d口服），两组均接受常规入院治疗2周症状好转出院，出院后根据医嘱规律服药。
1.4　观察方法
分别于入组后即刻及出院后1个月记录相关数据，其中疗效指标：心绞痛疗效积分[5]、Herth希望量表[6]以及QLQ-C30（生活质量调查评分表）评分[7]；安全指标：采集空腹静脉血，用真空采血管各收集1次空腹肘静脉血（3 mL/次），运用全自动血细胞分析仪（日本希森美康，型号XD1000i）检测血小板计数，采用全自动生化分析仪（西门子Atellica CH930型）检测肝功（谷丙转氨酶、谷草转氨酶）、肾功（肌酐）指标及P-D评分（PRECISE-DAPT评分，即接受冠状动脉支架植入术及后续双联抗血小板治疗的患者的出血并发症预测）[8]指标；不良事件指标：①出血：出血事件定义为脑出血、蛛网膜下腔出血、消化道出血、泌尿系统出血、咯血、痰中带血、鼻出血、牙龈出血、眼底出血、结膜出血、皮肤瘀斑/瘀点/紫癜等[9]，②再次心梗[4]，③死亡。
1.5　统计学方法
使用SPSS 25.0软件，计量资料先进行正态性检验，符合正态分布的计量资料以表示，两组间采用t检验，计数资料以百分率表示，采用χ2检验或Fisher精确概率法。P<0.05为差异有统计学意义。
2　结果
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2.1　两组基线情况比较
如表1所示，两组年龄、基础疾病及吸烟、饮酒等一般资料比较，差异均无统计学意义（P>0.05）。
2.2　两组治疗前后谷丙转氨酶、谷草转氨酶、血小板、肌酐安全指标水平比较
如表2所示，治疗前两组谷丙转氨酶、谷草转氨酶、血小板、肌酐等数值均差异无统计学意义（P>0.05）；治疗后观察组谷丙转氨酶较前下降，对照组谷丙转氨酶较前略上升，两者差异无统计学意义（P>0.05）；治疗后对照组谷草转氨酶较前下降，观察组谷草转氨酶较前未见明显变化，两者差异无统计学意义（P>0.05）；治疗后两组血小板较前下降，两者差异无统计学意义（P>0.05）；治疗后两组肌酐较前升高，两者差异无统计学意义（P>0.05）。
2.3　两组治疗前后QLQ-C30、心绞痛积分、Herth希望量表疗效指标水平比较
如表3所示，两组QLQ-C30、心绞痛积分、Herth积分在治疗前比较，无统计学意义（P>0.05）。治疗后，两组QLQ-C30积分及心绞痛积分明显下降，Herth积分对照组降低，观察组升高。观察组治疗后心绞痛积分明显低于对照组，有统计学意义（P<0.05），治疗后QLQ-C30积分及Herth积分无统计学意义（P>0.05）。
2.4　两组P-D评分比较
如表4所示，两组治疗前P-D评分无统计学意义（P>0.05），治疗后两组P-D评分较治疗前明显下降，观察组明显优于对照组，且P<0.05，存在统计学意义。
2.5　两组不良事件情况
如表5所示，两组不良事件差异无统计学意义（P>0.05）。
3　讨论
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与男性相比，女性冠心病的发病年龄较大，这可能是因为雌激素对血管内皮有保护作用，绝经后雌激素明显降低，致使血管内皮功能异常和脂质沉积加快，加速冠脉斑块的形成，使得冠心病危险因素进行性增加[10]。BAJAJS等[11]的研究发现急性心肌梗死患者血脂异常比例不同，女性（34%）明显大于男性（26%）。共识指出[8]：非血运重建ACS患者在经药物治疗且处于高出血风险的ACS患者中应予至少1个月的双抗治疗；老年女性这一类特殊患者，出血风险高，血栓风险亦是高危。综上，老年急性心肌梗死用药情况需特别谨慎，更应受到特殊关注。
麝香保心丸是目前我国最常使用的芳香温通类中成药，主要用于治疗胸痹气滞血瘀证，主要症状为：心前区疼痛、固定不移，心绞痛、心肌梗死见上述证候者，上市40余年，众多临床证据已充分证明其有效性和安全性[12-14]，但是对于高龄患者应用此药是否安全有效还没有特别多的临床研究。
基于此，本文主要研究麝香保心丸在高龄女性中应用是否安全有效，本研究结果显示，高龄患者短期应用麝香保心丸，不增加肝肾功风险，不降低血小板计数，麝香保心丸联合双联抗板可以明显改善心绞痛症状，同时，还能减少P-D评分数值，降低出血风险，P<0.05。
辨证论治是中医学诊治疾病的基本理论与思维方法，即根据中医理论分析四诊获得临床资料，明确病变的本质，拟定治疗原则。中药复方制剂麝香保心丸源于宋代《太平惠民和剂局方》中治疗“寒闭证”的经典名方苏合香丸，其集诸芳香药于一方，既长于辟秽开窍，又可行气温中止痛，且散收兼顾，补敛并施。戴瑞鸿教授在1972年以“同病异治，异病同治”为治疗原则，通过加减化裁苏合香丸得到现在的麝香保心丸，已在临床应用40余年。
麝香保心丸组方包括：人工麝香、人参、肉桂、蟾酥、苏合香、人工牛黄、冰片，诸药共奏开窍止痛、益气强心之效[15]。麝香开窍醒神、活血止痛，为君药；人参大补元气、补脾益肺，苏合香开窍醒神、辟秽止痛，共为臣药；肉桂补火助阳、散寒止痛、温经通脉，蟾酥开窍醒神、解毒止痛，牛黄化痰开窍、清热解毒，三者同为佐药；冰片开窍醒神、清热止痛为使药；全方温寒并用，以温为主，以补为辅，通补兼施，共同作用于心脉，组方温和，活血不伤正，扶正不留邪。麝香保心丸作为一种治疗心血管疾病的辅助药物，已广泛应用于临床[16-18]。
麝香所含的麝香酮具有抑制血小板聚集、提高中枢耐缺氧能力、扩张冠脉、降低心肌耗氧量、强心等药理作用[19]。人参具有抗动脉粥样硬化、抑制血小板聚集的作用，能降低心脏前后负荷和冠状动脉阻力[20]。苏合香的树脂类成分可抑制血小板聚集、抗凝、抑制炎症反应[21]。肉桂的主要化学成分具有扩张血管、抗氧化等作用[22]。宋涛[23]的研究，蟾酥中的蟾毒灵可浓度依赖性地抑制大鼠心室肌细胞钙电流，抑制心室肌细胞收缩，从而在一定程度上保护心肌。牛黄的成分牛磺酸可抑制心室肌细胞钙内流，抗心律失常。同时，抑制血管平滑肌细胞增生和内膜增厚，抗高血压和抗动脉粥样硬化，降血脂，抗血小板聚集与血栓形成，保护心肌，改善心功能[24]。中药冰片通过NO3-NO2-NO通路发挥强劲的NO生物活性，使得整体方药舒张血管的作用更为强烈[25]。近期一项前瞻性、双盲随机对照试验的研究已证实了麝香保心丸联合西药治疗急性心肌梗死的疗效和安全性[26]。尤其是由复旦大学附属中山医院葛均波院士及复旦大学附属华山医院范维琥教授牵头开展了一项符合国际规范的麝香保心丸大型循证研究——MUST研究，该研究历时10年，证实了长期使用（≥18个月）麝香保心丸作为最佳药物治疗的联合疗法是安全的，同时还降低了慢性稳定型冠心病患者的心绞痛频率和远期心脑血管事件发生率[26]。综上，麝香保心丸可以改善高龄女性心肌梗死患者心绞痛症状，降低心绞痛评分，且安全有效，不增加出血风险，不增加肝肾负担，值得临床推广应用。
此研究还发现，经过一个月治疗，不论观察组还是对照组，herth希望量表数值和QLQ-C30量表数值均没有显著改变，且两组治疗前后无统计学意义，这可能与高龄患者常伴随很多基础疾病，包括高血压、糖尿病、肾功能不全、脑梗等，这些都影响老年人的生活和心理变化，仅仅改变心绞痛程度并不能从根本上解决老年人的痛苦，改善老年人的生活质量，所以我们需要付出更多时间和精力来关注老年人的心理和身体健康。
本研究存在一定的局限性，观察对象均为高龄女性心肌梗死患者这一特殊人群，导致样本数量小，研究数据相对简单，随访周期较短，可能导致结论不准确，还需要更多大型临床研究延长时限进一步证实以上结论。
基金
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  • 国家自然科学基金青年科学基金项目(82305191)
  • 辽宁省科学技术计划项目(2022-MS-282)
  • 辽宁省科技计划联合计划项目(2024-MSLH-308)
文献
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2025年第43卷第8期
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doi: 10.13193/j.issn.1673-7717.2025.08.020
  • 首发时间：2026-10-30
  • 出版时间：2025-08-10
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出版历史
基金
国家自然科学基金青年科学基金项目(82305191)
辽宁省科学技术计划项目(2022-MS-282)
辽宁省科技计划联合计划项目(2024-MSLH-308)
作者信息
    1.锦州医科大学附属第三医院，辽宁 锦州 121000
    2.辽宁中医药大学附属医院，辽宁 沈阳 110032
    3.辽宁中医药大学，辽宁 沈阳 110847

通讯作者:

史海蛟（1981-），男，辽宁沈阳人，主任医师，博士，博士后，研究方向：中医药治疗心血管疾病。E-mail：。
何璠玙（1992-），女，辽宁沈阳人，助理研究员，在站博士后，研究方向：中西医结合防治心血管疾病。E-mail：。
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2种不同金属材料的力学参数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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