目的: 结合临床经验,探讨单独使用复方丹参滴丸治疗冠心病心绞痛和与其他西药联合使用治疗冠心病心绞痛的不良反应发生规律与发生特点,为复方丹参滴丸的合理用药提供参考。方法:回顾分析2010年1月至2016年1月在我院诊治的资料齐全的1359例冠心病心绞痛患者病例,其中单独使用复方丹参滴丸的658例(单独组),联合其他西药治疗的701例(联合组),对两组患者出现的不良反应进行统计分析。结果:研究结果显示,单独组的658例患者中有27例发生不良反应,不良反应发生率为4.10%(27/658);联合组的701例患者中有61例患者发生不良反应,不良反应发生率为8.70%(61/701)。单独用药组性别、年龄、用药剂量与患者不良反应之间无密切相关,但联合用药组消化系统反应与患者年龄和用药剂量密切相关。联合用药组中,联合应用马来酸桂哌奇特患者的皮肤反应最为严重,联合单硝酸异山梨酯患者的全身反应最为严重,联合前列地尔患者的血液系统和过敏性休克最为严重。单独组的不良反应发生率明显低于联合组,两者相比,具有显著性差异(χ2=11.85,P<0.05);两者在过敏性休克、皮肤反应、血液系统反应、消化系统反应、呼吸系统反应之间相比较为类似,但在全身反应方面,联合组明显高于单独组,两者相比具有显著性差异(χ2=4.06,P<0.05)。结论:复方丹参滴丸单独使用治疗冠心病心绞痛比联合西药使用时不良反应发生率低;在联合西药治疗时更应注意合理使用,减少不良反应的发生。
Objective: To investigate the occurrence patterns and features of adverse events caused by CSDP (Compound Danshen drop pill) alone or combined with western medicine in treatment of angina pectoris, so as to provide some clinical experience for rational drug use of CSDP. Methods: Retrospective analysis was conducted on the complete information of 1359 cases of angina pectoris patients treated in our hospital from January 2010 to January 2016, including 658 cases of CSDP monotherapy as well as 701 cases of CSDP in combination with other western medicine, and the adverse reactions in the two groups of patients were also analyzed. Results: 27 adverse events were reported in the 658 patients with CSDP monotherapy (the occurrence rate of adverse reaction is 4.10%),whereas 61 patients out of 701 patients in the combined group experienced adverse reactions and the reporting rate was 8.70% (61/701). There was no significant correlation between the gender, age, drug dosage of patients and the occurrence of adverse reactions in the monotherapy group. In the combination group, the skin reaction of the patients with combined use of cinepazide maleate was the most serious, and the systemic reaction was the most serious in patients with combined use of isosorbide mononitrate. The blood system and anaphylactic shock were the most serious in patients with combined use of alprostadil. The incidence of adverse reactions was significantly lower in CSDP monotherapy group than in combination group (χ2=11.85, P<0.05). There was no significant difference between the two groups in occurrence of anaphylactic shock, skin reaction, hematologic reaction, and digestive system reaction, but there was significant difference between the two groups (χ2=4.06, P<0.05) in the systemic response. Conclusion: The adverse reaction rate was lower when CSDP was used alone as compared to combined use with western medicine in treatment of angina pectoris. Therefore, special attention should be paid to rational drug use in combination with western medicine so as to reduce the occurrence of adverse reactions.
[1] 孙宏慧,周和,黎丽芸,等. 复方丹参滴丸在社区冠心病患者康复中的价值[J]. 重庆医学,2014,11(14):1382-1384.
[2] 徐芳琪. 复方丹参滴丸联合阿司匹林治疗冠心病的临床疗效观察[J]. 中外医疗,2013,5(10):117-118.
[3] 林淑梅,赵丽荣,秦玲,等. 生脉注射液与复方丹参注射液治疗冠心病心纹痛有效性及安全性的Meta分析[J].中国中医急症,2011,20(9):1446-1448.
[4] 周艺红. 麝香保心丸与丹参滴丸辅助治疗冠心病87例[J]. 中国社区医师:医学专业,2012,14(15):240-242.
[5] 王晔明. 临床应用复方丹参注射液不良反应[J]. 中国伤残医学,2014,22(5):112-113.
[6] 曾宪友. 复方丹参滴丸联合舒血宁治疗冠心病心绞痛的临床观察[J]. 医学理论与实践,2012,25(18):2198-2200.
[7] 金荣泉,唐晓清. 复方丹参制剂的临床应用及不良反应研究概况[J]. 中国现代应用药学,2005,22(23):838-839.
[8] 李伟珍. 复方丹参滴丸引发出血3例的临床观察[J]. 中国民族民间医药,2013,22(16):92,96.
[9] 林军,陈先养,王仲芳. 复方丹参滴丸治疗冠心病心绞痛临床观察[J]. 实用中医药杂志,2012,28(7):549-552.
[10] 胡利民,樊官伟,高秀梅,等. 天然冰片、合成冰片对大鼠胃黏膜屏障影响的比较[J]. 天津中医学院学报,2005,24(3):123-125.
[11] 许丙汉. 复方丹参滴丸治疗冠心病心绞痛疗效的观察[J]. 现代医药卫生,2009,25(4):528-530.
[12] 王雪清. 单硝酸异山梨酯缓释片联合复方丹参滴丸治疗老年不稳定型心绞痛临床疗效及安全性分析[J]. 实用心脑肺血管病杂志,2014,22(6):50-51.
[13] 贺志明. 复方丹参滴丸治疗老年冠心病心绞痛77例临床疗效分析[J]. 中国继续医学教育,2015,(4):249-250.
[14] 钟忆周,刘俊,王建英. 复方丹参滴丸引起糜烂性胃炎2例[J]. 药物流行病学杂志,2006,15(5):316-318.
[15] 保明恒. 应用复方丹参滴丸与硝酸甘油治疗血液透析并发心绞痛的效果分析[J]. 当代医药论丛,2015,(4):235-236.
[16] 赵红香. 复方丹参滴丸治疗冠心病心绞痛的可行性分析[J]. 大家健康(中旬版),2015,(1):133-133.
[17] 傅薇,杨昆. 复方丹参滴丸联合厄贝沙坦氢氯噻嗪片治疗老年性原发性高血压的临床观察[J]. 中国老年保健医学杂志,2012,10(6):40-41.
[18] 郭卫红. 波立维联合复方丹参滴丸治疗不稳定型心绞痛疗效观察[J]. 中国药物经济学,2014,(3):90-95.
[19] 李素芬,迟玉娥,孙江波,等. 复方丹参滴丸及运动法联合西药治疗老年性心绞痛随机平行对照研究[J]. 实用中医内科杂志,2013,27(9):110-111.
[20] 陈新. 复方丹参滴丸治疗不稳定性心绞痛的疗效及其对血清C反应蛋白的影响J]. 实用心脑肺血管病杂志,2011,19(8):1374-1375.