理气化痰祛瘀法对慢性心力衰竭气虚血瘀型患者心脏康复的观察  

Effect of Method of Regulating Qi to Dissipate Blood Stasis and Phlegm on Cardiac Rehabilitation in Patients with Qi Deficiency and Blood Stasis Type Chronic Heart Failure

作　　者：牟海萍[1] 刘婷[1] 马宏博[2] MOU Hal-ping;LIU Ting;MA Hong-bo(Ji'nan Huaiyin People's Hospital,Ji'nan 250021,China;Shandong Provincial Hospital,Ji'nan 250021,China)

机构地区：[1]济南市槐荫人民医院,济南250021 [2]山东省立医院,济南250021

出　　处：《中国实验方剂学杂志》2019年第3期131-136,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：济南市卫生和计划生育委员会科技发展计划项目(2016-2-14)

摘　　要：目的:观察理气化痰祛瘀法对慢性心力衰竭(CHF)气虚血瘀证患者心衰程度、心室重构和疾病进展的影响。方法:将134例符合CHF患者随机分为对照组和观察组各62例。对照组口服螺内酯片,20 mg/次,1次/d;贝那普利片,20 mg/次,1次/d;比索洛尔片,10 mg/次,1次/d,口服;并根据情况加服地高辛片。观察组在对照组治疗的基础上,加服丹参饮合血府逐瘀汤加减,1剂/d。两组疗程均为连续治疗3个月。进行治疗前后Lee氏心衰评分,纽约心脏协会(NYHA)心功能分级,6 min步行试验(6 MWT),气虚血瘀证评分和明尼苏达心衰生活质量调查表(MLHFQ)评价;行超声心动图检查,记录左室射血分数(LVEF),室间隔厚度(IVSd),左室心肌质量指数(LVMI),左室收缩末期内径(LVEDs),左室舒张末期内径(LVEDd);检测治疗前后基质金属蛋白酶-9(MMP-9),基质金属蛋白酶抑制因子-1(TIMP-1),转化生长因子(TGF)-β1,N末端B型利钠肽原(NT-proBNP),半乳糖凝集素3及和肽素水平。结果:经Ridit分析,治疗后观察组心功能疗效优于对照组(P<0. 05),纽约心脏病协会(NYHA)心功能分级轻于对照组(P<0. 05);观察组LVEDd,LVEDs和LVMI均低于对照组,LVEF高于对照组(P<0. 05),治疗后两组患者IVSd组间比较,无统计学差异;观察组患者Lee氏心衰评分,气虚血瘀证评分和MLHFQ评分均低于对照组,6 min步行距离多于对照组(P<0. 01);观察组血清MMP-9,TGF-β1,NT-proBNP,半乳糖凝集素3及和肽素水平均低于对照组,TIMP-1水平高于对照组(P<0. 01)。结论:在常规西医治疗的基础上,加服丹参饮合血府逐瘀汤加减治疗气虚血瘀型CHF患者,提高了患者的运动耐量,减轻了心衰症状和心衰程度,提高了患者的生活质量,并能抑制心室重构,促进了心脏康复,延缓病情进展。Objective: To observe effect of method of regulating Qi to dissipate blood stasis and phlegm on degree of heart failure,ventricular remodeling,disease progression in patients with Qi deficiency and blood stasis type chronic heart failure( CHF). Method: One hundred and thirty-four patients with CHF were randomly divided into control group( 62 cases) and observation group( 62 cases) by random number table. The patients in control group got spironolactone tablets,20 mg/time and qd. Benazepril,20 mg/time and qd. Bisoprolol,10 mg/time and qd. And digaoxin tablets if necessary. Based on the treatment in control group,patients in observation group additionally received Danshenyin and Xuefu Zhuyutang,1 dose/day. The treatment course was 3 months in both groups. Before and after treatment, scores of Lee heart failure score were graded, cardiac function classification of the New York Heart Association( NYHA),6 mins' walking test( 6 MWT),scores of Qi deficiency and blood stasis and Minnesota living with heart failure questionnaire( MLHFQ) were evaluated.Echocardiography,left ventricular ejection fraction( LVEF),Left ventricular end-diastolic diameter( LVEDd),left ventricular end-stolic diameter( LVEDs),interventricular septum thickness at end-diastole( IVSd) and left ventricular myocardial mass index( LVMI) were recorded. Levels of matrix metalloprotein-9( MMP-9),tissue inhibitor of matrix metalloprotease-1( TIMP-1),transforming growth factor-β1( TGF-β1),N-terminal pro-B-type na-triuretic peptide( NT-proBNP),galectin-3 and copeptin were detected. Result: Ridit analysis showed that after treatment,effect on cardiac function in observation group was better than that in control group( P< 0. 05).Classification of cardiac function of NYHA was lower than that in control group( P< 0. 05). The LVEDd,LVEDs and LVMI in observation group were all less than those in control group( P< 0. 05),while LVEF was higher than that in control group( P< 0. 05). There was no statistically significant difference in IVSd between two groups.Scores

关 键 词：慢性心力衰竭 丹参饮 血府逐瘀汤 心室重构 生活质量 疾病进展 心脏康复 

分 类 号：R25[医药卫生—中医内科学] R256[医药卫生—中医学]