宣导三焦、泻肺豁痰、活血利水法治疗慢性充血性心力衰竭的疗效观察  

A clinical study of using Xuandao Sanjiao, Xiefei Huotan and Huoxue Lishui traditional Chinese medicine methods for treatment of patients with chronic congestive heart failure

作　　者：王琴[1] 杨祥坤[2] 

机构地区：[1]杭州市第三人民医院老年科,浙江杭州310009 [2]武汉市中医医院心内科,湖北武汉430010

出　　处：《中国中西医结合急救杂志》2015年第5期492-495,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省杭州市科技局科研项目（20140633B16）

摘　　要：目的 观察宣导三焦、泻肺豁痰、活血利水法治疗慢性充血性心力衰竭（CHF）的临床疗效.方法 将60例辨证属三焦壅塞、痰瘀水停证的心功能Ⅲ～Ⅳ级CHF患者按随机数字表法分为中西医结合治疗组和对照组,每组30例.对照组采用西药常规治疗;中西医结合治疗组在常规治疗基础上加用宣导三焦、泻肺 豁痰、活血利水方药宣导泻肺饮（组成：葶苈子20 g,莱菔子15 g,泽泻15 g,桑白皮15 g,杏仁10 g,川厚朴10 g, 猪苓30 g,陈皮10 g,当归12 g,川木通6 g等）100 mL,每日2次;两组疗程均为8周.观察两组治疗前后心功能疗效、中医症状积分疗效,以及两组治疗前后左室射血分数（LVEF）、左室短轴缩短率（LVFS）,6 min步行试验（6MWT）,血浆N末端B型钠尿肽前体（NT-proBNP）、糖类抗原125（CA125）及生长分化因子-15（GDF-15） 水平,并评价治疗过程中药的安全性和不良反应.结果 治疗后中西医结合治疗组心功能疗效、中医症状积分疗效均明显高于对照组〔心功能疗效：86.7%（26/30）比63.3%（19/30）,中医症状积分疗效：83.3%（25/30）比60.0%（18/30）,均P〈0.05〕.两组治疗后LVEF、LVFS、6MWT均较治疗前明显增高,NT-proBNP、CA125及GDF-15水平均较治疗前明显降低,且中西医结合治疗组改善程度优于对照组〔LVEF：0.486±0.073比0.458±0.071;LVFS：（25.0±3.5）%比（23.8±3.0）%;6MWT（m）：310.7±42.6比298.4±38.2;NT-proBNP（ng/L）：345.6±76.2比426.7±83.9;GDF-15（ng/L）：923.3±187.3比1 026.7±201.6;CA125（U/L）：58.72±7.62比65.56±9.16;均P〈0.05〕.两组均未出现低血压,均未见肝肾功能损害或加重.结论 宣导三焦、泻肺豁痰、活血利水法可改善三焦壅塞,痰瘀水停型CHF患者的心功能,改善中医症状积分,增加LVEF、LVFS及6MWT,降低血浆GDF-15、CA125及NT-proBNP水平.Objective To observe the clinical effect of Xuandao Sanjiao, Xiefei Huotan and Huoxue Lishui traditional Chinese medicine （TCM） methods for treatment of patients with chronic congestive heart failure （CHF）. Methods Sixty patients with CHF and cardiac function Ⅲ or Ⅳ （NYHA Ⅲ or Ⅳ） accompanied by TCM syndrome of Sanjiao obstruction, phlegm and blood stasis and fluid-retention were randomly divided into two groups： combined TCM and western medicine treatment group and control group, 30 cases in each group. The patients in control group were treated by western medicine; the patients in TCM and western medicine treatment group were treated by conventional western medicine and additionally Xuedao Xiefei decoction including drugs for Xuandao Sanjiao, Xiefei Huotan, Huoxue Lishui （ingredients： Semen Lepidii 20 g, Semen Raphani 15 g, Rhizoma Alismatis 15 g, Cortex Mori 15 g, Armeniacae Semen 10 g, magnolia bark 10 g, Polyporus 30 g, Pericarpium Citri Reticulatae 10 g, Radix Angelicae Sinensis 12 g, Clematidis Amandii 6 g, etc） 100 mL, 2 times a day. The therapeutic course was 8 weeks in both groups. Heart function, TCM symptom scores, and left ventricular ejection fraction （LVEF）, left ventricular fractional shortening rate （LVFS）, 6-minute walking test （6MWT）, plasma levels of N terminal-B type natriuretic peptide precursor （NT-proBNP）, carbohydrate antigen 125 （CA125） and growth differentiation factor-15 （GDF-15） were measured in both groups before and after treatment. And the safety and adverse reactions of drugs were evaluated in the course of treatment. Results After treatment, the heart function and TCM symptom scores in TCM and western medicine treatment group were significantly better or higher than those in the control group [heart function： 86.7% （26/30） vs. 63.3% （19/30）, TCM symptoms scores： 83.3% （25/30） vs. 60.0% （18/30）, bothP 〈 0.05]. Compared with those before treatment in both groups, LVEF, LVFS, and 6MWT after treatment were signi

关 键 词：充血性心力衰竭 慢性 中医证候 宣导三焦 泻肺豁痰 活血利水 三焦壅塞 痰瘀水停 

分 类 号：R541.61[医药卫生—心血管疾病]