温肾活血汤对老年慢性心衰阳虚血瘀证患者活动耐量的改善  

Wenshen Huoxue Decoction in Ameliorating Activity Tolerance of Patients with Senile Chronic Heart Failure and Yang Blood Stasis

作　　者：石永[1] 刘凡[1] 彭杰[1] 何文锦[1] 

机构地区：[1]重庆市中医院,重庆400011

出　　处：《中国实验方剂学杂志》2017年第9期184-189,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：重庆市科技计划项目(cste2016jcyjAX0010)

摘　　要：目的:探讨温肾活血汤对老年慢性心衰阳虚血瘀证患者活动耐量的改善作用,及对N末端B型利钠肽原(NT-proBNP),和肽素,心肌肌钙蛋白T(CTnT)和血浆糖类抗原125(CA125)水平的影响。方法:将158例患者随机分为对照组和观察组。对照组在调整生活方式的基础上口服复方卡托普利片,2片/次,3次/d;阿替洛尔片,12.5 mg/次,2次/d;螺内酯片,10 mg/次,1次/d;地高辛片,0.125 mg/次,必要时服用。观察组在对照组治疗的基础上加服温肾活血汤,1剂/d。两组疗程均为16周。活动耐量采用6 min步行试验(6 MWT),于治疗前、治疗后8周和16周各评价1次;生活质量采用明尼苏达心衰生活质量调查表(MLHFQ)和简明健康问卷(SF-36),治疗前后各评价1次;进行治疗前后Lee氏心衰评分,NYHA心功能分级和中医证候评分;采用超声心动图记录治疗前后左室射血分数(LVEF),心输出量(CO),左室收缩末内径(LVESD)和舒张早期血流峰值(E)和舒张晚期血流峰值(A)之比(E/A),检测治疗前后NT-proBNP,和肽素,CTn T和CA125水平。结果:观察组心功能疗效总有效率为88.73%,高于对照组的71.43%(χ~2=6.631,P<0.05);观察组心衰疗效总有效率为85.92%,高于对照组的67.14%(χ~2=6.929,P<0.01);观察组在治疗后8周和16周,6 min步行距离均多于对照组(P<0.01);观察组SF-36量表各维度评分均较对照组高(P<0.01);治疗后观察组Lee氏心衰,MLHFQ,阳虚血瘀证和NYHA心功能分级评分均低于对照组(P<0.01);治疗后观察组LVEF,CO和E/A均高于对照组(P<0.05,P<0.01);治疗后观察组NT-proBNP,CTnT,CA125和和肽素水平低于对照组(P<0.01)。结论:温肾活血汤治疗老年CHF阳虚血瘀证患者,能减轻心衰症状,改善心功能,并能调节NT-proBNP,CTnT,CA125和和肽素水平,起到提高患者活动耐量和生活质量的作用。Objective： To discuss the effect of Wenshen Huoxue decoction in ameliorating the activity tolerance of patients with senile chronic heart failure and Yang blood stasis, and its impact on levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP）, peptide, cardiac troponin T （CTnT） and plasma carbohydrate antigen 125 （CA125）. Method： One hundred and fifty-eight patients were randomly divided into control group and observation group. Control group adjusted their way of life, and got compound captopril tablets, 2 tablets/time, 3 times/day. Atenolol tablets, 12.5 mg/time, 2 times/day. Spironolactone tablets, 10 mg/time, 1 time/day. And Digoxin tablets when necessary, 0.125 mg/time. In addition to the therapy of control group, patients in observation group were also administered with Wenshen Huoxue decoction, 1 dose/day. The course of treatment for both of the groups was 16 weeks. Before treatment, and at the 8th and 16th week after treatment, activity tolerance was evaluated by 6 MWT, quality of life survey of heart failure in Minnesota （MLHFQ） and concise health questionnaire （SF-36） were used to evaluate the quality of life. Before and after treatment, Lee＇s heart failure score, NYHA cardiac function classification and Chinese medicine syndrome were graded. Left ventricular ejection fraction （LVEF）, cardiac output （CO）, left ventricular end systolic diameter （LVESD）, and ratio of peak early diastolic blood flow （E） and peak late diastolic blood flow （A） （E/A） were recorded by echocardiography. Levels of NT-proBNP, peptide, CTnT and CA125 were detected before and after treatment. Result： The total effect rate of cardiac function in observation group was 88.73%, which was higher than 71.43% in control group （χ2=6.631, P〈0.05）. The total effect rate of heart failure in observation group was 85.92%, which was higher than 67.14% in control group （χ2=6.929, P〈0.01）. At the 8th and 16th week after treatment, 6 minutes walking distance in observation gr

关 键 词：慢性心力衰竭 温肾活血汤 阳虚证 血瘀证 活动耐量 生活质量 

分 类 号：R287[医药卫生—中药学]