真武汤加味联合常规西医疗法治疗Ⅰ型心肾综合征心肾阳虚兼水饮内停证临床研究  

Clinical Study on Modified Zhenwu Tang Combined with Routine Western Medicine Therapy for Cardiorenal Syndrome of Type Ⅰwith the Heart-Kidney Yang Deficiency and Internal Retention of Water Syndrome

作　　者：邵兴[1] 童洪杰[1] 邓鸿胜 陈琨[1] 徐晓[1] SHAO Xing;TONG Hongjie;DENG Hongsheng;CHEN Kun;XU Xiao

机构地区：[1]金华市中心医院重症医学科,浙江金华321000

出　　处：《新中医》2020年第14期20-23,共4页New Chinese Medicine

基　　金：浙江省医药卫生科技计划项目(2015KYA230)。

摘　　要：目的:观察真武汤加味联合常规西医疗法治疗Ⅰ型心肾综合征(CRS)心肾阳虚兼水饮内停证的临床疗效。方法:将80例Ⅰ型CRS心肾阳虚兼水饮内停证患者随机分为对照组和观察组各40例,对照组给予利尿剂、正性肌力药物、扩张血管药物、肾素-血管紧张素-醛固酮系统阻滞剂及连续性肾脏替代治疗(CRRT)等常规西医疗法治疗,观察组在对照组基础上服用真武汤加味,2组均连续治疗7 d。比较2组临床疗效,治疗前后心功能指标、肾功能指标,机械通气发生率及病死率。结果:观察组总有效率为87.5%,高于对照组的65.0%(P<0.05)。治疗后,2组肌钙蛋白(TnI)、B型钠尿肽(BNP)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)与治疗前比较均降低,观察组TnI、BNP、LVEDD、LVESD低于对照组(P<0.05);2组左室射血分数(LVEF)与治疗前比较均升高,观察组LVEF高于对照组(P<0.05)。治疗后,2组尿素氮(BUN)、血肌酐(SCr)、血清胱抑素-C (Cys-C)与治疗前比较均降低,观察组SCr、BUN、Cys-C低于对照组(P<0.05);2组24 h尿量与治疗前比较均升高,观察组24 h尿量高于对照组(P<0.05)。治疗后,2组机械通气发生率、病死率比较,差异均无统计学意义(P>0.05)。结论:真武汤加味联合常规西医疗法治疗Ⅰ型心肾综合征心肾阳虚兼水饮内停证,可明显改善患者心、肾功能,减轻临床症状,疗效确定。Objective:To observe the clinical effect of modified Zhenwu tang combined with routine western medicine therapy for Cardiorenal syndrome(CRS) of type Ⅰ with the heart-kidney yang deficiency and internal retention of water syndrome.Methods:A total of 80 cases of CRS patients of typeⅠwith the heart-kidney yang deficiency and internal retention of water syndrome were randomly divided into the control group and the observation group,40 cases in each group. The control group was given routine western medicine therapy, such as diuretic, positive inotropic medicine, vasodilators,renin-angiotensin-aldosterone system blocker, as well as continuous renal replacement therapy(CRRT), and the observation group was additionally given modified Zhenwu tang based on the treatment of the control group. Both groups were continuously treated for seven days. The clinical effect was compared between the two groups;the indexes of the heart function and the kidney function,the incidence of mechanical ventilation and mortality rate before and after treatment were compared between the two groups. Results:The total effective rate was 87.5% in the observation group,higher than that of 65.0% in the control group(P<0.05). After treatment,the indexes of troponin(TnI),B-type natriuretic peptide(BNP),left ventricular end-diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) in the two groups were all decreased when compared with those before treatment, and the four indexes in the observation group were lower than those in the control group(P<0.05). After treatment,the indexes of left ventricular ejection fraction(LVEF) in the two groups were increased when compared with those before treatment,and the index in the observation group was higher than that in the control group(P<0.05). After treatment,the indexes of blood urea nitrogen(BUN),serum creatinine(SCr) and cystatin-C(Cys-C) in the two groups were decreased when compared with those before treatment, and the three indexes in the observation group were lower than those

关 键 词：型心肾综合征 心肾阳虚证 水饮内停证 真武汤 中西医结合疗法 心功能 肾功能 

分 类 号：R541.6[医药卫生—心血管疾病] R692.5[医药卫生—内科学]