参蛤散辅助治疗慢性心力衰竭心肾阳虚证36例临床观察  

Clinical Observation on the Adjunctive Therapy with Shenge Powder (参蛤散) Treating 36 Cases of Chronic Heart Failure of Heart and Kidney Yang Deficiency Syndrome

作　　者：乔思雨 李广浩[1] 丁林委 张娜[1] 许轶君[1] 张帅[1] 王佑华[1] 苑素云[1] 魏易洪[1] 王雲 陈鸿莉 丙巴 沈琳[1] QIAO Siyu;LI Guanghao;DING Linwei;ZHANG Na;XU Yijun;ZHANG Shuai;WANG Youhua;YUAN Suyun;WEI Yihong;WANG Yun;CHEN Hongli;BING ba;SHEN Lin(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine;Shanghai University of Traditional Chinese Medicine)

机构地区：[1]上海中医药大学附属龙华医院,上海市 [2]上海中医药大学

出　　处：《中医杂志》2020年第17期1536-1540,共5页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81873264、81804010);上海市科学技术委员会科研计划(16401971800);上海市卫生局中医药科研基金(2012L036A);上海中医药大学第十批大学生创新活动计划项目(2017SHUTCM138)。

摘　　要：目的观察参蛤散治疗慢性心力衰竭心肾阳虚证患者的临床疗效。方法选取慢性心力衰竭心肾阳虚证患者72例,随机分为治疗组和对照组,每组36例。对照组给予西医基础治疗,治疗组在西医基础治疗的同时联合参蛤散每次1袋,每日3次口服,疗程均为12周。对两组患者在治疗前后进行心功能分级、中医证候积分、6分钟步行距离、Lee氏心衰评分及明尼苏达心衰生活质量量表(MLHFQ)评分的评估,并测定左室射血分数(LVEF)、心搏量(SV)、血清N末端B型利钠肽原(NT-proBNP)水平。结果治疗组患者心功能疗效、中医证候疗效、Lee氏心衰评分疗效的总有效率分别为94.4%、97.2%、94.4%,对照组分别为72.2%、66.7%、77.8%,治疗组明显高于对照组(P<0.05)。两组患者治疗后MLHFQ评分及血清NT-proBNP水平较治疗前明显降低(P<0.05或P<0.01),6分钟步行距离及LVEF值、SV水平较治疗前明显提高(P<0.05或P<0.01)。治疗组MLHFQ评分及血清NT-proBNP水平明显低于对照组,6分钟步行距离、LVEF、SV水平高于对照组(P<0.05或P<0.01)。结论参蛤散联合西医基础治疗可有效改善慢性心力衰竭心肾阳虚证患者的心功能与临床症状,其作用机制可能与提高心室收缩功能、抑制血清NT-proBNP水平相关。Objective To observe the clinical effects of Shenge Powder(参蛤散) on the patients of chronic heart failure with heart and kidney yang deficiency syndrome. Methods A total of 72 cases were collected and randomly divided into a treatment group and a control group with 36 cases in each group. The control group was given conventional western medicine, while the treatment group was given Shenge Powder in addition to western medicine. The course of the treatment was 12 weeks. The heart function level, traditional Chinese medicine(TCM) syndrome score, 6 minutes walking test(6 MWT), Lee′s heart failure score and Minnesota Living with Heart Failure Questionnaire(MLHFQ) were evaluated before and after treatment, left ventricular ejection fraction(LVEF), stroke volume(SV), serum N-terminal pro-B-type natriuretic peptide(NT-proBNP) level were determined. Results The total effective rates of heart function, TCM syndrome, Lee′s heart failure score of patients in the treatment group were 94.4%, 97.2%, and 94.4%, respectively, while those of the control group were 72.2%, 66.7%, and 77.8% respectively. The treatment group was significantly superior to the control group(P<0.05). After treatment, the MLHFQ score and serum NT-proBNP level of both groups were significantly lower than those before treatment(P<0.05 or P<0.01), and the 6-minute walking distance, LVEF value and SV level were significantly higher than those before treatment(P<0.05 or P<0.01). Compared with the control group, the MLHFQ score and serum NT-proBNP level of the treatment group were significantly lower, and the 6-minute walking distance, LVEF and SV levels were higher(P<0.05 or P<0.01). Conclusion Shenge Powder combined with conventional western medicine can effectively improve heart failure and symptoms of patients of chronic heart failure with heart and kidney yang deficiency syndrome. Its mechanism may be related to improving ventricular contractility and inhibiting serum NT-proBNP level.

关 键 词：慢性心力衰竭 参蛤散 心肾阳虚证 心功能 6分钟步行距离 N末端B型利钠肽原 

分 类 号：R541.6[医药卫生—心血管疾病]