四逆加黄连方结合西医常规疗法治疗慢性心力衰竭气虚血瘀证临床研究  

Clinical study of Sini-Jia-Huanglian Decoction combined with conventional western medicine therapy in the treatment of chronic heart failure with qi deficiency and blood stasis syndrome

作　　者：李玉明[1] 张子明[2] 杨向红[1] 宋玉勤[1] 李迎杰[1] 单继广 吕晓霞 Li Yuming;Zhang Ziming;Yang Xianghong;Song Yuqin;Li Yingjie;Shan Jiguang;Lyu Xiaoxia(Department of Internal Medicine-Cardiovascular,Handan Mingren Hospital,Handan 056001,China;Department of Encephalopathy,Handan Mingren Hospital,Handan 056001,China;Department of Functional,Handan Mingren Hospital,Handan 056001,China;Department of Emergency,Handan Mingren Hospital,Handan 056001,China)

机构地区：[1]河北省邯郸明仁医院心内科,056001 [2]河北省邯郸明仁医院脑病科,056001 [3]河北省邯郸明仁医院功能科,056001 [4]河北省邯郸明仁医院急诊科,056001

出　　处：《国际中医中药杂志》2020年第11期1064-1068,共5页International Journal of Traditional Chinese Medicine

摘　　要：目的评价四逆加黄连方治疗慢性心力衰竭(chronic heart failure, CHF)气虚血瘀证的临床疗效。方法将符合入选标准的2018年1月-2019年6月邯郸明仁医院CHF气虚血瘀证患者100例按随机数字表法分为2组,每组50例。对照组采用西医常规疗法治疗,治疗组在对照组基础上加服四逆加黄连方治疗,2组均治疗30 d。分别于治疗前后进行中医证候评分,采用放射免疫法检测N末端B型利钠肽原(N-terminal-pro-B-type natriuretic peptide, NT-proBNP)水平,采用ELISA法检测和肽素、半乳糖凝集素3(galectin 3, Gal-3)水平,采用6 min步行试验进行运动耐量检测,评价临床疗效。结果治疗组总有效率为92.0%(46/50)、对照组为76.0%(38/50),2组比较差异有统计学意义(χ^2=4.762,P=0.029)。治疗组治疗后气短、心悸、呼吸困难、头晕、心胸疼痛评分及总分均低于对照组(t值分别为4.257、8.493、8.211、4.481、5.500、6.977,P值均<0.01)。治疗后,治疗组血浆NT-proBNP[(2 349.61±683.50)ng/L比(3 026.27±714.35)ng/L,t=4.840]、和肽素[(12.16±3.43)ng/L比(17.52±3.98)ng/L,t=7.214]、Gal-3[(3.01±0.82)μg/L比(3.94±0.93)μg/L,t=5.304]水平均低于对照组(P<0.01),6 min步行距离[(450.66±79.25)m比(384.49±70.16)m,t=4.421]高于对照组(P<0.01)。结论四逆加黄连方可明显改善CHF气虚血瘀证患者的心功能及临床症状,提高临床疗效。Objective To evaluate the clinical efficacy of Sini-Jia-Huanglian Decoction on chronic heart failure(CHF)with qi deficiency and blood stasis syndrome.Methods A total of 100 patients with CHF and qi deficiency and blood stasis syndrome in Handan Mingren hospital from January 2018 to June 2019 who met the inclusion criteria were divided into two groups according to the random number table method,50 cases in each group.The control group was treated with conventional western medicine therapy,and the treatment group was treated with Sini-Jia-Huanglian Decoction on the basis of the control group.Both groups were treated for 30 days.TCM syndrome score was performed before and after treatment.The level of N-terminal-pro-B-type natriuretic peptide(NT-proBNP)was detected by radioimmunoassay.The levels of peptide and galectin 3(Gal-3)were detected by ELISA.The exercise tolerance was measured by 6-minute walking test,the clinical efficacy was tevaluated.Results The total effective rate of the treatment group was 92.0%(46/50),and the control group was 76.0%(38/50),there was significant difference between the two groups(χ^2=4.762,P=0.029).After treatment,the scores of shortness of breath,palpitation,dyspnea,dizziness,chest pain and total scores in the treatment group were significantly lower than those in the control group(t values were 4.257,8.493,8.211,4.481,5.500,6.977,respectively,all Ps<0.01).After treatment,the levels of NT-proBNP(2349.61±683.50 ng/L vs.3026.27±714.35 ng/L,t=4.840),and peptide(12.16±3.43 ng/L vs.17.52±3.98 ng/L,t=7.214)and Gal-3(3.01±0.82 mg/L vs.3.94±0.93 mg/L,t=5.304)in the treatment group were significantly lower than those in the control group(P<0.01),and the walking distance of 6 minutes(450.66±79.25 m vs.384.49±70.16 m,t=4.421)was significantly longer than that of the control group(P<0.01).Conclusions The Sini-Jia-Huanglian Decoction can improve the heart function and clinical symptoms of CHF patients with qi deficiency and blood stasis syndrome,and improve the clinical efficacy.

关 键 词：心力衰竭 中医病因证候 气虚血瘀 四逆加黄连方 中西医结合疗法 

分 类 号：R541.6[医药卫生—心血管疾病]