舒心饮结合西医常规疗法治疗冠状动脉硬化性心脏病合并慢性心力衰竭的临床观察  

Clinical observation on Shuxin Decoction combined with conventional western medicine in the treatment of coronary atherosclerotic heart disease complicated with chronic heart failure

作　　者：魏娜[1] 汤诺[1] 高继梅 史秀峰[1] 林钟香[1] 邓兵[1] 王佑华[1] 沈琳[1] 郑望[1] WEI Na;TANG Nuo;GAO Jimei;SHI Xiufeng;LIN Zhongxiang;DENG Bing;WANG Youhua;SHEN Lin;ZHENG Wang(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;TCM Hospital of Changxing County,Huzhou 313100,Zhejiang,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]浙江省湖州市长兴县中医院,浙江湖州313100

出　　处：《上海中医药大学学报》2021年第3期17-22,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：上海市科委科研基金项目(14401972500);国家中医药管理局第六批全国老中医药专家学术经验继承工作项目(2017-29)。

摘　　要：目的:评价舒心饮结合西医常规疗法治疗气阴两虚证冠状动脉硬化性心脏病合并慢性心力衰竭的临床疗效。方法:纳入124例气阴两虚证冠状动脉硬化性心脏病合并慢性心力衰竭患者,随机分为对照组61例和治疗组63例。对照组患者给予西医规范治疗,治疗组患者在对照组治疗基础上加用舒心饮口服,观察周期为4周。比较两组患者治疗前后的中医证候总积分及主症积分的变化;评价两组患者的心功能分级和心电图改善疗效;比较两组患者治疗前后的脑钠肽(BNP)水平及6 min步行距离(6MWD);治疗前后采用心脏超声检测患者的射血分数(EF)、每搏输出量(SV)、左心室舒张末期内径(LVEDD);比较两组患者的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果:治疗过程中,对照组剔除3例患者,最终治疗组63例、对照组58例纳入统计分析。(1)治疗后,两组患者的中医证候总积分均较治疗前明显降低(P<0.01),且治疗组患者的积分低于对照组(P<0.01);两组患者的胸闷胸痛、心悸气短、疲倦乏力积分较治疗前均明显降低(P<0.01),且治疗组患者的上述各项症状积分均低于对照组(P<0.05)。(2)治疗后,治疗组患者的心功能分级改善总有效率为84.13%,对照组为72.41%,治疗组的疗效优于对照组(P<0.05);治疗组患者的心电图改善总有效率为80.95%,对照组为60.34%,治疗组的疗效优于对照组(P<0.05)。(3)治疗后,两组患者的BNP水平较治疗前均明显降低(P<0.01),但组间比较差异无统计学意义(P>0.05)。(4)治疗后,两组患者的6MWD较治疗前均明显延长(P<0.01),且治疗组患者的6MWD较对照组亦明显延长(P<0.01)。(5)治疗前后,两组患者的EF、SV、LVEDD比较,差异均无统计学意义(P>0.05)。(6)治疗后,两组患者的HAMA、HAMD评分较治疗前均明显降低(P<0.01),且治疗组患者的HAMD评分低于对照组(P<0.05);治Objective:To evaluate the clinical efficacy of Shuxin Decoction combined with conventional western medicine in the treatment of coronary atherosclerotic heart disease(CHD)complicated with chronic heart failure(CHF)(syndrome of deficiency of both qi and yin).Methods:A total of 124 patients with CHD and CHF(syndrome of deficiency of both qi and yin)were included,and randomly divided into the control group(61 cases)and the treatment group(63 cases).The patients in the control group were treated with conventional western medicine,and the patients in the treatment group were orally treated with Shuxin Decoction based on the treatment for the control group.The observation course was 4 weeks.Before and after treatment,the total score of Chinese medical syndrome and the scores of main symptoms in both groups were compared.After treatment,the improvement effects on cardiac functional grading and electrocardiogram(ECG)were evaluated in both groups.Before and after treatment,the level of brain natriuretic peptide(BNP)and the 6-minute walking distance(6 MWD)in both groups were compared.Before and after treatment,the ejection fraction(EF),stroke volume(SV)and left ventricular end-diastolic dimension(LVEDD)were detected by echocardiography.The scores of Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD)and Minnesota living with heart failure questionnaire(MLHFQ)in both groups were compared.Results:In the course of treatment,3 patients in the control group were excluded,finally 63 cases in the treatment group and 58 cases in the control group were included for statistical analysis.(1)After treatment,the total score of Chinese medical syndrome in both groups was significantly decreased compared with that before treatment(P<0.01),and the score of the treatment group was lower than that of the control group(P<0.01).After treatment,the scores of chest distress and pain,palpitation and short breath,and fatigue in both groups were significantly decreased compared with those before treatment(P<0.01),and the scores of above s

关 键 词：冠状动脉硬化性心脏病 慢性心力衰竭 舒心饮 气阴两虚证 中西医结合 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]