补阳还五汤合葶苈大枣泻肺汤加减结合西医常规疗法治疗慢性心力衰竭气虚血瘀饮停证临床研究  

Clinical study on Buyang-Huanwu Decoction combined with Tingli-Dazao-Xiefei Decoction combined with conventional therapy of western medicine in the treatment of chronic heart failure with qi deficiency and blood stasis

作　　者：张洁[1] 高伟[2] 刘淑敏[1] 张军军[1] 金玫[3] Zhang Jie;Gao Wei;Liu Shumin;Zhang Junjun;Jin Mei(Department of Internal Medicine,Beijing Shijingshan District Hospital of Traditional Chinese Medicine,Beijing 100043,China;Department of Internal Medicine,Chaoyang District Hospital of Traditional Chinese Medicine,Beijing 100020,China;Department of Cardiology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]北京市石景山区中医医院内科,100043 [2]北京市朝阳区中医医院内科,100020 [3]首都医科大学附属北京中医医院心内科,100010

出　　处：《国际中医中药杂志》2021年第7期638-642,共5页International Journal of Traditional Chinese Medicine

基　　金：北京市首都区域特色重点专科项目(京中医政便函﹝2018﹞29号)。

摘　　要：目的评价补阳还五汤合葶苈大枣泻肺汤加减结合西医常规疗法治疗慢性心力衰竭(chronic heart failure,CHF)气虚血瘀饮停证的临床疗效。方法将符合入选标准的2017年11月-2019年11月石景山区中医医院内科CHF患者70例采用随机数字表法分为2组,每组35例。对照组给予CHF西医基础治疗,治疗组在对照组基础上结合补阳还五汤合葶苈大枣泻肺汤加减治疗。2组均治疗2周。分别于治疗前后进行中医证候评分;采用明尼苏达州心功能不全生命质量量表(Minnesota Living with Heart Failure Questionnaire,MLHFQ)评价患者生活质量;采用Lee氏心衰计分法评价症状严重程度;采用ELISA法检测N末端B型利钠肽原(N-terminal pro-B type natriuretic peptide,NT-proBNP),观察治疗期间的不良反应,评价临床疗效。结果治疗组总有效率为91.4%(32/35)、对照组为77.1%(27/35),2组比较差异有统计学意义(χ^(2)=7.050,P=0.014)。治疗后,治疗组血清NT-proBNP[(1725.3±1473.8)ng/L比(2485.7±2164.4)ng/L;U=341.200,P=0.031]水平低于对照组;NT-proBNP下降幅度[(54.3±26.7)%比(35.5±19.8)%;U=4.310,P=0.003]高于对照组。治疗组治疗后中医证候积分及MLHFQ评分均低于对照组(t值分别为3.785、9.925,P值分别为0.031、0.001)。治疗期间,2组均未见明显不良反应。结论在西医规范化治疗基础上结合补阳还五汤合葶苈大枣泻肺汤加减可提高CHF气虚血瘀饮停证患者的临床疗效,降低NT-proBNP水平以促进心肌损伤的修复,改善患者生活质量。Objective To evaluate the clinical efficacy of Buyang-Huanwu Decoction combined with modified Tingli-Dazao-Xiefei Decoction on the basis of conventional western medicine therapy in the treatment of chronic heart failure(CHF)with syndrome of qi deficiency and blood stasis.Methods Seventy patients who met the inclusion criteria from November 2017 to November 2019 in Shijingshan District Hospital of Traditional Chinese Medicine were randomly divided into two groups,35 in each group.The control group was treated with western medicine for chronic heart failure,and the treatment group was treated with Buyang-Huanwu Decoction combined with Tingli-Dazao-Xiefei Decoction on the basis of the control group.Both groups were treated for 2 weeks.The TCM syndrome scores were observed and compared before and after treatment.Minnesota Living with Heart Failure Questionnaire(MLHFQ)was used to evaluate the quality of life of patients.Lee’s Heart Failure Score was used to evaluate the severity of symptoms.The N-terminal pro-B type natriuretic peptide(NT-proBNP)was detected by ELISA.The adverse reactions during treatment were observed and the clinical efficacy was evaluated.Results The total effective rate was 91.4%(32/35)in the treatment group and 77.1%(27/35)in the control group,and the difference was statistically significant(χ^(2)=7.050,P=0.014).After treatment,the serum NT-proBNP in the treatment group[(1725.3±1473.8)ng/L vs.(2485.7±2164.4)ng/L;U=341.200,P=0.031]was significantly lower than that of the control group.The NT-proBNP[(54.3±26.7)%vs.(35.5±19.8)%;U=4.310,P=0.003]was significantly higher than that of the control group.After treatment,the TCM syndrome scores and MLHFQ scores in the treatment group were significantly lower than those in the control group(t=3.785,9.925,P=0.031,0.001).During the treatment,no obvious adverse reactions were observed in both groups.Conclusion On the basis of standardized treatment of Western medicine,Buyang-Huanwu Decoction and Tingli-Dazao-Xiefei Decoction can improve the clinical eff

关 键 词：心力衰竭 气虚血瘀饮停 补阳还五汤 葶苈大枣泻肺汤 中西医结合疗法 

分 类 号：R541.6[医药卫生—心血管疾病]