自拟益气活血化瘀方结合西医常规疗法治疗慢性心力衰竭合并心房颤动气虚血瘀证临床研究  

Clinical study of self-designed Yiqi Huoxue Huayu Decoction combined with western conventional therapy in the treatment of chronic heart failure complicated with atrial fibrillation

作　　者：王丽晓[1] 李晓丽[1] 唐海军[1] 浦强[1] 王婧伟 徐蕾蕾[1] 沈安明[1] Wang Lixiao;Li Xiaoli;Tang Haijun;Pu Qiang;Wang Jingwei;Xu Leilei;Shen Anming(Department of Cardiology,Rugao Hospital of Traditional Chinese Medicine,Rugao 226500,China)

机构地区：[1]如皋市中医院心病科,如皋226500

出　　处：《国际中医中药杂志》2022年第7期749-753,共5页International Journal of Traditional Chinese Medicine

摘　　要：目的观察自拟益气活血化瘀方结合西医常规疗法治疗慢性心力衰竭(CHF)合并心房颤动气虚血瘀证患者的疗效。方法将符合入选标准的2019年1月-2021年6月本院患者100例,采用随机数字表法分为2组,每组50例。对照组给予西医常规疗法,观察组在对照组基础上联合自拟益气活血化瘀方。2组均连续治疗4周。分别于治疗前后进行中医证候评分,采用超声心动图检测仪检测左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)和左室射血分数(LVEF);采用放射免疫法检测血清内皮素-1(ET-1)水平,双抗体夹心ELISA法检测血清MMP-9水平;检测GPT、GOT、尿酸(UA)、SCr水平用于药物安全性评价,记录治疗期间的不良反应,评价临床疗效。结果观察组总有效率为82.0%(41/50)、对照组为62.0%(31/50),2组比较差异有统计学意义(χ^(2)=4.96,P=0.026)。观察组治疗后心悸、气短、神疲乏力、胸胁作痛评分均低于对照组(t值分别为5.28、5.29、5.62、5.42,P值均<0.01)。观察组治疗后LVEDD[(51.23±6.59)mm比(55.65±6.17)mm,t=3.46]、LVESD[(43.10±4.76)mm比(45.99±5.31)mm,t=2.87]低于对照组(P<0.05),LVEF[(50.01±7.6)%比(46.25±6.96)%,t=2.57]高于对照组(P<0.05)。观察组治疗后血清ET-1[(65.79±8.29)μg/L比(79.83±10.08)μg/L,t=7.61]、MMP-9[(175.86±24.81)ng/L比(189.49±26.13)ng/L,t=2.68]水平低于对照组(P<0.01或P<0.05)。2组GPT、GOT、UA、SCr水平组内及组间比较,差异均无统计学意义(P>0.05),治疗期间未出现明显不良反应。结论自拟益气活血化瘀方结合西医常规疗法可有效改善CHF合并心房颤动患者的临床症状及心功能,降低血清ET-1和MMP-9水平,提高临床疗效,且安全性较好。Objective To observe the effects of self-designed Yiqi Huoxue Huayu Decoction on cardiac function and serum endothelin(ET-1)and matrix metalloproteinase-9(MMP-9)levels in patients with chronic heart failure(GHF)complicated with atrial fibrillation.Methods A total of 100 patients with GHF complicated with atrial fibrillation treated in our hospital from January 2019 to June 2021 were selected as the study subjects,and divided into experimental group and control group according to random number table method,with 50 patients in each group.Patients in both groups were given cardiotonic,diuretic,vasodilator and other conventional treatment,and patients in the experimental group added self-designed Yiqi Huoxue Huayu Decoction.TCM syndrome score,left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF),serum ET-1 and MMP-9 levels,clinical efficacy,safety and incidence of adverse reactions were observed and compared between 2 groups before and after treatment.Results The total response rate was 82.0%(41/50)in the observation group and 62.0%(31/50)in the control group,and the difference was statistically significant(χ^(2)=4.96,P=0.026).After treatment,the symptoms scores of palpitation,shortness of breath,fatigue,chest and hypochasm pain in the observation group were significantly significantly lower than those in the control group(t=5.28,5.29,5.62,5.42,P<0.01).After treatment,the LVEDD[(51.23±6.59)mm vs.(55.65±6.17)mm,t=3.46],LVESD[(43.10±4.76)mm vs.(45.99±5.31)mm,t=2.87],serum ET-1[(65.79±8.29)μg/L vs.(79.83±10.08)μg/L,t=7.61],MMP-9[(175.86±24.81)ng/L vs.(189.49±26.13)ng/L,t=2.68]in experimental group were significantly lower than those in the control group(P<0.05),while LVEF[(50.01±7.6)%vs.(46.25±6.96)%,t=2.57]was significantly higher than that of the control group(P<0.05).There were no significant differences in GPT,GOT,UA,SCr levels between both groups before and after treatment(P>0.05).There were no obvious adverse reactions

关 键 词：心力衰竭 心房颤动 自拟益气活血化瘀方 心功能 

分 类 号：R541.6[医药卫生—心血管疾病] R541.75[医药卫生—内科学]