加味归附五苓汤联合米力农治疗慢性肺心病合并心力衰竭疗效观察及对心功能的影响  

Clinical observation on Jiawei Guifu Wuling Decoction combined with milrinone in treatment of chronic pulmonary heart disease complicated with heart failure and its effects on cardiac function

作　　者：徐倩 聂伟 邵贵峰 梅志颖 许晴 XU Qian;NIE Wei;SHAO Gui-feng;MEI Zhi-ying;XU Qing(Huaibei Hospital of TCM,Huaibei 235000)

机构地区：[1]安徽省淮北市中医医院,安徽淮北235000

出　　处：《湖北中医药大学学报》2024年第3期26-29,共4页Journal of Hubei University of Chinese Medicine

基　　金：安徽省卫生健康委员会科研项目(项目编号:AHWJ2021b044)。

摘　　要：目的观察归附五苓汤加味联合米力农治疗慢性肺心病合并心力衰竭临床疗效及对心功能、N末端脑钠前体(NT-proBNP)、可溶性致癌抑制因子2(sST2)、内皮缩血管肽-1(ET-1)标志物的影响。方法将我院慢性肺心病合并心力衰竭患者90例随机分为对照组与观察组各45例。对照组以西医常规治疗联合米力农治疗。观察组在对照组治疗基础上给予归附五苓汤加味治疗。比较两组临床疗效,治疗前后中医证候积分、血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、二氧化碳分压(PaCO_(2))、左室舒张末期内径(LVEDD)、收缩末期内径(LVESD)、射血分数(LVEF)及NT-proBNP、s ST2、ET-1含量变化。结果治疗后,观察组总有效率高于对照组(P<0.05);两组心悸、气短乏力、畏寒肢冷、肢体浮肿等中医证候积分、Pa CO_(2)、LVEDD、LVESD、NT-proBNP、sST2、ET-1均低于治疗前,PaO_(2)、SaO_(2)、LVEF均高于治疗前(P<0.05);观察组心悸、气短乏力、畏寒肢冷、肢体浮肿等中医证候积分、PaCO_(2)、LVEDD、LVESD、NT-proBNP、s ST2、ET-1均低于对照组,PaO_(2)、SaO_(2)、LVEF均高于对照组(P<0.05)。结论归附五苓汤加味联合米力农可有效缓解慢性肺心病心力衰竭患者临床症状,改善心功能,降低血清NT-proBNP、s ST2、ET-1等标志物水平,治疗效果满意。Objective To observe the clinical therapeutic effect of modified Guifu Wuling Decoction combined with milrinone on chronic pulmonale heart disease complicated with heart failure and its effects on cardiopulmonary function and related biomarkers.Methods 90 patients with chronic pulmonary heart disease complicated with heart failure were randomly divided into control group and observation group,with 45 cases in each group.Control group was treated milrinone combined with conventional Western medical treatment;observation group was treated with modified Wuling Decoction on the basis of control group.The clinical efficacy of the two groups was compared,and the changes in TCM pattern score,partial pressure of oxygen(PaO_(2)),blood oxygen saturation(SaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),left ventricular end-diastolic diameter(LVEDD),end-systolic diameter(LVESD),ejection fraction(LVEF)and the contents of NT-proBNP,sST2 and ET-1 were compared before and after treatment.Results After treatment,the total effective rate of observation group was higher than that of control group(P<0.05);the TCM syndrome scores of palpitations,shortness of breath and fatigue,chills and limb edema,PaCO_(2),LVEDD,LVESD,NT-proBNP,sST2 and ET-1 levels in both groups were lower than those before treatment,and were lower in treatment group than control group;PaO_(2),SaO_(2),and LVEF levels were higher than those before treatment(P<0.05),and were higher in control group than control group(P<0.05).Conclusion Modified Guifu Wuling Decoction combined with milrinone can effectively alleviate the clinical symptoms of patients with chronic pulmonary heart disease and heart failure,improve cardiopulmonary function,lower the levels of serum NT-proBNP,sST2,ET-1 and other markers,and the treatment effect is satisfactory.

关 键 词：肺心病 心力衰竭 心肾阳虚证 归附五苓汤 米力农 

分 类 号：R256.21[医药卫生—中医内科学]