温阳化饮养心方对慢性心力衰竭合并利尿剂抵抗患者中医证候的影响及疗效观察  

Effects and Efficacy of Wenyang Huayin Yangxin Prescription on the Traditional Chinese Medicine Syndromes of Patients With Chronic Heart Failure Combined With Diuretic Resistance

作　　者：吴佳莉 肖丹[2] 詹洮 袁艺[1] 詹云[1] 刘洪[2] WU Jiali;XIAO Dan;ZHAN Tao;YUAN Yi;ZHAN Yun;LIU Hong(Department of Chinese Medicine/Integrative Medicine,Yibin Second People's Hospital/West China Hospital of Sichuan University Yibin Hospital,Yibin 644000,China;Division of Surgery,Institute of Integrated Traditional Chinese and Western Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]宜宾市第二人民医院·四川大学华西医院宜宾医院中医科/中西医结合科,宜宾644000 [2]四川大学华西医院中西医结合外科医疗单元,成都610041

出　　处：《四川大学学报(医学版)》2025年第1期94-101,共8页Journal of Sichuan University(Medical Sciences)

基　　金：四川省中医药管理局科技计划项目(No.2021MS329);宜宾市科技计划项目(No.2023ZYY024)资助。

摘　　要：目的本研究通过应用温阳化饮养心方对慢性心力衰竭合并利尿剂抵抗患者进行中医证候研究,并对其进行疗效观察。方法将68例慢性心力衰竭合并利尿剂抵抗的阳气亏虚血瘀证兼痰饮患者随机分为对照组和观察组,对照组在西医基础治疗上予以静脉泵入呋塞米(≥80 mg/d),观察组则以低剂量呋塞米(<80 mg/d)静脉泵入加自拟方温阳化饮养心方(黄芪30 g,茯苓15 g,白术15 g,川芎15 g,淡附片10 g,桂枝10 g,泽泻10 g,知母10 g),以利尿剂抵抗量化指标为主要结局指标,其次比较两组在中医证候、心功能相关指标、终点事件发生率、再入院率之间的差异。结果治疗2周后观察组滤过钠排泄分数(filtration sodium excretion fraction,FENa)为(0.18±0.04)%,对照组FENa为(0.16±0.03)%,差异有统计学意义(P=0.037),观察组24 h尿量、尿Na^(+)/K^(+)均较治疗前升高,且高于对照组(P<0.05);两组患者间24 h尿量、尿钠、FENa、尿Na^(+)/K^(+)治疗变化值的差异均有统计学意义(P<0.05)。中医证候积分经治疗2周后均有降低,观察组低于对照组(P<0.001),两组患者间中医证候积分治疗变化值的差异有统计学意义(P<0.001)。观察组在治疗2周后,心悸、气短、面肢浮肿、自汗、胸闷(痛)、气喘和尿少相对治疗前有改善(P<0.05),而对照组仅面肢浮肿、气喘和尿少相对治疗前有改善(P<0.05)。除外治疗后2周的气喘证候,观察组自汗、胸闷(痛)、气喘(随访24周)和尿少在治疗后不同时点均优于对照组(P<0.05)。治疗2周后观察组所测心输出量(cardiac output,CO)、每分钟搏出量(stroke volume,SV)均优于对照组(P<0.05)。两组患者间N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左室射血分数(left ventricular ejection fraction,LVEF)、SV、CO治疗变化值的差异均有统计学意义(P<0.05)。随访24周后,两组终点事件发生率及再住院率的差异均无统计学意义。结论温阳化�Objective To study the traditional Chinese medicine(TCM)syndromes of patients with chronic heart failure(CHF)combined with diuretic resistance by using the Wenyang Huayin Yangxin Prescription,and to observe its therapeutic efficacy.Methods A total of 68 CHF patients complicated with diuretic resistance and who had Yangqi deficiency and presenting blood stasis syndrome combined with Tanyin were randomly assigned to a control group and an observation group.The control group was given intravenous furosemide(≥80 mg/d)via infusion pump in addition to standard Western medical treatment,while the observation group was given intravenous furosemide(<80 mg/d)via infusion pump along with the Wenyang Huayin Yangxin Prescription(30 g Astragalus,15 g Poria,15 g Baizhu,15 g Chuanxiong,10 g Danfu tablet,10 g Cassia,10 g Alisma,and 10 g Zhimu).The quantitative index of diuretic resistance was used as the primary outcome measure.In addition,the differences between the two groups in TCM syndromes,cardiac function-related indicators,incidence of endpoint events,and readmission rate were compared.Results After 2 weeks of treatment,the filtration sodium excretion fraction(FENa)in the observation group was(0.18±0.04)%,while that of the control group was(0.16±0.03)%,showing a statistically significant difference(P=0.037).The 24-hour urine volume and urine Na^(+)/K^(+)ratio in the observation group increased significantly from baseline levels and were higher than those in the control group(P<0.05).The differences in the changes of 24-hour urine volume,urine sodium,FENa,and urine Na^(+)/K^(+)ratio between the two groups were statistically significant(P<0.05).The TCM syndrome scores decreased in both groups after 2 weeks of treatment,with the observation group showing a significantly greater reduction compared with the control group(P<0.001).The differences in the changes of TCM syndrome scores between the two groups were statistically significant(P<0.001).After 2 weeks of treatment,the observation group showed significant improvements

关 键 词：温阳化饮养心方 利尿剂抵抗 中医证候 疗效观察 

分 类 号：R259[医药卫生—中西医结合]