益气活血通脉汤联合西药对左心疾病相关性肺动脉高压的疗效及内皮功能的影响  

Therapeutic Efficacy of Yiqi Huoxue Tongmai Decoction Combined with Western Medicine for Pulmonary Hypertension Due to Left Heart Disease and Its Effect on Endothelial Function

作　　者：孙春喜[1] 商丹 刘静[2] 张文川 SUN Chunxi;SHANG Dan;LIU Jing;ZHANG Wenchuan(First Ward of Cardiovascular Department,Shangluo Central Hospital,Shangluo 726000 Shaanxi,China;Dept.of Pharmacy,the 987th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army of China,Baoji 721004 Shaanxi,China;Cardiovascular Department,Xi'an No.9 Hospital,Xi'an 710054 Shaanxi,China)

机构地区：[1]商洛市中心医院心血管内科一病区,陕西商洛726000 [2]中国人民解放军联勤保障部队第九八七医院药剂科,陕西宝鸡721004 [3]西安市第九医院心血管内科,陕西西安710054

出　　处：《广州中医药大学学报》2025年第3期575-582,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：陕西省自然科学基金基础研究计划项目(编号:2021JR324)。

摘　　要：【目的】探究益气活血通脉汤(补阳还五汤为主化裁)联合西药对左心疾病相关性肺动脉高压(PH-LHD)气虚血瘀证患者的疗效及内皮功能的影响。【方法】将2022年3月~2023年12月在商洛市中心医院接受治疗的80例PH-LHD气虚血瘀证患者随机分为研究组和对照组,每组各40例。对照组给予西医常规治疗,研究组在对照组的基础上加用益气活血通脉汤治疗,疗程为3周。观察2组患者干预前后中医证候积分、肺循环指标[平均肺动脉压(mPAP)和肺毛细血管楔压(PCWP)]、心肺运动试验(CPET)指标[峰值心率、峰值收缩压、峰值舒张压、峰值氧耗量(VO2max)、峰值氧脉搏]、血管内皮指标[血清一氧化氮(NO)和内皮素1(ET-1)]及生活质量的变化情况,比较2组患者的临床疗效和不良反应情况。【结果】(1)疗效方面,干预3周后,研究组的总有效率为90.00%(36/40),对照组为72.50%(29/40),组间比较(χ²检验),研究组的疗效明显优于对照组(P<0.05)。(2)中医证候积分方面,干预后,2组患者的主症积分、次症积分及总积分均较干预前降低(P<0.05),且研究组的降低幅度均明显优于对照组(P<0.01)。(3)肺循环指标方面,干预后,2组患者的mPAP、PCWP水平均较干预前降低(P<0.05),且研究组的降低幅度均明显优于对照组(P<0.01)。(4)CPET指标方面,干预后,2组患者的峰值心率、峰值收缩压和峰值舒张压均较干预前降低(P<0.05),VO2max和峰值氧脉搏均较干预前升高(P<0.05),且研究组对峰值心率、峰值收缩压和峰值舒张压的降低幅度及对VO2max和峰值氧脉搏的升高幅度均明显优于对照组(P<0.05或P<0.01)。(5)血管内皮指标方面,干预后,2组患者的血清ET-1水平均较干预前降低(P<0.05),血清NO水平均较干预前升高(P<0.05),且研究组对血清ET-1水平的降低幅度及对血清NO水平的升高幅度均明显优于对照组(P<0.01)。(6)生活质量方面,干预后,2组患者健康调查简表(SF-36)Objective To investigate the therapeutic efficacy of Yiqi Huoxue Tongmai Decoction(a modified priscription derived from Buyang Huanwu Decoction)combined with western medicines in the treatment of patients with pulmonary hypertension due to left heart disease(PH-LHD)of qi deficiency and blood stasis syndrome,and to explore its effect on endothelial function.Methods Eighty patients with PH-LHD of qi deficiency and blood stasis syndrome who were admitted to Shangluo Central Hospital from March 2022 to December 2023 were randomly divided into a study group and a control group,with 40 patients in each group.The control group was given routine treatment with western medicine,and the study group was treated with Yiqi Huoxue Tongmai Decoction on the basis of treatment for the control group,three weeks constituting a course of treatment.Before and after intervention,the two groups of patients were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,pulmonary circulation indicators[mean pulmonary arterial pressure(mPAP)and pulmonary capillary wedge pressure(PCWP)],cardiopulmonary exercise testing(CPET)indicators[peak heart rate,peak systolic blood pressure,peak diastolic blood pressure,maximal oxygen uptake(VO2max),peak oxygen pulse],vascular endothelial function indicators[serum nitric oxide(NO)and endothelin 1(ET-1)]and the scores of quality of life.After treatment,the clinical efficacy and incidence of adverse reactions of the patients between the two groups were compared.Results(1)After three-week of intervention,the total effective rate of the study group was 90.00%(36/40),while that of the control group was 72.50%(29/40),and the comparison between the two groups(tested by chi-square test)showed that the efficacy of the study group was significantly superior to that of the control group(P<0.05).(2)After intervention,the primary symptom scores,secondary symptom scores and total TCM syndrome scores of the two groups of patients were all decreased compared with those before intervention(P<0.05),an

关 键 词：左心疾病相关性肺动脉高压 气虚血瘀证 益气活血通脉汤 补阳还五汤 临床疗效 心肺功能 血管内皮功能 生活质量 

分 类 号：R543.2[医药卫生—心血管疾病]