中医药治疗心力衰竭伴利尿剂抵抗研究进展  

Research Progress on Traditional Chinese Medicine in the Treatment of Heart Failure with Diuretic Resistance

作　　者：徐铭阳 姜钧文[2] XU Mingyang;JIANG Junwen(Liaoning University of Traditional Chinese Medicine,Shenyang,Liaoning,China,110032;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang,Liaoning,China,110032)

机构地区：[1]辽宁中医药大学,辽宁沈阳110032 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《河南中医》2025年第5期772-777,共6页Henan Traditional Chinese Medicine

基　　金：2018年国家重点研发计划立项项目(2018YFC1707407);2019年辽宁省科学技术计划基金立项项目(2019-zd-0438)。

摘　　要：心力衰竭伴利尿剂抵抗的发病机制复杂,目前临床治疗尚无统一标准。中医治疗心力衰竭伴利尿剂抵抗强调辨证论治,其证型主要有心肾阳虚证、气阴两虚证、阳虚水泛证和气虚血瘀证等,常用中药有益气养心类(人参、黄芪)、温阳利水类(附子、桂枝)、活血化瘀类(丹参、川芎)和利水渗湿类(茯苓、泽泻);常用方剂有真武汤、五苓散、苓桂术甘汤等,此类药物能显著改善患者症状,提高利尿剂敏感性。但目前的研究尚存在以下不足:首先,缺乏以终点事件为疗效指标的远期预后研究,且缺乏中药治疗HF利尿剂抵抗的机制研究;其次,现有中医药临床研究多为小规模、小样本研究,且临床中医辨证分型及治疗体系方面缺乏系统中医诊疗规范,疗效缺乏统一评判标准。未来应开展更多高质量的临床研究,采用多中心、随机对照试验等方法,验证中医治疗利尿剂抵抗的有效性和安全性,制定中医诊疗指南,为充分体现中医药治疗优势提供理论基础及科学依据。The pathogenesis of heart failure with diuretic resistance is complex,and there is currently no unified clinical treatment standard.TCM emphasizes syndrome differentiation and treatment for heart failure with diuretic resistance.Common TCM syndrome patterns include heart-kidney yang deficiency,qi-yin deficiency,yang deficiency with water retention,and qi deficiency with blood stasis.Frequently used Chinese medicinals include qi-tonifying and heart-nourishing agents,such as Renshen(Radix Ginseng)and Huangqi(Radix Scutellariae);yang-warming and diuretic agents,such as Fuzi(Radix Aconiti Lateralis Preparata)and Guizhi(Ramulus Cinnamomi),blood-activating and stasis-resolving agents,such as Danshen(Radix Salviae Miltiorrhizae)and Chuanxiong(Rhizoma Chuanxiong),and dampness-eliminating diuretics,such as Fuling(Poria)and Zexie(Rhizoma Alismatis).Classic formulas such as True Warrior Decoction,Five Substances Powder with Poria,Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction have demonstrated significant efficacy in alleviating symptoms and improving diuretic sensitivity.However,current research still has several limitations:First,TCM clinical studies lack long-term prognostic evaluations using endpoint events as efficacy indicators,and mechanistic studies on TCM treatment for diuretic resistance in heart failure remain insufficient.Second,existing TCM clinical research predominantly involves small-scale studies with limited sample sizes,and there is a lack of standardized TCM diagnostic and treatment protocols for syndrome differentiation and outcome assessment.Therefore,in the future,efforts should revisit classical medical works,conduct high-quality clinical trials,adopt methods such as multi-center and randomized controlled trials to verify the effectiveness and safety of TCM in treating diuretic resistance,and assist modern science and technology and methods in formulating standardized guidelines for TCM diagnosis and treatment,providing a theoretical basis and scientific evidence for ful

关 键 词：心力衰竭 利尿剂抵抗 辨虚实 辨病位 单味药物 中药复方 名医验方 外用法 中成药 

分 类 号：R259.416[医药卫生—中西医结合]