茯苓四逆汤治疗重症心衰的临床观察  

Clinical Observation of Fuling Sini Decoction in the Treatment of Severe Heart Failure

作　　者：黄发根 陈冬杰 王评 曾圆圆 黄永莲 杨霞 黄兰琳 Huang Fagen;Chen Dongjie;Wang Ping;Zeng Yuanyuan;Huang Yonglian;Yang Xia;Huang Lanlin(Beijing University of Chinese Medicine Shenzhen Hospital(Longgang),Guangdong,Shenzhen 518172,China)

机构地区：[1]广东省深圳市北京中医药大学深圳医院(龙岗),广东深圳518172

出　　处：《中国中医急症》2025年第4期681-684,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：深圳市龙岗区科技创新专项资金(LGWJ2022-72)。

摘　　要：目的观察茯苓四逆汤治疗重症心衰的有效性及安全性。方法选择60例重症心衰患者按随机数字表法将患者分为对照组与治疗组各30例。两组均给予常规治疗,治疗组在常规治疗基础上加用茯苓四逆汤治疗,每剂煎煮成150 mL,每日1剂,分3次服用;两组疗程均为8 d。观察对比两组急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、28 d内死亡率、ICU总住院时间、有效率、左室射血分数(LVEF)、左心室收缩末期内径(LVEDs)、左心室舒张末直径(LVIDd)及三尖瓣瓣环运动位移(TAPSE)等指标;记录对比肝肾功能损伤、恶心、心律失常、呕吐等不良事件的发生情况。结果治疗后两组APACHEⅡ评分较治疗前明显下降(均P<0.05),治疗组降低更明显(均P<0.05);治疗组ICU住院时间、总住院时间均短于对照组(均P<0.01);两组28 d病死率差异无统计学意义(P>0.05);治疗组总有效率为93.33%,高于对照组的83.33%(P<0.05);治疗后两组LVEF、TAPSE水平均升高,同时间点治疗组上述指标均高于对照组(P<0.05);两组LVIDd、LVEDs治疗后均下降,同时间点治疗组上述指标均低于对照组(P<0.05)。结论茯苓四逆汤可降低重症心衰患者心功能及预后。Objective:To observe the efficacy and safety of Fuling Sini Decoction in the treatment of severe heart failure.Methods:60 patients with severe heart failure admitted to the Intensive Care Unit(ICU)were randomly divided into a control group and a treatment group,each with 30 patients.Both groups received conventional treatment,while the treatment group additionally received Fuling Sini Decoction.Each dose was decocted into 150 mL and taken three times daily for a course of 8 days.The APACHE I scores,28 day mortality,total ICU stay duration,efficacy rates,left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVEDs),left ventricular internal dimension in diastole(LVIDd),and tricuspid annular plane systolic excursion(TAPSE)were observed and compared between the two groups.Adverse events such as liver and kidney function damage,nausea,arrhythmia,and vomiting were recorded and compared.Results:After treatment,the APACHE II scores significantly decreased in both groups(all P<0.05),with more significant reductions observed in the treatment group(all P<0.05).The ICU stay duration and total hospitalization time were shorter in the treatment group than in the control group(all P<0.01).There was no statistically significant difference in 28 day mortality between the two groups(P>0.05).The overall effective rate in the treatment group was 93.33%,which was higher than 83.33%in the control group(P<0.05).The LVEF and TAPSE levels increased after treatment in both groups,and these indicators were higher in the treatment group at the same time points(P<0.05).The LVIDd and LVEDs levels decreased after treatment in both groups,with lower values in the treatment group at the same time points(P<0.05).Conclusion:Fuling Sini Decoction can improve cardiac function and prognosis in patients with severe heart failure.

关 键 词：重症心衰 扶阳理论 茯苓四逆汤 

分 类 号：R541.61[医药卫生—心血管疾病]