参附五苓散治疗气虚血瘀型冠心病心衰的临床研究
|
摘要
【目的】慢性心力衰竭其发病率高,5年存活率与恶性肿瘤相仿,严重威胁人类的生命安全,己经成为一个重要的公共卫生问题。本研究课题方向是观察并探讨参附五苓散治疗气虚血瘀型冠心病心衰的临床疗效及对其相关理化因素的影响。
【方法】入选病例60例均为2010年7月—2011年4月广州中医药大学第一附属医院普内科病房、心血管科病房及心血管专科门诊病人,以就诊时间的先后按随机数字表法随机分为治疗组及对照组各30例。对照组单纯使用西药,治疗组在西药基础上加用参附五苓散。4周为一个疗程。疗程结束后,观察两组疗效。
【结果】
1.两组间中医证候疗效比较,P<0.05,差异有统计学意义,治疗组优于对照组。
2.中医单项症状疗效分析表明,两组间心悸、疲倦乏力、气短、胸闷(痛)、小便短少、气喘、咯痰、自汗、口唇青紫的疗效比较, P<0.05,差异有统计学意义,治疗组优于对照组。
3.两组间心衰疗效、心功能疗效比较,P>0.05,无统计学差异。
4.两组间BNP水平比较,P>0.05,无统计学差异。
5.两组均无明显或严重的毒副反应,安全性和耐受性良好。
[结论]参附五苓散对气虚血瘀型冠心病心衰患者有明显临床效果,尤其是改善患者的临床症状方面优势明显,提高了患者的生活质量。
Objective
Chronic heart failure with the high incidence and the 5-year survival rate similar with malignant tumors, serious threat to human life and safety, already has become an important public health problem. This research direction is to observe and explore the clinical efficacy of SFWLS in the Treatment of Heart Failure Which is Induced by Coronary Heart Disease (syndrome of Qi deficiency and Blood stagnation), and its physical and chemical factors.
Methods
60 patients of Heart Failure coming from the Ordinary medical ward, the Cardiovascular Ward and the Cardiovascular specialist out-patient in the 1st affiliated hospital of Guangzhou university of Chinese traditional medicine, were divided randomly into treatment and control groups using a table of randomized numbers. The control group were only treated with western medicine, while the treatment group were treated with western medicine and FSWLS. The groups underwent 4 weeks of treatment
Result
1. Comparing the curative effect of TCM syndrome between the two groups, there was statistical differences, (P<0.05). The effect of treatment group better than the control group.
2. The difference of two groups after study had statistic significance about eight symptoms of TCM, such as xinji, qiduan and etc. (P<0.05). The effect of treatment group better than the control group.
3. Comparing the curative effect of NYHA and Lee heart failure between the two groups, there was not statistical differences after treatment, (P>0.05)
4. BNP levels had no statistical differences after treatment between the two groups, (P>0.05)
5. No obvious or serious side effects were observed in the study.
Conclusion
Comparing to the control group, the treatment group in CHF has the same clinic effective, even the effective has better than the other.
【方法】入选病例60例均为2010年7月—2011年4月广州中医药大学第一附属医院普内科病房、心血管科病房及心血管专科门诊病人,以就诊时间的先后按随机数字表法随机分为治疗组及对照组各30例。对照组单纯使用西药,治疗组在西药基础上加用参附五苓散。4周为一个疗程。疗程结束后,观察两组疗效。
【结果】
1.两组间中医证候疗效比较,P<0.05,差异有统计学意义,治疗组优于对照组。
2.中医单项症状疗效分析表明,两组间心悸、疲倦乏力、气短、胸闷(痛)、小便短少、气喘、咯痰、自汗、口唇青紫的疗效比较, P<0.05,差异有统计学意义,治疗组优于对照组。
3.两组间心衰疗效、心功能疗效比较,P>0.05,无统计学差异。
4.两组间BNP水平比较,P>0.05,无统计学差异。
5.两组均无明显或严重的毒副反应,安全性和耐受性良好。
[结论]参附五苓散对气虚血瘀型冠心病心衰患者有明显临床效果,尤其是改善患者的临床症状方面优势明显,提高了患者的生活质量。
Objective
Chronic heart failure with the high incidence and the 5-year survival rate similar with malignant tumors, serious threat to human life and safety, already has become an important public health problem. This research direction is to observe and explore the clinical efficacy of SFWLS in the Treatment of Heart Failure Which is Induced by Coronary Heart Disease (syndrome of Qi deficiency and Blood stagnation), and its physical and chemical factors.
Methods
60 patients of Heart Failure coming from the Ordinary medical ward, the Cardiovascular Ward and the Cardiovascular specialist out-patient in the 1st affiliated hospital of Guangzhou university of Chinese traditional medicine, were divided randomly into treatment and control groups using a table of randomized numbers. The control group were only treated with western medicine, while the treatment group were treated with western medicine and FSWLS. The groups underwent 4 weeks of treatment
Result
1. Comparing the curative effect of TCM syndrome between the two groups, there was statistical differences, (P<0.05). The effect of treatment group better than the control group.
2. The difference of two groups after study had statistic significance about eight symptoms of TCM, such as xinji, qiduan and etc. (P<0.05). The effect of treatment group better than the control group.
3. Comparing the curative effect of NYHA and Lee heart failure between the two groups, there was not statistical differences after treatment, (P>0.05)
4. BNP levels had no statistical differences after treatment between the two groups, (P>0.05)
5. No obvious or serious side effects were observed in the study.
Conclusion
Comparing to the control group, the treatment group in CHF has the same clinic effective, even the effective has better than the other.
引文
[1]中华中医药学会内科分会.内科疾病名称规范研究组；中医内科疾病名称规范研究.中医古籍出版社,2005
[2]黄平东.中医古籍对心力衰竭的论述探要[J].中医药学刊,2003,21(4)：392-393.
[3]杨纲领.心力衰竭的辨证治疗.实用医学杂志,1986(5)：35-37
[4]屈松柏.论中医对心力衰竭病机的认识.湖北中医杂志,1989(3)：34-36
[5]毛春燕.中医对充血性心力衰竭的认识及治疗对策[J].河北中医,2002,24(11)：823～824.
[6]李瑞.充血性心力衰竭的中医病机探讨[J].现代中医药,2003,(1)：13-14.
[7]葛鸿庆,赵梁,郝李敏.邓铁涛教授从脾论治慢性充血性心力衰竭之经验[J].上海中医药杂志,2002,36(4)：9-10.
[8]刘成源.心衰灵治疗慢性心衰的临床观察.中医杂志,1994(12)：726
[9]马艳东,杨艳玲.浅谈肺在心力衰竭发生发展和治疗方面的重要作用[J].河北中医,2001,23(1)： 58.
[10]史小青.中医辨证治疗心力衰竭的思路及方法[J].四川中医,2003；21(6)：11～12.
[11]马术明.慢性充血性心力衰竭的辨证论治.吉林中医药,2004,24(2)：6-8.
[12]杨培君,杨磊.充血性心力衰竭的中医证治概要[J].陕西中医学院学报,2002,25(1)：2.
[13]张瑞华,焦增绵,马丽红.慢性充血性心力衰竭的中医辨证论治[J].中国医药学报,2002,17(7)：440～441.
[14]梁文艳.辨证治疗慢性充血性心力衰竭80例疗效观察[J].天津中医,1999；16(1)：7.
[15]杨顺昆.慢性心力衰竭的辨证论治初探.云南中医学院学报,1993(2)：27-30
[16]黄永生.心衰论治.湖南中医药导报,2000(9)：3-5
[17]冯国标.略论慢性心衰的辨证论治[J].河南中医药学刊,1998,13(2)：6
[18]刘建民,张忠祥,闫振界.中医辨证治疗慢性心力衰竭182例临床观察.国医论坛,2002,17(3)20-21.
[19]丁有钦,黄衍寿,冼绍祥等.强心片治疗胸痹心水证62例临床疗效观察.新 中医,1998,30(2)：15
[20]郑筱萸.中药新药临床研究指导原则[M].北京：中国医药科技出版社,2002：77～80
[21]吴桐.温阳健心灵治疗阳虚型心衰临床总结.中国中医急症,1997(3)：101～103]
[22]马民.益心通脉汤治疗充血性心力衰竭的临床及实验研究[J].中华实用中西医杂志,2004,4(17)：21-24
[23]王中原心衰灵治疗充血性心力衰竭疗效观察河南中医,1997,17(6)：352～352
[24]严世芸.强心饮治疗慢性心功能不全38例临床观察.江西中医药,2004(4)：8-9
[25]杜云霄.温阳活血利水法治疗慢性充血性心力衰竭60例疗效观察,河北中医,2009,31(8)：1164-1165
[26]陈洁真,严夏,李俊.严夏用升清降浊法治疗慢性充血性心力衰竭经验[J].中医研究,2006,19(1)：60-61
[27]张万义,邱云卿,张万芬.升补宗气法治疗老年慢性充血性心力衰竭疗效观察[J].中国中西医结合杂志,2994,24(1)：43.
[28]宗武三.温阳泻肺方治疗难治性心衰42例小结[J].甘肃中医,2004,17(3)：8-9.
[29]肖春香,何泽云,曾松吟等.泻水扶正剂对实验兔心力衰竭ANF、CGMP及CAMP的影响[J].湖南中医学院学报,1999；18(1)：5
[30]郝燕梅.苓桂术甘汤加味配合西药治疗心肾阳虚型充血性心力衰竭40例[J].北京中医,2004,23(6)：342-344.
[31]吕仇星.生脉配伍多巴胺治疗扩张性心肌病心力衰竭疗效观察.中西医结合实用临床急救,1997(3)：112-113
[32]陈建永.参麦注射液对冠心病充血性心力衰竭52例疗效观察.浙江中医学院学报,1997(4)：12-13
[33]王芦群.桃红四物汤治疗冠心病左心功能不全46例.国医论坛,1999(6)：34-35
[34]曹雪滨.益气温阳活血化瘀法治疗充血性心力衰竭的中医机制探讨[J].现代中西医结合杂志.2003,12(23)：2618-2619.
[35]高克俭.血府逐瘀胶囊配合西药治疗心力衰竭疗效探索[J].北京中医,2006,25(4)：253-256
[36]杨祥坤·心衰的神经内分泌机制及对中医研究思路的影响阴·实用中西医结合志,1997,10(10)：1688
[37]马丽红,焦增绵,张瑞华.心虚证的客观化研究进展叨.中国中医基础医学杂志,1999,5(5)：59
[38]韩明向.人参注射液治疗心气虚证的临床研究[J].中医杂志,1995；36(6)：342
[39]王守富,李秋凤,徐毅等.参芪强心饮对慢性心力衰竭心功能及生活质量的影响阴.中国中医药信息杂志2005；12(9)：70
[40]周金荣.补气养心胶囊治疗慢性心功能不全136例[J]陕西中医：2005；26(11)：1 136～1137.
[41]赵淑华,张智龙.加味血府逐瘀汤治疗充血性心衰的临床观察[J].天津中医学院学报,2000;19(4)：21
[42]黄奕东.防己茯苓汤加减治疗60例充血性心力衰竭.上海中医药杂志,1992(11)：12～13
[43]胡元会,曹雪滨,曹贵民.中药心复康治疗气虚血瘀型充血性心力衰竭33例疗效观察[J].浙江中医学院学报,2002,24(2)：39
[44]黄衍寿,冼绍祥,吴辉.养心康治疗充血性心力衰竭临床研究[J].中国中西医结合急救杂志,2000；7(2)：71
[45]彭学海,邹世昌.乌梅丸合西药治疗充血性心力衰竭43例[J].浙江中西医结合杂志,2002,12(9)：555.
[46]刘金民,沈承玲,赵海滨.健心汤对充血性心力衰竭患者血清细胞因子的干预作用[J].中国中医急症,2004,13(1)：5-6.
[47]李立志,张京春,徐凤芹等.利心丸治疗充血性心力衰竭的临床研究[J].中国中西医结合杂志,2000；20(5)：341.-342.
[48]葛鸿庆,赵梁,郝李敏.邓铁涛教授从脾论治慢性充血性心力衰竭之经验[J].上海中医药杂志,2002；(4)：9
[49]谭璐芸,安莉萍.谈郭维琴教授辨治心衰经验[J].新疆中医药,2000；18(4)： 51
[50]单书健,陈子华.古今名医临证金鉴·心悸怔忡卷[M].北京：中医古籍出版社,1999：114
[51]王佳涛,王丹.张国伦教授治疗慢性心力衰竭的辨证经验[J].陕西中医.2005；6(2)：146-147
[52]贺福田.参芪扶正注射液治疗慢性充血性心力衰竭疗效观察.中国中医急症,2003,12(5)：399-400
[53]冯辉,王晓东,罗新民.强心口服液治疗慢性心力衰竭56例分析[J].中医药学刊,2003,21(11)：1960-1961.
[54]黄进,谈定玉,钱士明.心力舒滴鼻剂治疗慢性肺源性心脏病并心力衰竭25 例临床观察[J].中西医结合心脑血管病杂志,2004,2(1)：6-8.
[55]段可杰,郭利平,王强,等.新生脉片治疗慢性充血性心力衰竭临床观察[J].天津中医药,2003,20(2)：19-20.
[56]王慧珍.通心络胶囊治疗冠心病心衰.中国中医基础医学杂志,1999(9)：43-45
[57]Schocken DD, et al. Prevention of heart failure:a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group[J]. Circulation 2008; 117(19):2544-65.
[58]ESC, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)[J]. European heart journal.2008; 29(19): 2388-442.
[59]中华医学会心血管病学分会/中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12)：1076
[60]薛礼美,陈晓虎,等.CHF的神经内分泌激素、细胞因子变化的研究进展[J].医学综述,2004,10(3)：146-150
[61]Globits S, FrankH, Packer B, et al. Atrail natriuretic Peptide release is more dependengt on atrial filling volume than on filling pressure in chronic CHF[J].Am Heart J,1998,135(4):592-597.
[62]钱方毅.重视心力衰竭发病中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4)：243.
[63]Danser AH, Vankesteren CA, Bax WA, et al. Prorenin, venin, angiotensin and angiotensin—converting enzyme in normal and failing human hearts[J]. Circulation,1997,96(1):220-226.
[64]Yoshimura M, Yasue H, Ogawa H. PathoPhysiological significance and clinical application of ANP and BNP in patients with heart failure[J]. Can J Physiol Pharmacol,2001,79:730-735.
[65]Mukoyama A, Nakao K, Hosoda K, et al. Brain natriuretic peptide as a novel cardiac in humans:evidence for an exquisite kual natriuretic peptide system arrial natriuretic peptide and brain natriuretic peptide[J]. J Clin Invest,1991,87(4):1402.
[66]Ogawa Y, Itoh H, Nakao K, Molecular biology and bio-chemistry of natriuretic peptide family[J]. Clin Exp Phamacol Physiol,1995,22:49.
[67]Colucci WS. Molecular and cellular mechanisms of myocardial failure[J]. Am J Cardiol,1997.80(11A):15L-25L.
[68]Braunwald E, Bristow MR. Congestive heart failure:fifty years of progress[J]. Circulation,2000,102(20 Suppl 4):Ⅳ14-23.
[69]陈齐红,覃数.肿瘤坏死因子-α和充血性心力衰竭[J].心血管病学进展,2004,25(2)：89-91.
[70]Levine B, KaLman, Mayer L, et al. Elevated circulation levels of tumor necrosis factor in severe chronic heart failure[J]. N Engl J Med, 1990; 323(4):236-241.
[71]邱飞,王礼深.肿瘤坏死因子a与心力衰竭的研究进展[J].国外医学药学分册,2003,30(6)：326-330.
[72]BertonC, CordianoR. C-reactive Protein in acute myocardial infarction:association with heart failure[J]. Am Heart J,2003 Jun 145(6):1094-101.
[73]Alonso-Martinez JL, Elorent-Diez B.C-reactive protein as predictor of improvement and readlmission in heart failure[J]. Eur J Heart Fail 2002,4(3):331-6.
[74]孙宁玲,李明.慢性充血性心力衰蝎患者血浆中C-反应蛋白、肾上髓质素及内皮素水平变化的研究[J].中国循环杂志,2000,15(1)：37-39.
[75]尹芝兰,赵水平.充血性心力衰竭患者血清C-反应蛋白的变化及辛伐他汀的干预作用[J].中国医师杂志,2003,5(9)：1225-1226.
[76]金伟东,陶以嘉,等.纤维蛋白原,C-反应蛋白,白细胞计数与心功能不全的关系[J].中国临床医学,2001,8(3)：259-260.
[77]励伟芬,柳茵,等.充血性心力衰蝎患者血浆C-反应蛋白水平变化及其意义[J].心脑血管病防治,2004,4(1)：30-32.
[78]徐爱霞,李方雄.冠状动脉病变与血尿酸、血脂、血糖关系的研究[J].实用预防医学杂志,2003,10(1)：85.
[79]金惠铭.病理生理学[M].5版.北京：人民卫生出版社,2000：152.
[80]张连风,蒋云华,朱红·高尿酸血症与冠心病关系探讨[J].中国医学检验杂志,2002,3(4)：111.
[81]谭来勋,李容,叶心国,等.急性脑血管病患者血尿酸水平的研究[J].中国实用内科杂志,2000,20(12)：740-741.
[82]窦丽华.慢性心力衰竭时血清尿酸水平的变化规律及临床意义[J].山东医药,2008,48(1)：75-76.
[83]陈焕梅,张雪娥.慢性心力衰竭病人血清尿酸水平与心功能关系[J].山东医药,2008,6(7)：845-846.
[84]Lehnart SE, Marks AR, et al. Phosphodiesterase 4D deficiency in the ryanodine-receptor complex promotes heart failure and arrhythmias[J]. Cell,2005 Oct 7;123(1):25-35.
[85]刘国树.非洋地黄类正性肌力药物的临床应用[J].中华心血管杂志,2001,30(8)：510-512.
[86]Faris R, Flather M, Purcell H, et al. Current evidence supporting the role of diuretics in heart failure:a meta analysis of randomized controlled trials. Int J Cardiol,2002,82(2):149-158.
[87]Krum H, Cameron P. Diuretics in the treatment of heart failure: mainstay of therapy or potential hazard?J Card Fail,2006,12(5):333-335.
[88]Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality an d morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA,1995, 273(18):1450-1456
[89]Flather MD, Yusuf S, K(?)ber L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction:a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet,2000,355(9215):1575-1581.
[90]Gainer JV, Morrow JD, Loveland A, et al. Effect of bradykininreceptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects. N Engl J Med,1998,339(18):1285-1292.
[91]中华医学会心血管病学分会/中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12)：1082,1083,1086.
[92]Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-conveaing-enzyme inhibitors:the CHARM- Alternative trial. Lancet,2003,362(9386):772-776.
[93]戴闺柱.2005年美国慢性收缩性心力衰竭治疗指南浅析[J].中华心血管病杂志,2005,33(12)：1065-1066.
[94]Cohn JN. Improving outcomes in congestive heart failure:ValHeFT.Valsartan in Heart Failure Trial. Cardiology,1999,91 (Suppl 1):19-22.
[95]Pitt B, Zannad F, Remme WJ, et al.The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med, 1999,341 (10):709-717.
[96]Bristow MR.beta-adrenergic receptor blockade in chronic heart failure. Circulation,2000,101(5):558-569.
[97]Hood WB Jr.Dans AL. Guyatt GH Digitalis for treatment of congestive heart failure in patients in sinus rhythm:a systematic review and meta-analysis. J Card Fail,2004,10(2):155-164.
[98]胡大一,马长生.心脏病学实践2002一一规范化治疗[M].北京：人民卫生出版社,2002,第1版：341.
[99]YancyCW, SaltzbergMT, BerkowitzRL, et. al Safety and feasibility of using serial infusions of nesiritide for heart failure in an outpatient setting (from the FUSION I trial) [J].Am J Cardiology,2004, 94(5):595-601.
[100]PAPP JG. Introduction:positive inotropy by calcium sensitization— an evolving approach for the treatment of end-stage heart failure[J]. Am J Cardiology,1999,83 (12B):1-3.
[101]FOLLATH F, HINKKA S, JAGER D, et al. Dose-ranging and safety with intravenous levosimendan in low-output heart failure:experience in three pilot studies and outline of the levosimendan infusion versus dobutamine trial [J]. Am J Cardiology,1999,83 (12B):21-25.
[102]Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med.2005,352(15):1539-1549
[103]田志,陈明.干细胞治疗心力衰竭研究进展[J].重庆医学,2004,(12)：67-70.
[104]郭自强,朱陵群,张立平,等.党参对大鼠离体工作心脏缺血/再灌注损伤的保护作用[J].北京中医药大学学报,1995,18(5)：39-42.
[105]张晓丹,刘琳,佟欣.党参及黄芪对实验性心肌缺血大鼠心电图影响的比较 [J].中国临床康复,2005,9(47)：142-143.
[106]黄丽亚,叶嗣颖.党参注射液上调抗氧化酶表达作用的实验研究[J].中国老年学杂志,2006,26：70-71
[107]黄志刚,张玲,张嘉晴等.黄芪对家兔失血性体克时心肌功能的影响[J].九江医学,2001,16(2)：63
[108]周钦.黄芪对肾小球疾病物质代谢紊乱的调节作用[J].中草药,1999,30(5)：386
[109]韩公羽,梁华清,张卫东,等.四川江油附子生物碱和新的强心成分研究.天然产物研究与开发,1997,9(3)：30-34
[110]张梅,赵剑.附子抗心律失常有效组分研究.时珍国医国药,2000,11(3)：193-197
[111]阮期平.周立.赵莉.黄附子中性多糖和酸性蛋白多糖的分离、纯化与鉴定.中国生化药物杂志,2000,21(1)：20-22.
[112]金琦,曹静,王淑华.大剂量茯苓的药理作用及临床应用概况[J].浙江中医杂志,2003,38(9)：410-411。
[113]梁生旺.通淋胶囊质量标准的研究[J].中国药学杂志,1998,33(11)：675.
[114]单体中,汪以真.白术的生物学功能及其应用前景[J].中国饲料,2005(18)：25-27.
[115]毛俊浩.白术多糖对小鼠淋巴细胞功能的调节[J].免疫学杂志,1996,12(4)：233-236.
[116]吕圭源.李万里.白术抗衰老作用研究[J].现代应用药学,1996,13(5)：26-29.
[117]赵建一.桂枝的药理研究及临床新用[J].光明中医,2010(8)：1546-1546.
[118]吕志连,李继承.三种利水中药对小鼠腹膜孔调控作用的影响[J].中西医结合肝病杂志,1996,6(3)：31
[119]张洪,马红斌,蔡鸿生.降脂中药浅谈[J]肘珍国药研究,1995,6(1)：34
[120]钱家骏.泽泻抗动脉粥样硬化作用系列研究(一)-泽泻研究的进展[J].北京中医学院学报.1991,14(2)：42
[121]黄泰康.常用中药成分与药理手册[M],北京：中国医药科技出版社,1994.
[122]高梅,秦风华等.猪苓多糖对小鼠免疫功能的增强作用[J].中国免疫学杂志,1991,7(3)：185
[123]徐占兴,邹胜.复方丹参注射液治疗慢性充血性心力衰竭120例疗效分析[J].天津中医.1998,15(1)：20.
[124]吴晓玲,杨裕忠,黄东亮.葶苈子水提物对狗左心主功能的作用[J]·中药材,1998,21(5)：243,245
[125]甘肃省新医药学研究所.中药学[M].北京：人民卫生出版社,1982.542.
[126]冉先德.中华药海(下册：第二册).哈尔滨：哈尔滨出版社,1993：1396
[127]徐红梅,刘青云,戴敏,等.赤芍总苷抗血栓作用研究[J].安徽中医学院学报,2000,19(1)：46-47.
[128]刘超,王静,杨军.赤芍总甙活血化淤作用的研究[J].中药材,2000,23(9)：557-560.
[129]梁日欣,黄璐琦,刘菊福,等.药对川芎和赤芍对高脂血症大鼠降脂、抗氧化及血管内皮功能的实验观察[J].中国实验方剂学杂志,2002,8(1)：43-45.
[2]黄平东.中医古籍对心力衰竭的论述探要[J].中医药学刊,2003,21(4)：392-393.
[3]杨纲领.心力衰竭的辨证治疗.实用医学杂志,1986(5)：35-37
[4]屈松柏.论中医对心力衰竭病机的认识.湖北中医杂志,1989(3)：34-36
[5]毛春燕.中医对充血性心力衰竭的认识及治疗对策[J].河北中医,2002,24(11)：823～824.
[6]李瑞.充血性心力衰竭的中医病机探讨[J].现代中医药,2003,(1)：13-14.
[7]葛鸿庆,赵梁,郝李敏.邓铁涛教授从脾论治慢性充血性心力衰竭之经验[J].上海中医药杂志,2002,36(4)：9-10.
[8]刘成源.心衰灵治疗慢性心衰的临床观察.中医杂志,1994(12)：726
[9]马艳东,杨艳玲.浅谈肺在心力衰竭发生发展和治疗方面的重要作用[J].河北中医,2001,23(1)： 58.
[10]史小青.中医辨证治疗心力衰竭的思路及方法[J].四川中医,2003；21(6)：11～12.
[11]马术明.慢性充血性心力衰竭的辨证论治.吉林中医药,2004,24(2)：6-8.
[12]杨培君,杨磊.充血性心力衰竭的中医证治概要[J].陕西中医学院学报,2002,25(1)：2.
[13]张瑞华,焦增绵,马丽红.慢性充血性心力衰竭的中医辨证论治[J].中国医药学报,2002,17(7)：440～441.
[14]梁文艳.辨证治疗慢性充血性心力衰竭80例疗效观察[J].天津中医,1999；16(1)：7.
[15]杨顺昆.慢性心力衰竭的辨证论治初探.云南中医学院学报,1993(2)：27-30
[16]黄永生.心衰论治.湖南中医药导报,2000(9)：3-5
[17]冯国标.略论慢性心衰的辨证论治[J].河南中医药学刊,1998,13(2)：6
[18]刘建民,张忠祥,闫振界.中医辨证治疗慢性心力衰竭182例临床观察.国医论坛,2002,17(3)20-21.
[19]丁有钦,黄衍寿,冼绍祥等.强心片治疗胸痹心水证62例临床疗效观察.新 中医,1998,30(2)：15
[20]郑筱萸.中药新药临床研究指导原则[M].北京：中国医药科技出版社,2002：77～80
[21]吴桐.温阳健心灵治疗阳虚型心衰临床总结.中国中医急症,1997(3)：101～103]
[22]马民.益心通脉汤治疗充血性心力衰竭的临床及实验研究[J].中华实用中西医杂志,2004,4(17)：21-24
[23]王中原心衰灵治疗充血性心力衰竭疗效观察河南中医,1997,17(6)：352～352
[24]严世芸.强心饮治疗慢性心功能不全38例临床观察.江西中医药,2004(4)：8-9
[25]杜云霄.温阳活血利水法治疗慢性充血性心力衰竭60例疗效观察,河北中医,2009,31(8)：1164-1165
[26]陈洁真,严夏,李俊.严夏用升清降浊法治疗慢性充血性心力衰竭经验[J].中医研究,2006,19(1)：60-61
[27]张万义,邱云卿,张万芬.升补宗气法治疗老年慢性充血性心力衰竭疗效观察[J].中国中西医结合杂志,2994,24(1)：43.
[28]宗武三.温阳泻肺方治疗难治性心衰42例小结[J].甘肃中医,2004,17(3)：8-9.
[29]肖春香,何泽云,曾松吟等.泻水扶正剂对实验兔心力衰竭ANF、CGMP及CAMP的影响[J].湖南中医学院学报,1999；18(1)：5
[30]郝燕梅.苓桂术甘汤加味配合西药治疗心肾阳虚型充血性心力衰竭40例[J].北京中医,2004,23(6)：342-344.
[31]吕仇星.生脉配伍多巴胺治疗扩张性心肌病心力衰竭疗效观察.中西医结合实用临床急救,1997(3)：112-113
[32]陈建永.参麦注射液对冠心病充血性心力衰竭52例疗效观察.浙江中医学院学报,1997(4)：12-13
[33]王芦群.桃红四物汤治疗冠心病左心功能不全46例.国医论坛,1999(6)：34-35
[34]曹雪滨.益气温阳活血化瘀法治疗充血性心力衰竭的中医机制探讨[J].现代中西医结合杂志.2003,12(23)：2618-2619.
[35]高克俭.血府逐瘀胶囊配合西药治疗心力衰竭疗效探索[J].北京中医,2006,25(4)：253-256
[36]杨祥坤·心衰的神经内分泌机制及对中医研究思路的影响阴·实用中西医结合志,1997,10(10)：1688
[37]马丽红,焦增绵,张瑞华.心虚证的客观化研究进展叨.中国中医基础医学杂志,1999,5(5)：59
[38]韩明向.人参注射液治疗心气虚证的临床研究[J].中医杂志,1995；36(6)：342
[39]王守富,李秋凤,徐毅等.参芪强心饮对慢性心力衰竭心功能及生活质量的影响阴.中国中医药信息杂志2005；12(9)：70
[40]周金荣.补气养心胶囊治疗慢性心功能不全136例[J]陕西中医：2005；26(11)：1 136～1137.
[41]赵淑华,张智龙.加味血府逐瘀汤治疗充血性心衰的临床观察[J].天津中医学院学报,2000;19(4)：21
[42]黄奕东.防己茯苓汤加减治疗60例充血性心力衰竭.上海中医药杂志,1992(11)：12～13
[43]胡元会,曹雪滨,曹贵民.中药心复康治疗气虚血瘀型充血性心力衰竭33例疗效观察[J].浙江中医学院学报,2002,24(2)：39
[44]黄衍寿,冼绍祥,吴辉.养心康治疗充血性心力衰竭临床研究[J].中国中西医结合急救杂志,2000；7(2)：71
[45]彭学海,邹世昌.乌梅丸合西药治疗充血性心力衰竭43例[J].浙江中西医结合杂志,2002,12(9)：555.
[46]刘金民,沈承玲,赵海滨.健心汤对充血性心力衰竭患者血清细胞因子的干预作用[J].中国中医急症,2004,13(1)：5-6.
[47]李立志,张京春,徐凤芹等.利心丸治疗充血性心力衰竭的临床研究[J].中国中西医结合杂志,2000；20(5)：341.-342.
[48]葛鸿庆,赵梁,郝李敏.邓铁涛教授从脾论治慢性充血性心力衰竭之经验[J].上海中医药杂志,2002；(4)：9
[49]谭璐芸,安莉萍.谈郭维琴教授辨治心衰经验[J].新疆中医药,2000；18(4)： 51
[50]单书健,陈子华.古今名医临证金鉴·心悸怔忡卷[M].北京：中医古籍出版社,1999：114
[51]王佳涛,王丹.张国伦教授治疗慢性心力衰竭的辨证经验[J].陕西中医.2005；6(2)：146-147
[52]贺福田.参芪扶正注射液治疗慢性充血性心力衰竭疗效观察.中国中医急症,2003,12(5)：399-400
[53]冯辉,王晓东,罗新民.强心口服液治疗慢性心力衰竭56例分析[J].中医药学刊,2003,21(11)：1960-1961.
[54]黄进,谈定玉,钱士明.心力舒滴鼻剂治疗慢性肺源性心脏病并心力衰竭25 例临床观察[J].中西医结合心脑血管病杂志,2004,2(1)：6-8.
[55]段可杰,郭利平,王强,等.新生脉片治疗慢性充血性心力衰竭临床观察[J].天津中医药,2003,20(2)：19-20.
[56]王慧珍.通心络胶囊治疗冠心病心衰.中国中医基础医学杂志,1999(9)：43-45
[57]Schocken DD, et al. Prevention of heart failure:a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group[J]. Circulation 2008; 117(19):2544-65.
[58]ESC, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)[J]. European heart journal.2008; 29(19): 2388-442.
[59]中华医学会心血管病学分会/中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12)：1076
[60]薛礼美,陈晓虎,等.CHF的神经内分泌激素、细胞因子变化的研究进展[J].医学综述,2004,10(3)：146-150
[61]Globits S, FrankH, Packer B, et al. Atrail natriuretic Peptide release is more dependengt on atrial filling volume than on filling pressure in chronic CHF[J].Am Heart J,1998,135(4):592-597.
[62]钱方毅.重视心力衰竭发病中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4)：243.
[63]Danser AH, Vankesteren CA, Bax WA, et al. Prorenin, venin, angiotensin and angiotensin—converting enzyme in normal and failing human hearts[J]. Circulation,1997,96(1):220-226.
[64]Yoshimura M, Yasue H, Ogawa H. PathoPhysiological significance and clinical application of ANP and BNP in patients with heart failure[J]. Can J Physiol Pharmacol,2001,79:730-735.
[65]Mukoyama A, Nakao K, Hosoda K, et al. Brain natriuretic peptide as a novel cardiac in humans:evidence for an exquisite kual natriuretic peptide system arrial natriuretic peptide and brain natriuretic peptide[J]. J Clin Invest,1991,87(4):1402.
[66]Ogawa Y, Itoh H, Nakao K, Molecular biology and bio-chemistry of natriuretic peptide family[J]. Clin Exp Phamacol Physiol,1995,22:49.
[67]Colucci WS. Molecular and cellular mechanisms of myocardial failure[J]. Am J Cardiol,1997.80(11A):15L-25L.
[68]Braunwald E, Bristow MR. Congestive heart failure:fifty years of progress[J]. Circulation,2000,102(20 Suppl 4):Ⅳ14-23.
[69]陈齐红,覃数.肿瘤坏死因子-α和充血性心力衰竭[J].心血管病学进展,2004,25(2)：89-91.
[70]Levine B, KaLman, Mayer L, et al. Elevated circulation levels of tumor necrosis factor in severe chronic heart failure[J]. N Engl J Med, 1990; 323(4):236-241.
[71]邱飞,王礼深.肿瘤坏死因子a与心力衰竭的研究进展[J].国外医学药学分册,2003,30(6)：326-330.
[72]BertonC, CordianoR. C-reactive Protein in acute myocardial infarction:association with heart failure[J]. Am Heart J,2003 Jun 145(6):1094-101.
[73]Alonso-Martinez JL, Elorent-Diez B.C-reactive protein as predictor of improvement and readlmission in heart failure[J]. Eur J Heart Fail 2002,4(3):331-6.
[74]孙宁玲,李明.慢性充血性心力衰蝎患者血浆中C-反应蛋白、肾上髓质素及内皮素水平变化的研究[J].中国循环杂志,2000,15(1)：37-39.
[75]尹芝兰,赵水平.充血性心力衰竭患者血清C-反应蛋白的变化及辛伐他汀的干预作用[J].中国医师杂志,2003,5(9)：1225-1226.
[76]金伟东,陶以嘉,等.纤维蛋白原,C-反应蛋白,白细胞计数与心功能不全的关系[J].中国临床医学,2001,8(3)：259-260.
[77]励伟芬,柳茵,等.充血性心力衰蝎患者血浆C-反应蛋白水平变化及其意义[J].心脑血管病防治,2004,4(1)：30-32.
[78]徐爱霞,李方雄.冠状动脉病变与血尿酸、血脂、血糖关系的研究[J].实用预防医学杂志,2003,10(1)：85.
[79]金惠铭.病理生理学[M].5版.北京：人民卫生出版社,2000：152.
[80]张连风,蒋云华,朱红·高尿酸血症与冠心病关系探讨[J].中国医学检验杂志,2002,3(4)：111.
[81]谭来勋,李容,叶心国,等.急性脑血管病患者血尿酸水平的研究[J].中国实用内科杂志,2000,20(12)：740-741.
[82]窦丽华.慢性心力衰竭时血清尿酸水平的变化规律及临床意义[J].山东医药,2008,48(1)：75-76.
[83]陈焕梅,张雪娥.慢性心力衰竭病人血清尿酸水平与心功能关系[J].山东医药,2008,6(7)：845-846.
[84]Lehnart SE, Marks AR, et al. Phosphodiesterase 4D deficiency in the ryanodine-receptor complex promotes heart failure and arrhythmias[J]. Cell,2005 Oct 7;123(1):25-35.
[85]刘国树.非洋地黄类正性肌力药物的临床应用[J].中华心血管杂志,2001,30(8)：510-512.
[86]Faris R, Flather M, Purcell H, et al. Current evidence supporting the role of diuretics in heart failure:a meta analysis of randomized controlled trials. Int J Cardiol,2002,82(2):149-158.
[87]Krum H, Cameron P. Diuretics in the treatment of heart failure: mainstay of therapy or potential hazard?J Card Fail,2006,12(5):333-335.
[88]Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality an d morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA,1995, 273(18):1450-1456
[89]Flather MD, Yusuf S, K(?)ber L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction:a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet,2000,355(9215):1575-1581.
[90]Gainer JV, Morrow JD, Loveland A, et al. Effect of bradykininreceptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects. N Engl J Med,1998,339(18):1285-1292.
[91]中华医学会心血管病学分会/中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12)：1082,1083,1086.
[92]Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-conveaing-enzyme inhibitors:the CHARM- Alternative trial. Lancet,2003,362(9386):772-776.
[93]戴闺柱.2005年美国慢性收缩性心力衰竭治疗指南浅析[J].中华心血管病杂志,2005,33(12)：1065-1066.
[94]Cohn JN. Improving outcomes in congestive heart failure:ValHeFT.Valsartan in Heart Failure Trial. Cardiology,1999,91 (Suppl 1):19-22.
[95]Pitt B, Zannad F, Remme WJ, et al.The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med, 1999,341 (10):709-717.
[96]Bristow MR.beta-adrenergic receptor blockade in chronic heart failure. Circulation,2000,101(5):558-569.
[97]Hood WB Jr.Dans AL. Guyatt GH Digitalis for treatment of congestive heart failure in patients in sinus rhythm:a systematic review and meta-analysis. J Card Fail,2004,10(2):155-164.
[98]胡大一,马长生.心脏病学实践2002一一规范化治疗[M].北京：人民卫生出版社,2002,第1版：341.
[99]YancyCW, SaltzbergMT, BerkowitzRL, et. al Safety and feasibility of using serial infusions of nesiritide for heart failure in an outpatient setting (from the FUSION I trial) [J].Am J Cardiology,2004, 94(5):595-601.
[100]PAPP JG. Introduction:positive inotropy by calcium sensitization— an evolving approach for the treatment of end-stage heart failure[J]. Am J Cardiology,1999,83 (12B):1-3.
[101]FOLLATH F, HINKKA S, JAGER D, et al. Dose-ranging and safety with intravenous levosimendan in low-output heart failure:experience in three pilot studies and outline of the levosimendan infusion versus dobutamine trial [J]. Am J Cardiology,1999,83 (12B):21-25.
[102]Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med.2005,352(15):1539-1549
[103]田志,陈明.干细胞治疗心力衰竭研究进展[J].重庆医学,2004,(12)：67-70.
[104]郭自强,朱陵群,张立平,等.党参对大鼠离体工作心脏缺血/再灌注损伤的保护作用[J].北京中医药大学学报,1995,18(5)：39-42.
[105]张晓丹,刘琳,佟欣.党参及黄芪对实验性心肌缺血大鼠心电图影响的比较 [J].中国临床康复,2005,9(47)：142-143.
[106]黄丽亚,叶嗣颖.党参注射液上调抗氧化酶表达作用的实验研究[J].中国老年学杂志,2006,26：70-71
[107]黄志刚,张玲,张嘉晴等.黄芪对家兔失血性体克时心肌功能的影响[J].九江医学,2001,16(2)：63
[108]周钦.黄芪对肾小球疾病物质代谢紊乱的调节作用[J].中草药,1999,30(5)：386
[109]韩公羽,梁华清,张卫东,等.四川江油附子生物碱和新的强心成分研究.天然产物研究与开发,1997,9(3)：30-34
[110]张梅,赵剑.附子抗心律失常有效组分研究.时珍国医国药,2000,11(3)：193-197
[111]阮期平.周立.赵莉.黄附子中性多糖和酸性蛋白多糖的分离、纯化与鉴定.中国生化药物杂志,2000,21(1)：20-22.
[112]金琦,曹静,王淑华.大剂量茯苓的药理作用及临床应用概况[J].浙江中医杂志,2003,38(9)：410-411。
[113]梁生旺.通淋胶囊质量标准的研究[J].中国药学杂志,1998,33(11)：675.
[114]单体中,汪以真.白术的生物学功能及其应用前景[J].中国饲料,2005(18)：25-27.
[115]毛俊浩.白术多糖对小鼠淋巴细胞功能的调节[J].免疫学杂志,1996,12(4)：233-236.
[116]吕圭源.李万里.白术抗衰老作用研究[J].现代应用药学,1996,13(5)：26-29.
[117]赵建一.桂枝的药理研究及临床新用[J].光明中医,2010(8)：1546-1546.
[118]吕志连,李继承.三种利水中药对小鼠腹膜孔调控作用的影响[J].中西医结合肝病杂志,1996,6(3)：31
[119]张洪,马红斌,蔡鸿生.降脂中药浅谈[J]肘珍国药研究,1995,6(1)：34
[120]钱家骏.泽泻抗动脉粥样硬化作用系列研究(一)-泽泻研究的进展[J].北京中医学院学报.1991,14(2)：42
[121]黄泰康.常用中药成分与药理手册[M],北京：中国医药科技出版社,1994.
[122]高梅,秦风华等.猪苓多糖对小鼠免疫功能的增强作用[J].中国免疫学杂志,1991,7(3)：185
[123]徐占兴,邹胜.复方丹参注射液治疗慢性充血性心力衰竭120例疗效分析[J].天津中医.1998,15(1)：20.
[124]吴晓玲,杨裕忠,黄东亮.葶苈子水提物对狗左心主功能的作用[J]·中药材,1998,21(5)：243,245
[125]甘肃省新医药学研究所.中药学[M].北京：人民卫生出版社,1982.542.
[126]冉先德.中华药海(下册：第二册).哈尔滨：哈尔滨出版社,1993：1396
[127]徐红梅,刘青云,戴敏,等.赤芍总苷抗血栓作用研究[J].安徽中医学院学报,2000,19(1)：46-47.
[128]刘超,王静,杨军.赤芍总甙活血化淤作用的研究[J].中药材,2000,23(9)：557-560.
[129]梁日欣,黄璐琦,刘菊福,等.药对川芎和赤芍对高脂血症大鼠降脂、抗氧化及血管内皮功能的实验观察[J].中国实验方剂学杂志,2002,8(1)：43-45.