特色中药内外合治对老年气阴两虚兼血瘀湿阻型慢性心力衰竭影响的临床研究
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摘要
目的观察特色中药内外合治法联合常规西药治疗气阴两虚兼血瘀湿阻型老年慢性心力衰竭(CHF)的临床疗效。方法将136例气阴两虚兼血瘀湿阻型老年CHF患者随机分成治疗组与对照组,每组68例。对照组予常规西药治疗,治疗组在对照组治疗措施基础上加予强心Ⅱ号汤口服、足浴及二乌温阳贴穴位敷贴。两组疗程均为2个月,观察临床疗效及用药不良反应情况,比较心功能指标、6 min步行距离及血清B型钠尿肽(BNP)、C反应蛋白(CRP)及心肌肌钙蛋白I(c Tn I)水平的变化情况。结果 (1)最终完成试验者124例,治疗组62例,对照组62例。(2)治疗组、对照组总有效率分别为91.94%、75.81%;组间临床疗效比较,治疗组明显优于对照组(P<0.05)。(3)组间治疗后比较,治疗组LVEF明显高于对照组,而LVEDD、LVESD明显低于对照组(P<0.05)。(4)组间治疗后比较,治疗组6 min步行距离明显多于对照组(P<0.05)。(5)组间治疗后比较,治疗组BNP、CRP及c Tn I水平明显低于对照组(P<0.05)。(6)组间不良反应发生率比较,差异无统计学意义(P>0.05)。结论特色中药内外合治法联合常规西药治疗气阴两虚兼血瘀湿阻型老年CHF,可显著提高临床疗效及患者的运动耐量,改善其心功能,降低血清BNP、CRP及c Tn I水平,且安全性较好。
Objective To observe the clinical effect of internal and external treatment of traditional Chinese medicine combined with conventional Western medicine for chronic heart failure( CHF) in aged patients with qi-yin deficiency,blood stasis and damp obstruction. Methods One hundred and thirty-six aged CHF patients with qi-yin deficiency,blood stasis and damp obstruction were randomly divided into treatment group and control group with 68 cases in each group. The control group was treated with conventional Western medicine,and the treatment group was treated with Qiangxin ⅡDecoction,foot bath with herbs and point application with Erwu Wenyang Plaster on the basis of the treatment measures in the control group. The two groups were treated for 2 months. The clinical efficacy and adverse drug reactions were observed,and these indices were compared such as the cardiac function,walking distance of 6 min,levels of serum B natriuretic peptide( BNP),C-reactive protein( CRP) and cardiac troponin I( c Tn I). Results(1) There were 124 patients,62 patients in each group,who finally completed the trial.(2)The total effective rate in the treatment group was significantly higher than that of the control group( 91.93% vs 75.80%,P<0.05).(3)After treatment,the left ventricular ejection fraction( LVEF) of the treatment group was significantly higher than that of the control group,while the left ventricular end-diastolic diameter( LVEDD) and left ventricular end-systolic diameter( LVESD) of the treatment group were significantly lower than those of the control group( P<0.05).(4)After treatment,the walking distance of6 min in the treatment group was significantly longer than that in the control group( P<0.05).(5) The levels of serum BNP,CRP and c TnI in the treatment group were lower than those of the control group( P<0.05).(6) There was no significant difference in the incidence of adverse reactions between the two groups( P>0.05). Conclusion The internal and external treatment with traditional Chinese medicine combined with conventional Western medicine can significantly improve clinical efficacy and exercise tolerance,ameliorate cardiac function,reduce levels of serum BNP,CRP and c TnI,and has better safety for CHF in aged patients with qi-yin deficiency,blood stasis and damp obstruction.
Objective To observe the clinical effect of internal and external treatment of traditional Chinese medicine combined with conventional Western medicine for chronic heart failure( CHF) in aged patients with qi-yin deficiency,blood stasis and damp obstruction. Methods One hundred and thirty-six aged CHF patients with qi-yin deficiency,blood stasis and damp obstruction were randomly divided into treatment group and control group with 68 cases in each group. The control group was treated with conventional Western medicine,and the treatment group was treated with Qiangxin ⅡDecoction,foot bath with herbs and point application with Erwu Wenyang Plaster on the basis of the treatment measures in the control group. The two groups were treated for 2 months. The clinical efficacy and adverse drug reactions were observed,and these indices were compared such as the cardiac function,walking distance of 6 min,levels of serum B natriuretic peptide( BNP),C-reactive protein( CRP) and cardiac troponin I( c Tn I). Results(1) There were 124 patients,62 patients in each group,who finally completed the trial.(2)The total effective rate in the treatment group was significantly higher than that of the control group( 91.93% vs 75.80%,P<0.05).(3)After treatment,the left ventricular ejection fraction( LVEF) of the treatment group was significantly higher than that of the control group,while the left ventricular end-diastolic diameter( LVEDD) and left ventricular end-systolic diameter( LVESD) of the treatment group were significantly lower than those of the control group( P<0.05).(4)After treatment,the walking distance of6 min in the treatment group was significantly longer than that in the control group( P<0.05).(5) The levels of serum BNP,CRP and c TnI in the treatment group were lower than those of the control group( P<0.05).(6) There was no significant difference in the incidence of adverse reactions between the two groups( P>0.05). Conclusion The internal and external treatment with traditional Chinese medicine combined with conventional Western medicine can significantly improve clinical efficacy and exercise tolerance,ameliorate cardiac function,reduce levels of serum BNP,CRP and c TnI,and has better safety for CHF in aged patients with qi-yin deficiency,blood stasis and damp obstruction.
引文
[1]王健,曾庆宁,周晓露,等.益气温阳活血利水方对慢性心力衰竭患者ICAM-1水平的影响[J].四川中医,2017,36(2):76-78.
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[3]马妮娜,柴小奇,李子杰,等.参松养心胶囊联合阿托伐他汀对慢性心力衰竭患者心电图相关指标及心率变异性的影响[J].中医学报,2017,32(6):1025-1028.
[4]唐胜,沈建锋,谢玉华,等.自拟益气活血方治疗冠心病慢性心力衰竭临床效果及对炎症因子水平的影响[J].河北中医药学报,2018,33(1):857-859.
[5]吕俊芳,张宝霞.益气活血利水方治疗冠状动脉粥样硬化性心脏病慢性心力衰竭心肾阳虚证临床研究[J].中医学报,2018,33(1):133-137.
[6]中华医学会心血管病学分会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[7]冠心病中医临床研究联盟,中国中西医结合学会心血管疾病专业委员会,中华中医药学会心病分会,等.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[8] The Criteria Committee of the New York Heart Association.Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels[M]. 9 th ed. Boston:Little Brown and Co,1994:253-256.
[9]国家药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:78-83.
[10]全振华,艾民,金娟,等.芪苈强心胶囊对慢性心衰的治疗作用及机制的研究进展[J].中医药学报,2016,44(2):108-110.
[11]肖冬,张会珍,左希宏,等.参芪扶正注射液治疗老年急性心肌梗死后心力衰竭的疗效观察[J].中西医结合心脑血管病杂志,2016,14(10):1061-1063.
[12] WANG J,SHI J,WEI J,et al.Safety and efficacy of Qishen granules in patients with chronic heart failure:study protocol for a randomized controlled trial[J].Trials,2017,18(1):468.
[13]赵军香,王慧云,张丽荣.补心汤联合卡维地洛治疗慢性心力衰竭的疗效及对心功能的影响[J].现代中西医结合杂志,2016,25(16):1768-1770.
[14]戚凤君,董志,郭文娟,等.丹参多酚酸盐联合缬沙坦对慢性心力衰竭患者血浆BNP及高敏肌钙蛋白T的影响[J].辽宁中医杂志,2017,60(11):2341-2343.
[15]张金龙,谭亚萍,赵晓蓉,等.芪苈强心胶囊对老年慢性心力衰竭患者心功能、血浆脑钠肽、D-二聚体及肌钙蛋白I的影响[J].疑难病杂志,2017,16(11):1145-1148.
[16]赵书刚,李厚英,陈昕,等.补气畅络方治疗气虚血瘀型冠心病慢性心衰的疗效观察及对炎症因子的影响[J].中西医结合心脑血管病杂志,2016,14(3):238-240.
[17]俞梅,刘兆龙,马丽娟,等.加味参附汤对心阳亏虚型慢性心力衰竭BNP、CRP、TNF-α的影响[J].中华中医药学刊,2016,34(3):664-666.
[18]沙琬婧.穴位敷贴治疗慢性心力衰竭的研究概况[J].上海中医药杂志,2017,51(S1):269-273.
[19]王转转.长期口服芪红汤对慢性心力衰竭患者左心室重构、MMP-9及NP-proBNP的影响[J].陕西中医,2017,38(2):165-166.
[20]谭晓慧,张连云,张娟娟,等.活血利水法对老年心力衰竭患者hsCRP、c TnⅠ以及BNP的影响[J].中医学报,2016,31(12):1976-1979.
[21]韩轶,陈继红,高玉,等.芪红汤联合美托洛尔治疗冠心病合并慢性心力衰竭的疗效及对心功能、hs-CRP、NT-proBNP的影响[J].陕西中医,2015,36(7):800-801.
[2] SANDRI M,VIEHMANN M,ADAMS V,et al.Chronic heart failure and aging-effects of exercise training on endothelial function and mechanisms of endothelial regeneration:results from the Leipzig Exercise Intervention in Chronic heart failure and Aging(LEICA)study[J].European J Prevent Cardiol,2016,23(4):349.
[3]马妮娜,柴小奇,李子杰,等.参松养心胶囊联合阿托伐他汀对慢性心力衰竭患者心电图相关指标及心率变异性的影响[J].中医学报,2017,32(6):1025-1028.
[4]唐胜,沈建锋,谢玉华,等.自拟益气活血方治疗冠心病慢性心力衰竭临床效果及对炎症因子水平的影响[J].河北中医药学报,2018,33(1):857-859.
[5]吕俊芳,张宝霞.益气活血利水方治疗冠状动脉粥样硬化性心脏病慢性心力衰竭心肾阳虚证临床研究[J].中医学报,2018,33(1):133-137.
[6]中华医学会心血管病学分会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[7]冠心病中医临床研究联盟,中国中西医结合学会心血管疾病专业委员会,中华中医药学会心病分会,等.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[8] The Criteria Committee of the New York Heart Association.Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels[M]. 9 th ed. Boston:Little Brown and Co,1994:253-256.
[9]国家药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:78-83.
[10]全振华,艾民,金娟,等.芪苈强心胶囊对慢性心衰的治疗作用及机制的研究进展[J].中医药学报,2016,44(2):108-110.
[11]肖冬,张会珍,左希宏,等.参芪扶正注射液治疗老年急性心肌梗死后心力衰竭的疗效观察[J].中西医结合心脑血管病杂志,2016,14(10):1061-1063.
[12] WANG J,SHI J,WEI J,et al.Safety and efficacy of Qishen granules in patients with chronic heart failure:study protocol for a randomized controlled trial[J].Trials,2017,18(1):468.
[13]赵军香,王慧云,张丽荣.补心汤联合卡维地洛治疗慢性心力衰竭的疗效及对心功能的影响[J].现代中西医结合杂志,2016,25(16):1768-1770.
[14]戚凤君,董志,郭文娟,等.丹参多酚酸盐联合缬沙坦对慢性心力衰竭患者血浆BNP及高敏肌钙蛋白T的影响[J].辽宁中医杂志,2017,60(11):2341-2343.
[15]张金龙,谭亚萍,赵晓蓉,等.芪苈强心胶囊对老年慢性心力衰竭患者心功能、血浆脑钠肽、D-二聚体及肌钙蛋白I的影响[J].疑难病杂志,2017,16(11):1145-1148.
[16]赵书刚,李厚英,陈昕,等.补气畅络方治疗气虚血瘀型冠心病慢性心衰的疗效观察及对炎症因子的影响[J].中西医结合心脑血管病杂志,2016,14(3):238-240.
[17]俞梅,刘兆龙,马丽娟,等.加味参附汤对心阳亏虚型慢性心力衰竭BNP、CRP、TNF-α的影响[J].中华中医药学刊,2016,34(3):664-666.
[18]沙琬婧.穴位敷贴治疗慢性心力衰竭的研究概况[J].上海中医药杂志,2017,51(S1):269-273.
[19]王转转.长期口服芪红汤对慢性心力衰竭患者左心室重构、MMP-9及NP-proBNP的影响[J].陕西中医,2017,38(2):165-166.
[20]谭晓慧,张连云,张娟娟,等.活血利水法对老年心力衰竭患者hsCRP、c TnⅠ以及BNP的影响[J].中医学报,2016,31(12):1976-1979.
[21]韩轶,陈继红,高玉,等.芪红汤联合美托洛尔治疗冠心病合并慢性心力衰竭的疗效及对心功能、hs-CRP、NT-proBNP的影响[J].陕西中医,2015,36(7):800-801.