利水活血温阳方治疗血瘀阻络、水液停聚型慢性心力衰竭临床观察
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摘要
目的观察利水活血温阳方治疗血瘀阻络、水液停聚型慢性心力衰竭(CHF)的临床疗效。方法将95例血瘀阻络、水液停聚型CHF患者随机分为2组。对照组48例予西医常规治疗;治疗组47例在对照组治疗基础上应用利水活血温阳方治疗。2组均治疗14 d。观察2组临床疗效、中医证候疗效;比较2组治疗前后心功能指标[血浆B型脑钠肽(BNP)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、舒张早期血流峰值速度/舒张晚期血流峰值速度(E/A)]变化及中医证候积分变化;观察2组安全性指标变化。结果临床疗效:治疗组总有效率91.5%,对照组总有效率77.1%,治疗组临床疗效优于对照组(P<0.05)。中医证候疗效:治疗组总有效率89.4%,对照组总有效率79.2%,治疗组中医证候疗效优于对照组(P<0.05)。2组治疗后BNP、LVEDD、LVESD均较本组治疗前降低(P<0.05),LVEF、E/A均较本组治疗前升高(P<0.05);治疗后治疗组BNP、LVEDD、LVESD均低于对照组(P<0.05),LVEF、E/A均高于对照组(P<0.05)。2组治疗后中医证候积分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。结论利水活血温阳方治疗血瘀阻络、水液停聚型CHF疗效显著,能更好地改善患者心功能和中医证候。
Objective To observe the clinical effects of Lishui-Huoxue-Wenyang prescription in treating congestive heart failure(CHF) with blood stasis blocking collateral type and aqueous fluid stopping type.Methods95 CHF patients with blood stasis blocking collateral type and aqueous fluid stopping were randomly divided into two groups.48 cases in control group were treated by routine treatment of western medicine,and 47 cases in treatment group were treated by Lishui-Huoxue-Wenyang prescription on the basis of control group treatment.The treatment course was 14 d.The clinical efficacy and the effects of TCM syndromes in two groups were observed.The heart function parameters including B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular contraction End-diastolic diameter(LVESD),peak diastolic blood flow velocity/peak diastolic blood flow velocity(E/A),and changes of TCM syndromes scores before and after treatment were compared in two groups.The changes of safety indexes in the two groups were observed.Results The total effective rate of the clinical efficacy in treatment group(91.5%) was superior to that in control group(77.1%).The clinical efficacy in the treatment group was better than that in the control group(P < 0.05).The total effective rate of TCM syndromes in treatment group(89.4%) was superior to that in control group(79.2%).The curative effect of TCM syndromes in the treatment group was better than that in the control group(P < 0.05).The BNP,LVEDD and LVESD after treatment were lower than those before treatment in two groups(P < 0.05).The LVEF and E/A were higher than those before treatment(P <0.05).The BNP,LVEDD and LVESD after treatment in the treatment group were lower than those in the control group(P < 0.05),and the levels of LVEDD and LVESD in the treatment group were higher than those in the control group(P < 0.05).The TCM syndrome scores after treatment in two groups were lower than that before treatment(P < 0.05),and the treatment group decreased more significantly(P < 0.05).Conclusion On the basis of routine western medicine treatment,using Lishui-Huoxue-Wenyang prescription has significant effect on CHF with blood stasis blocking collateral type and aqueous fluid stopping type,and it can better improve the patient's heart function and TCM syndromes.
Objective To observe the clinical effects of Lishui-Huoxue-Wenyang prescription in treating congestive heart failure(CHF) with blood stasis blocking collateral type and aqueous fluid stopping type.Methods95 CHF patients with blood stasis blocking collateral type and aqueous fluid stopping were randomly divided into two groups.48 cases in control group were treated by routine treatment of western medicine,and 47 cases in treatment group were treated by Lishui-Huoxue-Wenyang prescription on the basis of control group treatment.The treatment course was 14 d.The clinical efficacy and the effects of TCM syndromes in two groups were observed.The heart function parameters including B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular contraction End-diastolic diameter(LVESD),peak diastolic blood flow velocity/peak diastolic blood flow velocity(E/A),and changes of TCM syndromes scores before and after treatment were compared in two groups.The changes of safety indexes in the two groups were observed.Results The total effective rate of the clinical efficacy in treatment group(91.5%) was superior to that in control group(77.1%).The clinical efficacy in the treatment group was better than that in the control group(P < 0.05).The total effective rate of TCM syndromes in treatment group(89.4%) was superior to that in control group(79.2%).The curative effect of TCM syndromes in the treatment group was better than that in the control group(P < 0.05).The BNP,LVEDD and LVESD after treatment were lower than those before treatment in two groups(P < 0.05).The LVEF and E/A were higher than those before treatment(P <0.05).The BNP,LVEDD and LVESD after treatment in the treatment group were lower than those in the control group(P < 0.05),and the levels of LVEDD and LVESD in the treatment group were higher than those in the control group(P < 0.05).The TCM syndrome scores after treatment in two groups were lower than that before treatment(P < 0.05),and the treatment group decreased more significantly(P < 0.05).Conclusion On the basis of routine western medicine treatment,using Lishui-Huoxue-Wenyang prescription has significant effect on CHF with blood stasis blocking collateral type and aqueous fluid stopping type,and it can better improve the patient's heart function and TCM syndromes.
引文
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[14]双晓萍,王昃睿,袁安冬,等.王治强教授治疗心力衰竭用药经验[J].吉林中医药,2016,36(4):338-340.
[15]杨利生,张扶莉.通阳利水汤联合西药治疗充血性心力衰竭30例[J].陕西中医,2013,34(6):646-647.
[16]朱红俊,龚少愚,魏慧渊,等.益气通阳利水法对慢性心力衰竭患者B型钠尿肽水平及生存率的影响[J].中医杂志,2007,48(10):888-890.
[17]汤琪,何明丰,李淑艳,等.温阳方治疗心阳虚证心衰临床研究[J].新中医,2010,42(9):20-22.
[18]韩娟,刘宏艳,王怡.益气、温阳、活血、利水法治疗慢性充血性心力衰竭的研究进展[J].实用中西医结合临床,2008,8(3):91-93.
[19]耿冲,安冬青,谢冲,等.益气温阳、活血利水法联合西药与常规西药治疗慢性心力衰竭临床疗效比较的Meta分析[J].中国全科医学,2015,18(2):180-183,190.
[2]陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2008:165.
[3]张艳,礼海,王彩玲.浅谈慢性心衰中医病名病机研究[J].时珍国医国药,2011,22(6):1547-1548.
[4]王科军,张秀荣,苏德成.古代医家对慢性心衰病因病机的认识[J].吉林中医药,2011,31(8):711-712.
[5]孟伟,李本志,马丽华,等.基于古籍医案文献分析的心力衰竭证治规律研究[J].世界中西医结合杂志,2013,8(8):840-843.
[6]王喆.《中国心力衰竭诊断和治疗指南2014》解读[J].中国临床医生,2016,44(5):14-16.
[7]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):1076-1095.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:112-125.
[9]周仲瑛.中医内科学[M].2版.北京:中国中医药出版社,2007:101.
[10]郝丽梅,毛静远,王贤良.中医学对心力衰竭认识的历史脉络考略[J].中医杂志,2013,54(8):637
[11]解琳莉,赵勇,张为,等.从气、血、水关系探析心水之病机与治疗[J].中华中医药杂志,2012,27(8):2113-2115.
[12]徐淑乐,曹雪滨.充血性心力衰竭中医病机演变规律认识[J].现代中西医结合杂志,2008,17(35):5545-5547.
[13]潘洪,罗钢,陈冲,等.杨思进教授辨治心衰血瘀证经验[J].四川中医,2010,28(11):12-14.
[14]双晓萍,王昃睿,袁安冬,等.王治强教授治疗心力衰竭用药经验[J].吉林中医药,2016,36(4):338-340.
[15]杨利生,张扶莉.通阳利水汤联合西药治疗充血性心力衰竭30例[J].陕西中医,2013,34(6):646-647.
[16]朱红俊,龚少愚,魏慧渊,等.益气通阳利水法对慢性心力衰竭患者B型钠尿肽水平及生存率的影响[J].中医杂志,2007,48(10):888-890.
[17]汤琪,何明丰,李淑艳,等.温阳方治疗心阳虚证心衰临床研究[J].新中医,2010,42(9):20-22.
[18]韩娟,刘宏艳,王怡.益气、温阳、活血、利水法治疗慢性充血性心力衰竭的研究进展[J].实用中西医结合临床,2008,8(3):91-93.
[19]耿冲,安冬青,谢冲,等.益气温阳、活血利水法联合西药与常规西药治疗慢性心力衰竭临床疗效比较的Meta分析[J].中国全科医学,2015,18(2):180-183,190.