保元汤联合苓桂术甘汤治疗慢性心力衰竭利尿剂抵抗的临床效果
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摘要
目的探讨保元汤联合苓桂术甘汤治疗慢性心力衰竭利尿剂抵抗的临床效果。方法选取我院2015年7月至2017年12月住院治疗的慢性心力衰竭利尿剂抵抗患者70例作为研究对象,按随机数字表法将其分为观察组和对照组,每组35例。对照组予以芪苈强心胶囊治疗,观察组予以保元汤联合苓桂术甘汤治疗,两组均治疗1个月。比较两组患者的临床疗效、治疗前、后左室射血分数(LVEF)、日尿量以及血浆氨基末端B型利钠肽前体(NT-pro BNP)水平。结果观察组患者的治疗总有效率显著高于对照组,差异具有统计学意义(P<0.05);观察组患者的心功能改善程度优于对照组,差异具有统计学意义(P<0.001)。治疗前,两组患者的LVEF、日尿量及血浆NT-pro BNP水平比较,差异无统计学意义(P>0.05);治疗后,两组患者的LVEF、日尿量及血浆NT-pro BNP水平均优于治疗前,差异具有统计学意义(P<0.05);治疗后,观察组患者的LVEF及血浆NT-pro BNP水平均优于对照组,差异具有统计学意义(P<0.001),但两组患者的日尿量比较,差异不具有统计学意义(P>0.05)。结论在常规西药治疗的基础上予以保元汤合苓桂术甘汤治疗慢性心力衰竭利尿剂抵抗临床效果,有助于改善患者心功能,进一步改善预后。
Objective To evaluate the clinical effect of Baoyuan decoction combined with Linggui Zhugan decoction in the treatment of chronic heart failure complicated with diuretic resistance. Methods A total of 70 patients with chronic heart failure complicated with diuretic resistance treated in our hospital from July 2015 to December 2017 were selected as the research objects. Patients were divided into observation group and control group by random number table method, with35 cases in each group. Patients in the control group were treated with Qili Qiangxin capsule, while patients in the observation group were given Baoyuan decoction combined with Linggui Zhugan decoction. Both groups were treated for one month. The clinical effects, left ventricle ejection fraction(LVEF), daily urine volume and the levels of plasma N-terminal B-type natriuretic peptide(NT-pro BNP) before and after treatment were compared between the two groups. Results The total effective rate of treatment in the observation group was significantly higher than that in the control group, the difference was statistically significant(P<0.05); the improvement of cardiac function of patients in the observation group was better than that in the control group, the difference was statistically significant(P<0.001). Before treatment, there were no significant differences in LVEF, daily urine volume and levels of plasma NT-pro BNP between the two groups(P>0.05);after treatment, the LVEF, daily urine volume and levels of plasma NT-pro BNP in the two groups significantly improved,the differences were statistically significant(P <0.05); after treatment, the LVEF and level of NT-pro BNP in the observation group were better than those in the control group, the differences were statistically significant(P<0.001), but there was no significant difference in daily urine volume between the two groups(P >0.05). Conclusion On the basic treatment of western medicine, administration of Baoyuan decoction combined with Linggui Zhugan decoction for the treatment of chronic heart failure complicated with diuretic resistance has a significant clinical effect, which can help improve cardiac function and prognosis of patients.
Objective To evaluate the clinical effect of Baoyuan decoction combined with Linggui Zhugan decoction in the treatment of chronic heart failure complicated with diuretic resistance. Methods A total of 70 patients with chronic heart failure complicated with diuretic resistance treated in our hospital from July 2015 to December 2017 were selected as the research objects. Patients were divided into observation group and control group by random number table method, with35 cases in each group. Patients in the control group were treated with Qili Qiangxin capsule, while patients in the observation group were given Baoyuan decoction combined with Linggui Zhugan decoction. Both groups were treated for one month. The clinical effects, left ventricle ejection fraction(LVEF), daily urine volume and the levels of plasma N-terminal B-type natriuretic peptide(NT-pro BNP) before and after treatment were compared between the two groups. Results The total effective rate of treatment in the observation group was significantly higher than that in the control group, the difference was statistically significant(P<0.05); the improvement of cardiac function of patients in the observation group was better than that in the control group, the difference was statistically significant(P<0.001). Before treatment, there were no significant differences in LVEF, daily urine volume and levels of plasma NT-pro BNP between the two groups(P>0.05);after treatment, the LVEF, daily urine volume and levels of plasma NT-pro BNP in the two groups significantly improved,the differences were statistically significant(P <0.05); after treatment, the LVEF and level of NT-pro BNP in the observation group were better than those in the control group, the differences were statistically significant(P<0.001), but there was no significant difference in daily urine volume between the two groups(P >0.05). Conclusion On the basic treatment of western medicine, administration of Baoyuan decoction combined with Linggui Zhugan decoction for the treatment of chronic heart failure complicated with diuretic resistance has a significant clinical effect, which can help improve cardiac function and prognosis of patients.
引文
[1]甄宇治,邓彦东,刘坤申.慢性心力衰竭伴利尿剂抵抗的研究进展[J].中国全科医学,2012,15(11):1290-1292.
[2]张倩,尹玉洁,贾振华.慢性心力衰竭伴利尿剂抵抗中西医研究进展[J].中国老年学杂志,2017,37(18):4683-4685.
[3]王鹏军,苗阳,王健,等.慢性心力衰竭中医辨证客观化研究现状[J].中国中西医结合杂志,2013,33(6):854-857.
[4]王恒和,程刚,刘兴磊.慢性心力衰竭中医辨证分型与患者心功能及生存质量的关系[J].山东医药,2015,59(34):52-53.
[5]崔炜.心力衰竭患者利尿剂抵抗的处理策略[J].中国心血管病杂志,2015,43(1):1-3.
[6]复旦大学上海医学院.《实用内科学》[M].13版.中国医刊,2009.
[7]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.
[8]邹旭,潘光明,盛小刚,等.慢性心力衰竭中医证候规律的临床流行病学调查研究[J].中国中西医结合杂志,2011,31(7):903-908.
[9]冠心病中医临床研究联盟.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[10]杨靖,任雨笙,厉娜,等.托伐普坦治疗合并低钠血症及利尿剂抵抗的心力衰竭[J].第二军医大学学报,2015,36(10):1133-1137.
[11] RAHIMTOOLA SH.Device therapy and cardiac transplantation forend-stage heart failure. Foreword[J].Curr Prob Cardiology,2010,35(1):8-64.
[12]邢冬梅,李彬,朱明军,等.慢性心力衰竭中医药临床研究设计要点[J].中华中医药杂志,2018,25(3):993-995.
[13]赵志强,毛静远,王贤良,等.中医药在慢性心力衰竭治疗中的应用及评价[J].中国中西医结合杂志,2013,33(12):1701-1704.
[14] LU S,CHEN K,YANG Q,et al.Progress in the research of radixstra-gali in treating chronic heart failure:Effective ingredients,dose-ef-fect relationship and adverse reaction[J].Chin J Integr Med,2011,17(6):473-477.
[15]单晓晶.中西医结合治疗冠心病伴心功能不全38例[J].实用中医内科杂志,2004,18(3):209-210.
[16]中华医学会心血管病学分会,中华心血管病杂志编委会.不稳定性心绞痛诊断和治疗建议[J].中华心血管病杂志,2000,28(6):409-412.
[17]李小球,耿小茵,王沙燕,等.苓桂术甘汤治疗充血性心力衰竭的临床研究[J].中华中医药杂志,2005,20(7):220-222.
[18]浴生,邓文龙,薛春生.中国药理与应用[M].北京:人民卫生出版社,1998:1145-1147.
[19]刘佼磊,逢帅.老年慢性心力衰竭患者血清HSP70、NT-pro BNP水平的临床价值研究[J].现代预防医学,2015,42(12):2279-2281.
[20]高小群,廉哲勋,齐玉军,等.肾功能损伤对N末端B型利钠肽原应用于心力衰竭诊断的影响[J].中国循环杂志,2016,31(12):1189-1193.
[21] LEMOS JAD,MCGUIRE DK,DRAZNER MH.B-type natriureticpeptide in cardiovascular disease[J].Lancet,2003,362(9380):316-322.
[2]张倩,尹玉洁,贾振华.慢性心力衰竭伴利尿剂抵抗中西医研究进展[J].中国老年学杂志,2017,37(18):4683-4685.
[3]王鹏军,苗阳,王健,等.慢性心力衰竭中医辨证客观化研究现状[J].中国中西医结合杂志,2013,33(6):854-857.
[4]王恒和,程刚,刘兴磊.慢性心力衰竭中医辨证分型与患者心功能及生存质量的关系[J].山东医药,2015,59(34):52-53.
[5]崔炜.心力衰竭患者利尿剂抵抗的处理策略[J].中国心血管病杂志,2015,43(1):1-3.
[6]复旦大学上海医学院.《实用内科学》[M].13版.中国医刊,2009.
[7]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.
[8]邹旭,潘光明,盛小刚,等.慢性心力衰竭中医证候规律的临床流行病学调查研究[J].中国中西医结合杂志,2011,31(7):903-908.
[9]冠心病中医临床研究联盟.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[10]杨靖,任雨笙,厉娜,等.托伐普坦治疗合并低钠血症及利尿剂抵抗的心力衰竭[J].第二军医大学学报,2015,36(10):1133-1137.
[11] RAHIMTOOLA SH.Device therapy and cardiac transplantation forend-stage heart failure. Foreword[J].Curr Prob Cardiology,2010,35(1):8-64.
[12]邢冬梅,李彬,朱明军,等.慢性心力衰竭中医药临床研究设计要点[J].中华中医药杂志,2018,25(3):993-995.
[13]赵志强,毛静远,王贤良,等.中医药在慢性心力衰竭治疗中的应用及评价[J].中国中西医结合杂志,2013,33(12):1701-1704.
[14] LU S,CHEN K,YANG Q,et al.Progress in the research of radixstra-gali in treating chronic heart failure:Effective ingredients,dose-ef-fect relationship and adverse reaction[J].Chin J Integr Med,2011,17(6):473-477.
[15]单晓晶.中西医结合治疗冠心病伴心功能不全38例[J].实用中医内科杂志,2004,18(3):209-210.
[16]中华医学会心血管病学分会,中华心血管病杂志编委会.不稳定性心绞痛诊断和治疗建议[J].中华心血管病杂志,2000,28(6):409-412.
[17]李小球,耿小茵,王沙燕,等.苓桂术甘汤治疗充血性心力衰竭的临床研究[J].中华中医药杂志,2005,20(7):220-222.
[18]浴生,邓文龙,薛春生.中国药理与应用[M].北京:人民卫生出版社,1998:1145-1147.
[19]刘佼磊,逢帅.老年慢性心力衰竭患者血清HSP70、NT-pro BNP水平的临床价值研究[J].现代预防医学,2015,42(12):2279-2281.
[20]高小群,廉哲勋,齐玉军,等.肾功能损伤对N末端B型利钠肽原应用于心力衰竭诊断的影响[J].中国循环杂志,2016,31(12):1189-1193.
[21] LEMOS JAD,MCGUIRE DK,DRAZNER MH.B-type natriureticpeptide in cardiovascular disease[J].Lancet,2003,362(9380):316-322.