桂枝茯苓汤加味对老年原发性高血压血瘀证患者脉压差及血细胞比容的影响
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摘要
目的观察在常规治疗基础上加用桂枝茯苓汤加味治疗老年原发性高血压血瘀证的临床疗效。方法68例老年原发性高血压血瘀证患者随机分为治疗组和对照组各34例。对照组口服培哚普利片和氢氯噻嗪片治疗,治疗组在对照组治疗基础上加用桂枝茯苓汤加味口服,每日1剂,连续用药12周。治疗前后进行中医症状评分,并判断中医证候疗效;进行动态血压检测,包括24 h平均收缩压(24-SBP)、24 h平均舒张压(24-DBP)、夜间平均收缩压(N-SBP)、夜间平均舒张压(N-DBP)、白昼平均收缩压(D-SBP)、白昼平均舒张压(D-DBP),计算脉压差;测定血细胞比容。结果治疗组中医证候疗效显效20例,有效12例,无效2例,加重0例,总有效率95.59%;对照组显效17例,有效10例,无效6例,加重1例,总有效率79.41%,治疗组中医证候疗效优于对照组(P<0.05)。治疗组治疗后24-SBP、24-DBP、N-SBP、D-SBP、D-DBP均较本组治疗前下降,且低于对照组治疗后(P<0.05或P<0.01)。两组治疗后脉压差、血细胞比容均较本组治疗前降低,并且治疗组较对照组下降更为明显(P<0.05)。结论常规治疗基础上加用桂枝茯苓汤加味可以缩小老年原发性高血压血瘀证患者的脉压差及改善血细胞比容,其疗效优于单纯常规西药治疗。
Objective To discuss the effect of modified Guizhi Fuling Tang(桂枝茯苓汤,GFT) combined with conventional treatment in senile essential hypertension with blood stasis syndrome. Methods Sixty-eight elderly essential hypertension patients with blood stasis syndrome were randomized into a treatment group and a control group,with 34 cases in each. Both groups were treated with conventional western medicine perindopril tablets and hydrochlorothiazide tablets. Additionally,the treatment group was added with oral modified GFT,one dose a day,for 12 weeks. Before and after treatment,Chinese medicine symptom scores were measured to determine the efficacy of improving Chinese medicine syndromes; ambulatory blood pressure were tested,including 24 h mean systolic blood pressure(24-SBP),24 h mean diastolic blood pressure(24-DBP),nighttime mean systolic blood pressure(N-SBP),nighttime mean diastolic blood pressure(N-DBP),daytime mean systolic blood pressure(D-SBP) and daytime mean diastolic pressure(D-DBP),to calculate the pulse pressure; and hematocrit was calculated. Results After treatment in the treatment group,20 cases were markedly effective,12 cases effective,2 cases ineffective,and 0 cases aggravated. The total effective rate was 95. 59%. In the control group,17 cases were markedly effective,10 effective,6 ineffective and 1 case aggravated. The total effective rate was 79. 41%. Effect of improving Chinese medicine syndrome in the treatment group was better than that in the control group(P < 0. 05). The 24-SBP,24-DBP,NSBP,D-SBP and D-DBP in the treatment group after treatment were significantly lower than those before treatment,and also significantly lower than those in the control group after treatment(P < 0. 05 or P < 0. 01). The pulse pressure and hematocrit after treatment were lower than those before treatment in each group,and the decrease in the treatment group was more obvious than that in the control group(P < 0. 05). Conclusion Modified GFT combined with conventional western medicine can reduce the pulse pressure and improve the hematocrit in elderly patients with essential hypertension with blood stasis syndrome,and its curative effect seems superior to that of conventional treatment alone.
Objective To discuss the effect of modified Guizhi Fuling Tang(桂枝茯苓汤,GFT) combined with conventional treatment in senile essential hypertension with blood stasis syndrome. Methods Sixty-eight elderly essential hypertension patients with blood stasis syndrome were randomized into a treatment group and a control group,with 34 cases in each. Both groups were treated with conventional western medicine perindopril tablets and hydrochlorothiazide tablets. Additionally,the treatment group was added with oral modified GFT,one dose a day,for 12 weeks. Before and after treatment,Chinese medicine symptom scores were measured to determine the efficacy of improving Chinese medicine syndromes; ambulatory blood pressure were tested,including 24 h mean systolic blood pressure(24-SBP),24 h mean diastolic blood pressure(24-DBP),nighttime mean systolic blood pressure(N-SBP),nighttime mean diastolic blood pressure(N-DBP),daytime mean systolic blood pressure(D-SBP) and daytime mean diastolic pressure(D-DBP),to calculate the pulse pressure; and hematocrit was calculated. Results After treatment in the treatment group,20 cases were markedly effective,12 cases effective,2 cases ineffective,and 0 cases aggravated. The total effective rate was 95. 59%. In the control group,17 cases were markedly effective,10 effective,6 ineffective and 1 case aggravated. The total effective rate was 79. 41%. Effect of improving Chinese medicine syndrome in the treatment group was better than that in the control group(P < 0. 05). The 24-SBP,24-DBP,NSBP,D-SBP and D-DBP in the treatment group after treatment were significantly lower than those before treatment,and also significantly lower than those in the control group after treatment(P < 0. 05 or P < 0. 01). The pulse pressure and hematocrit after treatment were lower than those before treatment in each group,and the decrease in the treatment group was more obvious than that in the control group(P < 0. 05). Conclusion Modified GFT combined with conventional western medicine can reduce the pulse pressure and improve the hematocrit in elderly patients with essential hypertension with blood stasis syndrome,and its curative effect seems superior to that of conventional treatment alone.
引文
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[5]陈亚飞,王春霞,袁中尚,等.血细胞比容与高血压发生风险的队列研究[J].中华心血管病杂志,2016,44(11):973-978.
[6]NAKANISHI N,YOSHIDA H,OKAMOTO M,et al.Hematocrit and risk for hypertension in middle-aged Japanese male office workers[J].Ind Health,2001,39(1):17-20.
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[8]陈丽芳.桂枝茯苓丸加味在心血管病中的运用[J].辽宁中医学院学报,2005,7(3):235.
[9]吴修红,杨恩龙,何录文,等.桂枝茯苓丸治疗血瘀证研究进展[J].中国中医药信息杂志,2014,31(5):133-135.
[10]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[11]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,2002:18.
[12]黄榕,邓烈华,沈安娜,等.单纯收缩期高血压患者血管内皮功能与左心室肥厚的关系[J].中华老年心血管病杂志,2012,12(7):580-583.
[13]NISHIKIDO N,KOBAYASHI T,KASHIWAZAKI H.Hematocrit correlates with blood pressure in young male office woekers[J].Ind Health,1999,37(1):76-81.
[14]SMITH WC,LOWE GD,LEE AJ,et al.Rheological determinants of blood pressure in a Scottish adult population[J].J Hypertens,1992,10(5):467-472.
[15]CIRILLO M,LAURENZI M,TREVISAN M,et al.Hematocrit,blood pressure,and hypertension.The gubbio population study[J].Hypertension,1992,20(3):319-326.
[16]寇宗莉,王记.桂枝茯苓胶囊对缺血性脑卒中患者神经功能的影响[J].甘肃中医学院学报,2012,29(1):26-28.
[17]金敬梅.桂枝茯苓汤合二陈汤加减治疗痰瘀交阻型冠心病心绞痛合并高血压病45例[J].河北中医,2010,32(6):854-855.
[2]BENETOS A,RUDNICHI A,SAFAR M,et al.Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects[J].Hypertension,1998,32(3):560-564.
[3]PANNIER B,BRUNEL P,EL AROUSSY W,et al.Pulse pressure and echocardiographic findings in essential hypertension[J].J Hypertens,1989,7(2):127-132.
[4]FACCHINI FS,CARANTONI M,JEPPESEN J,et al.Hematocrit and hemoglobin are independently related to insulin resistance and compensatory hyperinsulinemia in healthy,non-obese men and women[J].Metabolism,1998,47(7):831-835.
[5]陈亚飞,王春霞,袁中尚,等.血细胞比容与高血压发生风险的队列研究[J].中华心血管病杂志,2016,44(11):973-978.
[6]NAKANISHI N,YOSHIDA H,OKAMOTO M,et al.Hematocrit and risk for hypertension in middle-aged Japanese male office workers[J].Ind Health,2001,39(1):17-20.
[7]谷万里,史载祥,余云旭,等.原发性高血压的中医证型特征[J].中西医结合学报,2010,8(9):842-847.
[8]陈丽芳.桂枝茯苓丸加味在心血管病中的运用[J].辽宁中医学院学报,2005,7(3):235.
[9]吴修红,杨恩龙,何录文,等.桂枝茯苓丸治疗血瘀证研究进展[J].中国中医药信息杂志,2014,31(5):133-135.
[10]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[11]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,2002:18.
[12]黄榕,邓烈华,沈安娜,等.单纯收缩期高血压患者血管内皮功能与左心室肥厚的关系[J].中华老年心血管病杂志,2012,12(7):580-583.
[13]NISHIKIDO N,KOBAYASHI T,KASHIWAZAKI H.Hematocrit correlates with blood pressure in young male office woekers[J].Ind Health,1999,37(1):76-81.
[14]SMITH WC,LOWE GD,LEE AJ,et al.Rheological determinants of blood pressure in a Scottish adult population[J].J Hypertens,1992,10(5):467-472.
[15]CIRILLO M,LAURENZI M,TREVISAN M,et al.Hematocrit,blood pressure,and hypertension.The gubbio population study[J].Hypertension,1992,20(3):319-326.
[16]寇宗莉,王记.桂枝茯苓胶囊对缺血性脑卒中患者神经功能的影响[J].甘肃中医学院学报,2012,29(1):26-28.
[17]金敬梅.桂枝茯苓汤合二陈汤加减治疗痰瘀交阻型冠心病心绞痛合并高血压病45例[J].河北中医,2010,32(6):854-855.