加味生脉散治疗老年慢性心力衰竭（气阴两虚型）的疗效观察
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摘要
目的:观察加味生脉散治疗老年慢性心力衰竭(气阴两虚型)的临床疗效,并探究其治疗优势。
方法:将60例符合纳入标准的患者随机分为试验组和对照组,每组30人。对照组采用西医常规治疗,试验组在对照组基础上加用加味生脉散;治疗周期为4周。观察治疗前后患者心功能分级、脑钠尿肽(BNP)、生活质量及中医证侯评分改善情况。
结果:两组在心功能分级、BNP治疗前后的比较中均有良好的改善作用(P=0.000<0.01),组间疗效无统计学差异(心功能分级P=1.000>0.05,BNP P=0.548>0.05)。中医证侯评分比较中试验组显效率43.3%、有效率53.3%、总有效率为96.7%,与对照组比较有显著差异(P=0.000<0.01)。生活质量方面两组治疗前后组内比较体力、社会关系、情绪影响及总分均有显著改善(P=0.000<0.01);试验组各项改善程度均优于对照组(P=0.000<0.01)。
结论:加味生脉散通过益气养阴,补益心脾提高心功能,改善老年慢性心力衰竭患者的临床症状及心理状态,提高生活质量,是临床治疗老年慢性心力衰竭(气阴两虚型)的有效方剂,值得临床广泛应用。
Purpose: To observe the clinical curative effect of Jiaweishengmai decoction on the aged chronic heart failure (qiyin deficiency) and investigate its curative preponderance.
Method: 60 patients were selected according to the diagnostic criteria and randomly divided into two groups, 30 as the experimental group and the other 30 as the control group. Both groups were treated by western medical regular therapy, while the Jiaweishengmai decoction was applied to the experimental group in addition. The treatment cycles for the two groups were both 4 weeks. The improvement statements of main clinical syndrome (cardiac functional grading), quality of life, and traditional Chinese medicine (TCM) disease score and the changes of brain natriuretic factor (BNP) were observed before and after the treatment.
Result: Both groups have good improvements in cardiac functional grading and BNP after the treatment (P=0.000<0.01). There are no differences in the curative effect between the groups before and after the treatment(P=1.000>0.05,for cardiac functional grading, and P=0.548>0.05, for BNP). For the comparison of the traditional Chinese medicine disease score, the markedly effective rate , the effective rate and the total effective rate are 43.3%, 53.3% and 96.7% respectively in the experimental group, which there are significant differences comparing with the control group (P=0.000<0.01). There are significant differences in physical strength part, social relations part, emotional effect part and total score of quality of life in the experimental group before and after the treatment (P=0.000<0.001, respectively), and no statistical difference was found in economic effect part; The improved grades of all the parts in the experimental group are better than those in the control group (P=0.000<0.001, respectively).
Conclusion: Jiaweishengmai decoction is an excellent effective prescription for the clinical treatment of the aged chronic heart failure (qiyin deficiency). This prescription can not only relieve the syndrome such as choking sensation in chest by nourishing qi and yin and benefiting heart and spleen, but also improve other clinical syndromes, mental state and quality of life, which means that it is worth using widely in clinic.
方法:将60例符合纳入标准的患者随机分为试验组和对照组,每组30人。对照组采用西医常规治疗,试验组在对照组基础上加用加味生脉散;治疗周期为4周。观察治疗前后患者心功能分级、脑钠尿肽(BNP)、生活质量及中医证侯评分改善情况。
结果:两组在心功能分级、BNP治疗前后的比较中均有良好的改善作用(P=0.000<0.01),组间疗效无统计学差异(心功能分级P=1.000>0.05,BNP P=0.548>0.05)。中医证侯评分比较中试验组显效率43.3%、有效率53.3%、总有效率为96.7%,与对照组比较有显著差异(P=0.000<0.01)。生活质量方面两组治疗前后组内比较体力、社会关系、情绪影响及总分均有显著改善(P=0.000<0.01);试验组各项改善程度均优于对照组(P=0.000<0.01)。
结论:加味生脉散通过益气养阴,补益心脾提高心功能,改善老年慢性心力衰竭患者的临床症状及心理状态,提高生活质量,是临床治疗老年慢性心力衰竭(气阴两虚型)的有效方剂,值得临床广泛应用。
Purpose: To observe the clinical curative effect of Jiaweishengmai decoction on the aged chronic heart failure (qiyin deficiency) and investigate its curative preponderance.
Method: 60 patients were selected according to the diagnostic criteria and randomly divided into two groups, 30 as the experimental group and the other 30 as the control group. Both groups were treated by western medical regular therapy, while the Jiaweishengmai decoction was applied to the experimental group in addition. The treatment cycles for the two groups were both 4 weeks. The improvement statements of main clinical syndrome (cardiac functional grading), quality of life, and traditional Chinese medicine (TCM) disease score and the changes of brain natriuretic factor (BNP) were observed before and after the treatment.
Result: Both groups have good improvements in cardiac functional grading and BNP after the treatment (P=0.000<0.01). There are no differences in the curative effect between the groups before and after the treatment(P=1.000>0.05,for cardiac functional grading, and P=0.548>0.05, for BNP). For the comparison of the traditional Chinese medicine disease score, the markedly effective rate , the effective rate and the total effective rate are 43.3%, 53.3% and 96.7% respectively in the experimental group, which there are significant differences comparing with the control group (P=0.000<0.01). There are significant differences in physical strength part, social relations part, emotional effect part and total score of quality of life in the experimental group before and after the treatment (P=0.000<0.001, respectively), and no statistical difference was found in economic effect part; The improved grades of all the parts in the experimental group are better than those in the control group (P=0.000<0.001, respectively).
Conclusion: Jiaweishengmai decoction is an excellent effective prescription for the clinical treatment of the aged chronic heart failure (qiyin deficiency). This prescription can not only relieve the syndrome such as choking sensation in chest by nourishing qi and yin and benefiting heart and spleen, but also improve other clinical syndromes, mental state and quality of life, which means that it is worth using widely in clinic.
引文
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[6]李建生,等.临床中医老年病学.北京:人民卫生出版社,2008:293-306.
[7]李莉,关继华.古代中医对心衰的认识.新疆中医药,2000,18:7-9.
[8]沙龙.通过分析中医对心衰的临床研究认识,谈临床应如何开展中西医结合治究,2009,06:171-172.
[9]高巍.参附汤与生脉散并用治疗心衰5O例观察.实用中医内科杂志, 2006, 20(2): 180-181.
[10]顾小琼.黄芪合生脉散治疗充血性心衰32例.甘肃中医,2007,20(12):5-6.
[11]顾颖敏,叶穗林,吴文峰.生脉散对慢性心衰心室重塑作用的临床研究.实用中医内科学杂志,2008,22 (5):63-65.
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