加味苓桂术甘汤治疗充血性心力衰竭的疗效观察
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摘要
目的:观察加味苓桂术甘汤治疗充血性心力衰竭(CHF)的临床疗效,并通过临床实验研究探讨其对心脏左室射血分数及血浆BNP的影响。
方法:将60例符合纳入标准的充血性心力衰竭患者随机分为治疗组和对照组,每组各30例。对照组采用西医规范治疗:采用最新的《慢性充血性心力衰竭治疗建议》(中华心血管病杂志,2002;30(1):7—21)推荐的最适合的治疗方法,患者入院后即根据病情进行基础治疗:①一般的常规治疗:休息、限盐、吸氧等;②予利尿(双氢克尿噻25～50mg或速尿20mg、安体舒通20mg,每日1-3次口服);③ACEI:(开搏通6.25mg,每日2次开始);④β—受体阻滞剂(倍他乐克从6.25mg,每日1次口服开始);⑤强心(地高辛0.25mg,每日一次口服,一周后依据患者的病情,调整其用量或暂停药)。治疗组在西医规范治疗基础上,口服加味苓桂术甘汤治疗,每日一剂,疗程21日。观察治疗前后临床症状、体征及总有效率,左室射血分数(LVEF)、血浆BNP的变化,两组治疗副作用及停药率,并做统计学处理,比较其疗效。
结果:(1)两组患者临床症状、体征治疗后均有改善,治疗组与对照组相比,差异有统计学意义(P＜0.05)。
(2)两组治疗前后比较,均可改善左室射血分数(LVEF),其中治疗组作用更为显著,与对照组相比差异有统计学意义(P＜0.05),治疗组优于对照组。
(3)两组治疗前后比较,血液中BNP含量均有显著性差异(P＜0.05),其中治疗组与对照组相比差异有统计学意义(P＜0.05),治疗组优于对照组。
(4)治疗组的低钾血症较对照组低,有统计学意义(P＜0.05);治疗组的停药率较对照组高,有统计学意义(P＜0.05)。
结论:(1)加味苓桂术甘汤可明显改善充血性心力衰竭患者的临床症状及体征。
(2)加味苓桂术甘汤可有效改善左室收缩功能,提高左室射血分数,从而改善机体血液循环,减轻心衰临床症状。
(3)加味苓桂术甘汤可明显降低血浆BNP含量,从而起到心肌保护作用。
(4)中西医结合治疗较单纯西药治疗可以更好的减少低钾血症,减少甚至停用利尿剂或洋地黄制剂,有更好的临床安全性及依从性。
OBJECTIVE:Observes doctor practicing western medicine convention treatment+ addition and subtraction water chestnut Gui Zhugan soup treatment chronic congested heart failure(CHF) in the clinical symptoms alleviation,the heart function improvement,contrasts it with the western medicine convention treatment result,is the two difference whether remarkable,thus provides certain fundamental research for the traditional Chinese medicine treatment chronic congested heart failure.
METHODS:60 patients with the standards included in patients with congestive heart failure were randomly divided into treatment and control groups,each of the 30 cases. Regulating the control group used traditional western medicine treatment:The application of the latest "chronic congestive heart failure treatment recommendations"(China cardiovascular disease magazine,2002;30(1):7-21) Recommend the most appropriate method of treatment, According to patients after hospital-based treatment of illness:①general routine treatment: rest,salt restriction,oxygen,etc.;②to the diuretic(urine dihydrochloride grams thiadiazole 25～50 mg or 20 mg furosemide,antisterone 20 mg,1 to 3 times daily oral);③ACEI: (captopril 625 mg,twice daily beginning);④β-receptor blocker(metoprolol from 6.25 mg daily oral dose of 1 start);⑤cardio(digoxin 0.25 mg daily oral administration,a week after the condition of patients based on the alignment of their drug dosage or suspension).Western medicine in the treatment group on the basis of standard treatment,Modified oral Lingguizhugan Decoction of treatment,a daily,the course on the 21st.Before and after the treatment clinical symptoms,signs and the total effective rate,left ventricular ejection fraction (LVEF),the changes in blood BNP,And do statistical analysis to compare their efficacy.
Results:(1) After treatment group and control group patient's clinical symptoms, heart function treatment,has the enhancement,compares before the treatment,the difference has statistics significance(P＜0.05).
(2) After the treatment,treats the group patient's left room to shoot the menstruation number,blood BNP and the control group compares the difference to have statistics significance(P＜0.05).
(3) Comparison of the two groups before and after treatment,BNP levels in the blood were significantly different(P＜0.05,P＜0.01),in which the treatment group compared with the control group had a significant difference(P＜0.05),the treatment group than the control group.
(4) Hypokalemia the treatment group than the control group,statistical significance(P＜0.05);The withdrawal rate of the treatment group than the control group,a statistically significant(P＜0.05).
Conclusions:(1) The doctor practicing western medicine convention treatment and doctor practicing western medicine convention treatment+addition and subtraction water chestnut Gui Zhugan the soup treatment may improve the chronic congested heart failure patient's clinical symptoms and the heart function.
(2) Doctor practicing western medicine convention treatment+addition and subtraction water chestnut Gui Zhugan the soup treatment compares the doctor practicing western medicine convention treatment curative effect to be good..
(3) Effects of jiaweiLingguizhugan decoction can significantly reduce plasma BNP levels,which play a role in myocardial protection.
(4) Integrated Treatment of a purely western medicine can better reduce hypokalemia, Reduce or even stop using diuretics or digitalis preparations,A better clinical safety and compliance.
方法:将60例符合纳入标准的充血性心力衰竭患者随机分为治疗组和对照组,每组各30例。对照组采用西医规范治疗:采用最新的《慢性充血性心力衰竭治疗建议》(中华心血管病杂志,2002;30(1):7—21)推荐的最适合的治疗方法,患者入院后即根据病情进行基础治疗:①一般的常规治疗:休息、限盐、吸氧等;②予利尿(双氢克尿噻25～50mg或速尿20mg、安体舒通20mg,每日1-3次口服);③ACEI:(开搏通6.25mg,每日2次开始);④β—受体阻滞剂(倍他乐克从6.25mg,每日1次口服开始);⑤强心(地高辛0.25mg,每日一次口服,一周后依据患者的病情,调整其用量或暂停药)。治疗组在西医规范治疗基础上,口服加味苓桂术甘汤治疗,每日一剂,疗程21日。观察治疗前后临床症状、体征及总有效率,左室射血分数(LVEF)、血浆BNP的变化,两组治疗副作用及停药率,并做统计学处理,比较其疗效。
结果:(1)两组患者临床症状、体征治疗后均有改善,治疗组与对照组相比,差异有统计学意义(P＜0.05)。
(2)两组治疗前后比较,均可改善左室射血分数(LVEF),其中治疗组作用更为显著,与对照组相比差异有统计学意义(P＜0.05),治疗组优于对照组。
(3)两组治疗前后比较,血液中BNP含量均有显著性差异(P＜0.05),其中治疗组与对照组相比差异有统计学意义(P＜0.05),治疗组优于对照组。
(4)治疗组的低钾血症较对照组低,有统计学意义(P＜0.05);治疗组的停药率较对照组高,有统计学意义(P＜0.05)。
结论:(1)加味苓桂术甘汤可明显改善充血性心力衰竭患者的临床症状及体征。
(2)加味苓桂术甘汤可有效改善左室收缩功能,提高左室射血分数,从而改善机体血液循环,减轻心衰临床症状。
(3)加味苓桂术甘汤可明显降低血浆BNP含量,从而起到心肌保护作用。
(4)中西医结合治疗较单纯西药治疗可以更好的减少低钾血症,减少甚至停用利尿剂或洋地黄制剂,有更好的临床安全性及依从性。
OBJECTIVE:Observes doctor practicing western medicine convention treatment+ addition and subtraction water chestnut Gui Zhugan soup treatment chronic congested heart failure(CHF) in the clinical symptoms alleviation,the heart function improvement,contrasts it with the western medicine convention treatment result,is the two difference whether remarkable,thus provides certain fundamental research for the traditional Chinese medicine treatment chronic congested heart failure.
METHODS:60 patients with the standards included in patients with congestive heart failure were randomly divided into treatment and control groups,each of the 30 cases. Regulating the control group used traditional western medicine treatment:The application of the latest "chronic congestive heart failure treatment recommendations"(China cardiovascular disease magazine,2002;30(1):7-21) Recommend the most appropriate method of treatment, According to patients after hospital-based treatment of illness:①general routine treatment: rest,salt restriction,oxygen,etc.;②to the diuretic(urine dihydrochloride grams thiadiazole 25～50 mg or 20 mg furosemide,antisterone 20 mg,1 to 3 times daily oral);③ACEI: (captopril 625 mg,twice daily beginning);④β-receptor blocker(metoprolol from 6.25 mg daily oral dose of 1 start);⑤cardio(digoxin 0.25 mg daily oral administration,a week after the condition of patients based on the alignment of their drug dosage or suspension).Western medicine in the treatment group on the basis of standard treatment,Modified oral Lingguizhugan Decoction of treatment,a daily,the course on the 21st.Before and after the treatment clinical symptoms,signs and the total effective rate,left ventricular ejection fraction (LVEF),the changes in blood BNP,And do statistical analysis to compare their efficacy.
Results:(1) After treatment group and control group patient's clinical symptoms, heart function treatment,has the enhancement,compares before the treatment,the difference has statistics significance(P＜0.05).
(2) After the treatment,treats the group patient's left room to shoot the menstruation number,blood BNP and the control group compares the difference to have statistics significance(P＜0.05).
(3) Comparison of the two groups before and after treatment,BNP levels in the blood were significantly different(P＜0.05,P＜0.01),in which the treatment group compared with the control group had a significant difference(P＜0.05),the treatment group than the control group.
(4) Hypokalemia the treatment group than the control group,statistical significance(P＜0.05);The withdrawal rate of the treatment group than the control group,a statistically significant(P＜0.05).
Conclusions:(1) The doctor practicing western medicine convention treatment and doctor practicing western medicine convention treatment+addition and subtraction water chestnut Gui Zhugan the soup treatment may improve the chronic congested heart failure patient's clinical symptoms and the heart function.
(2) Doctor practicing western medicine convention treatment+addition and subtraction water chestnut Gui Zhugan the soup treatment compares the doctor practicing western medicine convention treatment curative effect to be good..
(3) Effects of jiaweiLingguizhugan decoction can significantly reduce plasma BNP levels,which play a role in myocardial protection.
(4) Integrated Treatment of a purely western medicine can better reduce hypokalemia, Reduce or even stop using diuretics or digitalis preparations,A better clinical safety and compliance.
引文
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