冠心病所致心力衰竭的中医证型分布及药证对应关系研究
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摘要
目的:总结临床住院冠心病所致心力衰竭患者中医证型分布,分析常见证型与一般临床指标的关系;总结对于冠心病所致心力衰竭疾病的治疗中的药证对应关系,并研究年龄、心功能、诊治医师等临床相关因素对冠心病心衰证型分布的影响及诊治特点。
方法:通过对中国中医科学院广安门医院心内科2006年12月-2008年3月出院冠心病所致心力衰竭患者病例相关信息的采集,整理汇集成大量临床研究数据,然后按照标准进行筛选,使用SPSS13.0对数据进行统计分析,以及进行后期整理归纳,形成对我院冠心病所致心力衰竭患者证型分布、一般影响因素及诊疗规律的认识。
结果:
1.冠心病所致心力衰竭疾病的各中医证型在年龄、性别、左室舒张末期内径方面比较无显著差异;阳虚水泛证与其余证型相比在心功能、左室收缩功能方面有显著差异。
2.临床治疗冠心病所致心力衰竭相同中医证候时的方药组成大致相同,但具体到各医师时又有各自不同的侧重点。
结论:
1.临床冠心病所致心力衰竭的回顾性研究表明,此类疾病为本虚标实之证,本虚为气虚、阳虚、阴虚,标实为血瘀、水饮、痰饮。病变过程为心气虚→病理产物蓄积(瘀血、痰浊、水饮)→心阴虚→病理产物进一步蓄积→心阳虚(气虚加重)。阳虚证是心力衰竭的终末阶段,与其余证型相比,在心功能、左室收缩功能方面有显著差异。
2.通过对冠心病所致心力衰竭的药证对应性研究的结果表明,临床治疗各种证候的方药组成大致相同,但各医师又有各自不同的侧重点。
Objective:to discuss the clinical TCM syndrome distribution of CHF,caused by coronary heart disease(CHD),and analyze the relationship between syndrome and general report of clinical examination.To discuss the relationship between drug and syndrome in healing people with CHF.Then we analyze the relative factors such as gender,age,etc.To sum up the regulations of CHF syndrome differentiation and therapeutic determineation.
Methods:Collecting the inpatients's corresponding information in the Guang An Men hospital from Dec,2006 to Mar 2008 then adapt the mass information to research data base.Process the clinical data by SPSS13.0.Through statistics analyzing,grasp the primary station of CHF(which caused by CHD)syndrome distribution,general influences regulations and characteristics of TCM diagnosing and treating.
Result:
1.When it comes to age,gender,left ventricular internal diameter at end-diastole(LVIDD),there are no deferences between CHF syndrome.But compare with other syndromes,yang-defiency and fluid-retention syndrome has poor heart function and left ventricular's contractile function.
2.The herb used to treat the CHF patients are accord with the TCM syndrome, but different doctor has different emphases.
Conclusion:
1.The retrospective study tells us that the reason of this disease is asthenia in origin and asthenia in superficiality.Asthenia in origin can be divided into qi-deficiency,yin- deficiency and yang- deficiency.Asthenia in superficiality can also be divided into phlegm block,fluid-retention and blood stasis.The process of the disease is:heart qi deficiency→pathological products block(phlegm block, fluid-retention and blood stasis,etc)→heart yin deficiency→the growing amount of pathological products→heart yang deficiency.Heart yang-defiency which is the last stage of CHF has poor heart function and left ventricle's contractile function ompare with other syndromes.
2.The research of the relationship between herb and syndrome tells us:The herb used to treat the CHF patients are accord with the TCM syndrome,but different doctor has different emphases.
方法:通过对中国中医科学院广安门医院心内科2006年12月-2008年3月出院冠心病所致心力衰竭患者病例相关信息的采集,整理汇集成大量临床研究数据,然后按照标准进行筛选,使用SPSS13.0对数据进行统计分析,以及进行后期整理归纳,形成对我院冠心病所致心力衰竭患者证型分布、一般影响因素及诊疗规律的认识。
结果:
1.冠心病所致心力衰竭疾病的各中医证型在年龄、性别、左室舒张末期内径方面比较无显著差异;阳虚水泛证与其余证型相比在心功能、左室收缩功能方面有显著差异。
2.临床治疗冠心病所致心力衰竭相同中医证候时的方药组成大致相同,但具体到各医师时又有各自不同的侧重点。
结论:
1.临床冠心病所致心力衰竭的回顾性研究表明,此类疾病为本虚标实之证,本虚为气虚、阳虚、阴虚,标实为血瘀、水饮、痰饮。病变过程为心气虚→病理产物蓄积(瘀血、痰浊、水饮)→心阴虚→病理产物进一步蓄积→心阳虚(气虚加重)。阳虚证是心力衰竭的终末阶段,与其余证型相比,在心功能、左室收缩功能方面有显著差异。
2.通过对冠心病所致心力衰竭的药证对应性研究的结果表明,临床治疗各种证候的方药组成大致相同,但各医师又有各自不同的侧重点。
Objective:to discuss the clinical TCM syndrome distribution of CHF,caused by coronary heart disease(CHD),and analyze the relationship between syndrome and general report of clinical examination.To discuss the relationship between drug and syndrome in healing people with CHF.Then we analyze the relative factors such as gender,age,etc.To sum up the regulations of CHF syndrome differentiation and therapeutic determineation.
Methods:Collecting the inpatients's corresponding information in the Guang An Men hospital from Dec,2006 to Mar 2008 then adapt the mass information to research data base.Process the clinical data by SPSS13.0.Through statistics analyzing,grasp the primary station of CHF(which caused by CHD)syndrome distribution,general influences regulations and characteristics of TCM diagnosing and treating.
Result:
1.When it comes to age,gender,left ventricular internal diameter at end-diastole(LVIDD),there are no deferences between CHF syndrome.But compare with other syndromes,yang-defiency and fluid-retention syndrome has poor heart function and left ventricular's contractile function.
2.The herb used to treat the CHF patients are accord with the TCM syndrome, but different doctor has different emphases.
Conclusion:
1.The retrospective study tells us that the reason of this disease is asthenia in origin and asthenia in superficiality.Asthenia in origin can be divided into qi-deficiency,yin- deficiency and yang- deficiency.Asthenia in superficiality can also be divided into phlegm block,fluid-retention and blood stasis.The process of the disease is:heart qi deficiency→pathological products block(phlegm block, fluid-retention and blood stasis,etc)→heart yin deficiency→the growing amount of pathological products→heart yang deficiency.Heart yang-defiency which is the last stage of CHF has poor heart function and left ventricle's contractile function ompare with other syndromes.
2.The research of the relationship between herb and syndrome tells us:The herb used to treat the CHF patients are accord with the TCM syndrome,but different doctor has different emphases.
引文
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[2]Cleland JGF.Improving patient outcomes in heart failure:Evidence and barriers.Heart,2000,84(Suppl I):8-10
[3]顾东风等.中国心力衰竭流行病学调查及其患病率[J].中华心血管病杂志.2003,31(1):3-6
[4]中华医学会心血管病学分会.中国部分地区1980、1990、2000年慢性心力衰竭住院病例回顾性调查[J]。中华心血管病杂志.2002,30(8):450-454
[5]Komajda M,Wimart MC.Anglotensin converting enzyme inhibition:From viper to patient.Heart,2000;84(Suppll):11-14
[6]葛丽华,刘梅林.发展中国家心衰人群的流行病学特点[J].中华实用医药杂志.2003,3(17):1576-1578
[7]郑三晖,庄霖鹏,曾哲.76例住院慢性心衰患者病因分析[J].河北医学.2004.1(2):130-132
[8]薛礼美,陈晓虎,等.CHF的神经内分泌激素、细胞因子变化的研究进展[J].医学综述.2004,10(3):146-150
[9]Globits S,Frank H,Packer B,etal.Atrail natriuretic Peptide release is more dependent on atrial filling volume than on filling pressure in chronic CHF[J].Am Heart J,1998,135(4):592-597
[10]钱方毅.重视心力衰竭发病中的神经内分泌细胞因子系统的研究[J].中国循环杂志.2001,16(4):243
[11]沈冰.利钠肽系统在心血管疾病中的作用探讨[J].心血管病学进展.2003,24(3):185-188
[12]Torre-Amiore G,Kapadia S,Benedict C,et al.Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the studies of left ventricular dysfunction (SOLVD) [J].J Am Coll Cardiol, 1996, 27: 1201-1206
[13]Cohn JN. Structural changes in cardiovascular disease[J]. Am J Cardiol, 1995, 76 (1): 34
[14]Weber KJ, Sun Y. bell SE. Structural remodeling of the heart by fibrous tissue: role of circulating hormos and locally produced peptides[J]. Eur Heart J.1995, 16 (1): 12
[15] 林曙光,陈鲁原．心力衰竭治疗领域之用药进展[J]．中国处方药．2004,22：26—28
[16]Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programmer [J]. Lancet, 2003, 362 (9386): 759-766
[17]Haim M, Shotan A, Boyko V, et al. Effect of β2 blocker therapy in Patients with cardiol oronary disease in New York heart association Classesand[J].Am J Cardiol, 1998, 81 (9): 1455
[18]Pitt B, Zannad F, REmme WJ, et al. Spirono lactone appears beneficial regardless of ejection fraction: the RALES trial[J]. Circulation, 1999, 100 (suppl): 709-717
[l9]Ward MR, Kanellakis P, Ramsey D, et al. Eplerenone suppresses constrictive remodeling and collagen accumulation after angioplasty in procine coronary arteries. Circulation, 2001, 104 (4), 467-472
[20] John A, Joseph MD, Phil MS, et al. Expanding the outcomes in clinical trials of heart failure: The quality of life and economic components of EPHESUS (EPlerenone's neuro Hormonal efficacy and survival study) .Am Heart J, 2002, 143: 636-642
[21]Toussaint JF, Lavergne T, Olitrant J, et al.Biventricular pacing in severe heart failure patients reverses electromechanical dysynchronization from apex to base[J]. PACE, 2000, 23: 1731-1734
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