温阳利水法治疗慢性充血性心力衰竭的临床观察
摘要
研究背景:透过文献研究得知充血性心力衰竭(CHF)是所有不同种类心脏病的主要并发症,是临床常见的危重症,是多数器质性心脏病几乎不可避免的结局,发病率逐年增加。充血性心力衰竭不仅威胁人类生命,还造成极高的经济成本,带给个人家庭及社会相当大的负担。
研究目的:温阳利水法治疗充血性心力衰竭的临床疗效。
研究方法:广州中医药大学第一附属医院门诊和病房病人。针对符合充血性心力衰竭诊断标准的患者50例。随机分为治疗组30例,对照组20例,两组均运用抗心衰西药治疗,基础疾病治疗用药继续使用,治疗组中药使用五苓散加减,对照组中药使用安慰剂。
研究结果:入选治疗组30例病人,12例心功能Ⅳ级,16例为Ⅲ级,2例为Ⅱ级,温阳利水法治疗14天后,10例进步2级,18例进步1级以上,无变化的2例;对照组20例病人,7例心功能Ⅳ级,10例为Ⅲ级,3例为Ⅱ级,治疗后5例进步2级,13例进步1级以上,无变化的2例。心功能分级疗效方面治疗组总有效率为93.3.%,对照组总有效率为90%,两组总有效率之比较,结果p>0.05,说明治疗组与对照组的临床疗效对比疗效相当。但两组患者自觉症状有效率比较,心悸、气促、乏力、胸闷、形寒肢冷等症状及体征紫绀,p<0.01,有极显著差异,治疗组明显优于对照组。治疗组患者体征前后对比,舒张压、心率、脉搏,p<0.01,有极显著差异;呼吸、收缩压,p<0.05,有显著性差异;但体重、LVEF无显著差异;水肿、肝脏情况、颈静脉怒张,p<0.05,差异有显著性。
结论:温阳利水法治疗充血性心力衰竭有一定疗效,尤其对于控制症状,心率、脉搏、呼吸频率降低,均有显著的疗效。
Theory background: CHF is the major complication of all different kinds of heart disease via document research. It's a common clinical dangerous disease which inevitably ends up majority organic heart disease. And the incidence of it increases year by year. CHF not only threatens human life but also causes high economy cost that brings great burden to individual family and whole society.Objective: The clinical curative effect of warming Yang and diuretic treatment for CHF. Measures: 50 patients who fit the CHF diagnosis standard from outpatient service and ward of the First Affiliated Hospital of Guangzhou University of TCM. They are divided by random into two groups which have 30 cases in remedy group and 20 cases in contrast group. Both groups are treated by anti-heart failure western medicine and basis disease remedy continues. Remedy group uses Chinese medicine- Wu-Ling-San, when the contrast group uses that of the placebo.Results: 30 cases in remedy group, 12 cases heart function are IV degree, 16 cases are III degree, and 2 cases are II degree. After treated by warming Yang and diuretic for 14 days, 10 cases made progress 2 degree, 18 cases made progressed 1 degree at least, 2 cases unchanged. 20 cases in contrast group, 7 cases heart function are IV degree, 10 cases are III degree, and 3 cases are II degree. After treated, 8 cases made progress 2 degree, 10 cases made progress 1 degree at least, 2 cases unchanged. Overall efficiency of heart function classified curative effect in remedy group is 93.3% while the contrast group is 90%. The comparison of overall efficiency in two groups the result is p>0.05. This shows that the curative effect in two groups is similar. But after comparing subjective symptoms in two groups, there are remarkable differences in symptoms of palpitations, short of breath, lack of strength, stuffy chest, feeling cold, etc; also symptoms of anoxia; p<0.01. Remedy group is obviously superior to contrast group. After comparing, body symptoms in remedy group, there are remarkable difference in diastolic pressure, heart rate, and breath; p<0.01. Those have obvious difference in systolic pressure, and breath; p<0.05. But there is no obvious difference in body weight and LVEF. There are obvious
研究目的:温阳利水法治疗充血性心力衰竭的临床疗效。
研究方法:广州中医药大学第一附属医院门诊和病房病人。针对符合充血性心力衰竭诊断标准的患者50例。随机分为治疗组30例,对照组20例,两组均运用抗心衰西药治疗,基础疾病治疗用药继续使用,治疗组中药使用五苓散加减,对照组中药使用安慰剂。
研究结果:入选治疗组30例病人,12例心功能Ⅳ级,16例为Ⅲ级,2例为Ⅱ级,温阳利水法治疗14天后,10例进步2级,18例进步1级以上,无变化的2例;对照组20例病人,7例心功能Ⅳ级,10例为Ⅲ级,3例为Ⅱ级,治疗后5例进步2级,13例进步1级以上,无变化的2例。心功能分级疗效方面治疗组总有效率为93.3.%,对照组总有效率为90%,两组总有效率之比较,结果p>0.05,说明治疗组与对照组的临床疗效对比疗效相当。但两组患者自觉症状有效率比较,心悸、气促、乏力、胸闷、形寒肢冷等症状及体征紫绀,p<0.01,有极显著差异,治疗组明显优于对照组。治疗组患者体征前后对比,舒张压、心率、脉搏,p<0.01,有极显著差异;呼吸、收缩压,p<0.05,有显著性差异;但体重、LVEF无显著差异;水肿、肝脏情况、颈静脉怒张,p<0.05,差异有显著性。
结论:温阳利水法治疗充血性心力衰竭有一定疗效,尤其对于控制症状,心率、脉搏、呼吸频率降低,均有显著的疗效。
Theory background: CHF is the major complication of all different kinds of heart disease via document research. It's a common clinical dangerous disease which inevitably ends up majority organic heart disease. And the incidence of it increases year by year. CHF not only threatens human life but also causes high economy cost that brings great burden to individual family and whole society.Objective: The clinical curative effect of warming Yang and diuretic treatment for CHF. Measures: 50 patients who fit the CHF diagnosis standard from outpatient service and ward of the First Affiliated Hospital of Guangzhou University of TCM. They are divided by random into two groups which have 30 cases in remedy group and 20 cases in contrast group. Both groups are treated by anti-heart failure western medicine and basis disease remedy continues. Remedy group uses Chinese medicine- Wu-Ling-San, when the contrast group uses that of the placebo.Results: 30 cases in remedy group, 12 cases heart function are IV degree, 16 cases are III degree, and 2 cases are II degree. After treated by warming Yang and diuretic for 14 days, 10 cases made progress 2 degree, 18 cases made progressed 1 degree at least, 2 cases unchanged. 20 cases in contrast group, 7 cases heart function are IV degree, 10 cases are III degree, and 3 cases are II degree. After treated, 8 cases made progress 2 degree, 10 cases made progress 1 degree at least, 2 cases unchanged. Overall efficiency of heart function classified curative effect in remedy group is 93.3% while the contrast group is 90%. The comparison of overall efficiency in two groups the result is p>0.05. This shows that the curative effect in two groups is similar. But after comparing subjective symptoms in two groups, there are remarkable differences in symptoms of palpitations, short of breath, lack of strength, stuffy chest, feeling cold, etc; also symptoms of anoxia; p<0.01. Remedy group is obviously superior to contrast group. After comparing, body symptoms in remedy group, there are remarkable difference in diastolic pressure, heart rate, and breath; p<0.01. Those have obvious difference in systolic pressure, and breath; p<0.05. But there is no obvious difference in body weight and LVEF. There are obvious
引文
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[4] 赵永华.中西医结合救治重度心力衰竭的探讨.中国中西医结合急救杂志,2003;1(10):64～65.
[5] 徐润,等.实用中医内科急症学,北京:北京出版社,1992,1:186.
[6] 丁有钦,等.强心煎治疗慢性充血性心力衰竭的疗效观察.新中医,1991;2(4):25.
[7] 李用梓.证治汇补,上海:上海卫生出版社,1958,1:331.
[8] 沈金鏊.杂病源流犀烛,上海:上海科学技术出版社,1962,1:139。
[9] 谭璐芸.郭维琴治疗心力衰竭经验介绍.云南中医学院学报,2000;23(2):43.
[10] 韩明向.对心功能不全病机的探讨.安徽中医学院学报,1988;7(2):2。
[11] 霍根红.试论充血性心力衰竭的中医病理实质.河南中医药学刊,1996;16(1):12.
[12] 周仲瑛,金妙,吴勉华,等.益阴助阳,活血通脉治疗充血性心力衰竭的临床研究.南京中医药大学报,2001;16(1):13～16.
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[14] 杜惠芳,杨加禄,郭素英.慢性充血性心力衰竭与痰之关系初探.河南中医药学刊.1998;9(3):34～36.
[15] 李春艳,曹守沛.中医药治疗充血性心力衰竭的临床研究进展.安徽中医临床杂志2003:2(15):2.
[16] 谭焕民,骆亚利,等.辨证分型治疗慢性充血性心力衰竭86例.河南中医,1999;19(3):40～41.
[17] 马晓云.益气强心与温阳利水法治疗充血性心力衰竭43例.中国医药 学报,1993;8(6):30
[18] 李青,琚坚,詹青,等.詹文涛教授治疗难治性心力衰竭临床经验.中国中医急症2002;11(5):375～376
[19] 陈汝兴.益气温阳利水汤治疗充血性心力衰竭的临床经验.上海中医药杂志2002;(2):9～10
[20] 黄丽华.益气温阳利水法治疗老年心力衰竭42例.天津中医2002;19(5):78
[21] 徐瑛,等.益气温阳泻肺利水治疗慢性充血性心力衰竭.辽宁中医杂志2003;30(7):540～541
[22] 姜希才,等.益气活血温阳利水治难治性心力衰竭100例临床观察.江西中医药2000;31(4):22.
[23] 安海英,黄丽娟,金敬善,等.益气温阳和活血利水法对充血性心力衰竭患者神经内分泌系统的影响.中国中西医结合杂志.2002;22(5):349～351.
[24] 李成林.加用益气温阳法对充血性心力衰竭患者甲状腺激素水平的影响.广西中医药.2001;24(3):3～5.
[25] 匡调元.中医病理研究,上海:上海科学技术出版社,1990;1:123.
[26] 关继华.辨证治疗充血性心力衰竭58例.陝西中医,1994;15(3):99.
[27] 关德民,张春燕.运用温阳利水法主治慢性充血性心力衰竭60例.中医药学报.2002;30(3):11.
[28] 周晔玲.苓桂朮甘汤加减治疗慢性充血性心力衰竭28例.广西医学2003;25(11):2356～2357.
[29] 马有凤,常广树.五苓散佐治充血性心力衰竭.实用中医内科杂志2003;16(1):11
[30] 范红玲.中西医结合治疗慢性心力衰竭58例.河南中医.2002;22(4):23.
[31] 宋峻,王永标.真武汤加减治疗慢性心衰172例.四川中医.1999;17(6):25.
[32] 龙新生,吕萍,莫劲松,等加味真武汤对充血性心力衰竭少阴病阳虚水停证兔内皮素的影响.中医中西医结合急救杂志2003;10(5):287～289.
[33] 龚成初,等.中西医结合治疗肺心病心力衰竭48例.中西医结合实用临床急救,1996;3(4):154.
[34] 陈可冀,袁钟,钱自奋·实用中西医结合内科学,北京:中国协和医科大学北京医科大学出版社,1998;1:452～461.
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