化痰通络活血方治疗原发性高血压的临床观察
发布时间：2018-09-08 18:26
【摘要】：目的:原发性高血压简称高血压病,主要临床表现就是血压升高。它的患病率和发病率因国度、地域和种族的差别而有不同,当前在我国高血压成人患病率为18.8%,中年人群中患病率为24%。高血压发展到晚期可形成心、脑、肾等靶器官的损害,使病人的的发病率、死亡率很高,严重影响患者的寿命、生活质量,已经成为严重威胁人类健康、性命的疾病。在我国40岁以上人群的死亡原因中,第一位和第三位分别是心脏病和脑血管病,而高血压是总死亡的第一危险因素。如何安全、有效地防治高血压病是广大患者所关注的焦点,也是临床医师研究的主要课题之一。研究表明中、西医结合比单独的中医或西医的应用,可以增强身体对抗高血压药物的敏感性,减少靶器官损伤,取得较好的疗效。本课题主要通过进行对化痰通络活血方的临床观察,探讨高血压病的中医药治疗效果以及应用前景。方法:将80例符合诊断标准的病人随机分成中西药组和西药组进行临床观察,两组病人的一般情况无统计学差异。西药组40例,给予苯磺酸氨氯地平(络活喜、辉瑞制药有限公司,国药准字H10950224),每次5mg,每日一次口服;中西药组共40例,给予化痰通络活血方(半夏10克,陈皮10克,天麻10克,炒白术10克,桃仁10克,红花10克,当归10克,白芍15克,川芎10克,葛根30克,全虫6克,蜈蚣2条),每日一剂,分早晚两次口服;同时服用苯磺酸氨氯地平,每次5mg,每日一次口服;疗程为4周。两组病人经西医诊断均属高血压病,中医辩证均属痰瘀互结型。治疗期间观察病人的生命体征、血压、临床症状以及血糖,血脂,C反应蛋白,血液流变学,血浆肾素及血管紧张素Ⅱ等相关指标的变化情况,观察期间停服对血压有影响的所有药物。在治疗前后各对病人做1次安全性检查,结果:1两组患者血压变化情况比较治疗前血压水平比较无显著性差异(P0.05),两组在治疗后收缩压、舒张压水平较治疗前均有显著性差异(P0.01),中西药组较之西药组治疗后收缩压、舒张压降低更为明显,有显著性差异(P0.05)。表明中西药组的血压较西药组下降持续、稳定,说明加用化痰通络活血方的中西药组降压效果比单用西药组的降压效果更明显。2两组患者治疗前后动态血压平均值测定比较治疗前两组间收缩压及舒张压平均值比较无显著性差异(P0.05);治疗后同治疗前比较,两组均有显著性差异(P0.05);治疗后比较,中西药组收缩压及舒张压平均值改善均优于西药组,有显著性差异(P0.05)。表明加用化痰通络活血方组高血压病人的降压效果优于单用西药组。3两组患者降压疗效比较中西药组显效28例(70.00%),有效10例(25.00%),无效2例(5.00%),总有效率95.00%;西药组显效26例(65.00%),有效6例(15.00%),无效8例(20.00%),总有效率80.00%。两组降压疗效的总有效率经过比较,差异具有显著性(P0.05)。表明加用化痰通络活血方的降压疗效优于单用西药组。4两组患者临床症状疗效比较中西药组显效30例(75.00%),有效6例(15.00%),无效4例(10.00%),总有效率90.00%;西药组显效10例(25.00%),有效16例(40.00%),无效14例(35.00%),总有效率65.00%。两组相比有显著性差异(P0.01)。说明加用化痰通络活血方的中西药组在改善临床症状的治疗效果明显优于单用西药组。5两组患者治疗前后空腹血糖、血脂测定比较治疗后中西药组在血糖、胆固醇、甘油三酯、低密度脂蛋白较治疗前均有明显降低(P0.05),而且在治疗后对两组的各项指标做同期比较,两者间有显著性差异(P0.05),但西药组的各项指标治疗前后差异无统计学意义。说明加用化痰通络活血方组在促进血糖代谢和改善脂质代谢紊乱的治疗效果优于单用西药组。6两组患者治疗前后血液流变学比较治疗后与治疗前相比,中西药组纤维蛋白原及全血粘度明显降低(P0.05),纤维蛋白原与西药组治疗后比较有显著性差异(P0.05);西药组各项指标变化无统计学意义。表明加用化痰通络活血方的中西药组降低血液粘度的效果优于单用西药组。7两组患者治疗前后C反应蛋白测定比较治疗前两组间C反应蛋白比较无显著性差异(P0.05);治疗后较治疗前比较,两组均有显著性差异(P0.05);治疗后比较,中西药组C反应蛋白降低明显优于西药组,有显著性差异(P0.05),表明加用化痰通络活血方组降低C反应蛋白的效果优于单用西药组。8两组患者治疗前后肾素、血管紧张素Ⅱ测定的比较治疗前两组肾素、血管紧张素Ⅱ测定比较无显著性差异(P0.05);治疗后同治疗前比较,中西药组下降明显,有显著性差异(P0.05);西药组上升明显,有显著性差异(P0.05)。治疗后两组比较,有显著性差异(P0.01)。说明加用化痰通络活血方的中西药组能明显降低血浆肾素、血管紧张素Ⅱ水平,抑制了肾素活性和血管紧张素Ⅱ的生成。9不良反应仅西药组2例出现轻度踝部水肿,可耐受;两组均未发现肝肾功能受损等其它不良反应。结论:本课题临床研究结果表明:加用化痰通络活血方的中西医治疗较单独西药治疗原发性高血压具有明显的优势。1加用化痰通络活血方组对于痰瘀互结型高血压病有显著疗效,降压效果明显优于单用西药组。2加用化痰通络活血方与单用西药苯磺酸氨氯地平的对比结果,证实了中西药组在改善症状(如头晕、头痛等)、减少危险因素(如血糖、血脂等)方面明显优于单用西药组。3化痰通络活血方可能是通过抑制了肾素活性和血管紧张素Ⅱ的生成、有效降低血液粘度、降低C反应蛋白、促进血糖代谢和改善脂质代谢紊乱等因素来有效降低血压和改善临床症状,从而控制高血压病的发生与发展以及延缓并发症的发生。
[Abstract]:Objective:Essential hypertension is called hypertension for short.Its main clinical manifestation is elevated blood pressure.Its prevalence and incidence are different according to different countries,regions and races.At present,the prevalence rate of hypertension in China is 18.8% in adults and 24% in middle-aged people.Hypertension can cause damage to target organs such as heart,brain and kidney in advanced stage. As a result, the morbidity and mortality of the patients are very high, which seriously affects the life span and quality of life of the patients, and has become a serious threat to human health and life of the disease. Effective prevention and treatment of hypertension is the focus of attention of the majority of patients and one of the main topics of clinical physicians. Research shows that the combination of Chinese and Western medicine can enhance the body's sensitivity to antihypertensive drugs, reduce target organ damage, and achieve better results than the application of traditional Chinese medicine or western medicine alone. Methods: 80 cases of hypertension were randomly divided into Chinese and Western medicine group and Western medicine group for clinical observation. There was no significant difference in the general situation between the two groups. 40 cases in Western medicine group were given amlodipine besylate (Luohuoxi, Pfizer). Pharmaceutical Co., Ltd., the Chinese character H10950224, 5 mg each time, oral once a day; Chinese and Western medicine group, a total of 40 cases, given Huatan Tongluo Huoxue prescription (Banxia 10 grams, Chen Pei 10 grams, Gastrodia 10 grams, fried Atractylodes macrocephala 10 grams, peach kernel 10 grams, safflower 10 grams, Angelica 10 grams, white peony 15 grams, Chuanxiong 10 grams, Pueraria 30 grams, whole worm 6 grams, centipede 2), oral twice a day, morning and evening. The two groups of patients were diagnosed as hypertension by Western medicine, and they belonged to the syndrome of phlegm and blood stasis. The vital signs, blood pressure, clinical symptoms and blood glucose, blood lipids, C-reactive protein, hemorheology, plasma renin and vascular tension were observed during the treatment. The changes of blood pressure and other related indicators were observed. All the drugs that had effect on blood pressure were stopped during the observation period. The patients were checked for safety before and after treatment. Results: 1. There was no significant difference in blood pressure between the two groups before and after treatment (P 0.05). The systolic blood pressure and diastolic blood pressure in the Chinese and Western medicine group were significantly lower than those in the Western medicine group (P 0.05). The results showed that the blood pressure in the Chinese and Western medicine group decreased continuously and steadily compared with the Western medicine group, indicating that the hypotensive effect of the Chinese and Western medicine group with Huatan Tongluo Huoxue Fang was more obvious than that of the western medicine group alone. Before and after treatment, there was no significant difference between the two groups in systolic blood pressure and diastolic blood pressure (P The results showed that the effect of Huatan Tongluo Huoxue Decoction on hypertension was better than that of Western medicine alone. 3 Compared with western medicine group, 28 cases (70.00%), 10 cases (25.00%) were effective, 2 cases (5.00%) were ineffective, the total effective rate was 95.00%; 26 cases (65.00%), 6 cases (15.00%) were effective, 8 cases (20.00%) were ineffective, and the total effective rate was 80.00%. The total effective rate of antihypertensive therapy in the two groups was significantly different (P 0.05). The results showed that the antihypertensive effect of Huatan Tongluo Huoxue Fang was better than that of the western medicine alone. 16 cases (40.00%) were effective, 14 cases (35.00%) were ineffective, the total effective rate was 65.00%. There was a significant difference between the two groups (P 0.01). It showed that the treatment effect of Chinese and Western medicine plus Huatan Tongluo Huoxue Recipe on improving clinical symptoms was significantly better than that of Western medicine alone. The levels of sterol, triglyceride and low density lipoprotein were significantly lower than those before treatment (P 0.05), and there was significant difference between the two groups after treatment (P 0.05). However, there was no significant difference between the two groups before and after treatment. The therapeutic effect of lipid metabolism disorder was better than that of Western medicine alone. 6 Compared with before and after treatment, the fibrinogen and whole blood viscosity of the two groups decreased significantly (P 0.05), and there was significant difference between the fibrinogen and Western medicine groups (P 0.05). The results showed that the effect of Huatan Tongluo Huoxue Decoction on reducing blood viscosity was better than that of Western medicine alone.7 There was no significant difference in C-reactive protein between the two groups before and after treatment (P 0.05), and there was significant difference between the two groups after treatment (P 0.05). The decrease of CRP in western medicine group was significantly better than that in western medicine group (P After treatment, the levels of plasma renin, angiotensin II and renin were significantly decreased in the Chinese and Western medicine group (P 0.05), and significantly increased in the Western medicine group (P 0.05). The adverse reactions of activity and angiotensin II were mild ankle edema and tolerable in 2 cases of Western medicine group, and no other adverse reactions such as liver and kidney function impairment were found in both groups. Superiority.1 Additional Huatan Tongluo Huoxue Recipe group for phlegm and blood stasis type of hypertension has a significant effect, hypotensive effect is significantly better than the western medicine group.2 Additional Huatan Tongluo Huoxue Recipe and the western medicine Amlodipine Benzenesulfonate alone in the comparison of the results confirmed that the Chinese and Western medicine group in improving symptoms (such as dizziness, headache, etc.), reduce risk factors (such as blood sugar, blood sugar, blood circulation, etc.). 3. Huatan Tongluo Huoxue Decoction can effectively reduce blood pressure and improve clinical symptoms by inhibiting renin activity and angiotensin II production, effectively reducing blood viscosity, lowering C-reactive protein, promoting blood glucose metabolism and improving lipid metabolism disorders, and so on. Occurrence and development, and delay the occurrence of complications.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1
本文编号：2231330
[Abstract]:Objective:Essential hypertension is called hypertension for short.Its main clinical manifestation is elevated blood pressure.Its prevalence and incidence are different according to different countries,regions and races.At present,the prevalence rate of hypertension in China is 18.8% in adults and 24% in middle-aged people.Hypertension can cause damage to target organs such as heart,brain and kidney in advanced stage. As a result, the morbidity and mortality of the patients are very high, which seriously affects the life span and quality of life of the patients, and has become a serious threat to human health and life of the disease. Effective prevention and treatment of hypertension is the focus of attention of the majority of patients and one of the main topics of clinical physicians. Research shows that the combination of Chinese and Western medicine can enhance the body's sensitivity to antihypertensive drugs, reduce target organ damage, and achieve better results than the application of traditional Chinese medicine or western medicine alone. Methods: 80 cases of hypertension were randomly divided into Chinese and Western medicine group and Western medicine group for clinical observation. There was no significant difference in the general situation between the two groups. 40 cases in Western medicine group were given amlodipine besylate (Luohuoxi, Pfizer). Pharmaceutical Co., Ltd., the Chinese character H10950224, 5 mg each time, oral once a day; Chinese and Western medicine group, a total of 40 cases, given Huatan Tongluo Huoxue prescription (Banxia 10 grams, Chen Pei 10 grams, Gastrodia 10 grams, fried Atractylodes macrocephala 10 grams, peach kernel 10 grams, safflower 10 grams, Angelica 10 grams, white peony 15 grams, Chuanxiong 10 grams, Pueraria 30 grams, whole worm 6 grams, centipede 2), oral twice a day, morning and evening. The two groups of patients were diagnosed as hypertension by Western medicine, and they belonged to the syndrome of phlegm and blood stasis. The vital signs, blood pressure, clinical symptoms and blood glucose, blood lipids, C-reactive protein, hemorheology, plasma renin and vascular tension were observed during the treatment. The changes of blood pressure and other related indicators were observed. All the drugs that had effect on blood pressure were stopped during the observation period. The patients were checked for safety before and after treatment. Results: 1. There was no significant difference in blood pressure between the two groups before and after treatment (P 0.05). The systolic blood pressure and diastolic blood pressure in the Chinese and Western medicine group were significantly lower than those in the Western medicine group (P 0.05). The results showed that the blood pressure in the Chinese and Western medicine group decreased continuously and steadily compared with the Western medicine group, indicating that the hypotensive effect of the Chinese and Western medicine group with Huatan Tongluo Huoxue Fang was more obvious than that of the western medicine group alone. Before and after treatment, there was no significant difference between the two groups in systolic blood pressure and diastolic blood pressure (P The results showed that the effect of Huatan Tongluo Huoxue Decoction on hypertension was better than that of Western medicine alone. 3 Compared with western medicine group, 28 cases (70.00%), 10 cases (25.00%) were effective, 2 cases (5.00%) were ineffective, the total effective rate was 95.00%; 26 cases (65.00%), 6 cases (15.00%) were effective, 8 cases (20.00%) were ineffective, and the total effective rate was 80.00%. The total effective rate of antihypertensive therapy in the two groups was significantly different (P 0.05). The results showed that the antihypertensive effect of Huatan Tongluo Huoxue Fang was better than that of the western medicine alone. 16 cases (40.00%) were effective, 14 cases (35.00%) were ineffective, the total effective rate was 65.00%. There was a significant difference between the two groups (P 0.01). It showed that the treatment effect of Chinese and Western medicine plus Huatan Tongluo Huoxue Recipe on improving clinical symptoms was significantly better than that of Western medicine alone. The levels of sterol, triglyceride and low density lipoprotein were significantly lower than those before treatment (P 0.05), and there was significant difference between the two groups after treatment (P 0.05). However, there was no significant difference between the two groups before and after treatment. The therapeutic effect of lipid metabolism disorder was better than that of Western medicine alone. 6 Compared with before and after treatment, the fibrinogen and whole blood viscosity of the two groups decreased significantly (P 0.05), and there was significant difference between the fibrinogen and Western medicine groups (P 0.05). The results showed that the effect of Huatan Tongluo Huoxue Decoction on reducing blood viscosity was better than that of Western medicine alone.7 There was no significant difference in C-reactive protein between the two groups before and after treatment (P 0.05), and there was significant difference between the two groups after treatment (P 0.05). The decrease of CRP in western medicine group was significantly better than that in western medicine group (P After treatment, the levels of plasma renin, angiotensin II and renin were significantly decreased in the Chinese and Western medicine group (P 0.05), and significantly increased in the Western medicine group (P 0.05). The adverse reactions of activity and angiotensin II were mild ankle edema and tolerable in 2 cases of Western medicine group, and no other adverse reactions such as liver and kidney function impairment were found in both groups. Superiority.1 Additional Huatan Tongluo Huoxue Recipe group for phlegm and blood stasis type of hypertension has a significant effect, hypotensive effect is significantly better than the western medicine group.2 Additional Huatan Tongluo Huoxue Recipe and the western medicine Amlodipine Benzenesulfonate alone in the comparison of the results confirmed that the Chinese and Western medicine group in improving symptoms (such as dizziness, headache, etc.), reduce risk factors (such as blood sugar, blood sugar, blood circulation, etc.). 3. Huatan Tongluo Huoxue Decoction can effectively reduce blood pressure and improve clinical symptoms by inhibiting renin activity and angiotensin II production, effectively reducing blood viscosity, lowering C-reactive protein, promoting blood glucose metabolism and improving lipid metabolism disorders, and so on. Occurrence and development, and delay the occurrence of complications.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1
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