益气活血复方治疗气虚血瘀型慢性心衰的临床疗效评价

发布时间：2018-03-21 12:24

本文选题：慢性心衰　切入点：益气活血复方　出处：《辽宁中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在研究益气活血复方对气虚血瘀型慢性心力衰竭患者的临床疗效。通过观察患者服用益气活血复方前后各项指标的变化,验证益气活血复方对慢性心衰患者的临床效果。从而阐明益气活血法治疗慢性心衰的病机实质。为中医药治疗慢性心衰提供新的治疗思路与方法。材料与方法:本试验研究对象为2015年3月至2016年3月在辽宁中医药大学附属医院门诊就诊或住院的患者,共纳入慢性心衰心功能为Ⅱ级或Ⅲ级,中医证型为气虚血瘀型的符合纳入标准的患者60例,按随机数字表法将纳入的60例患者随机分为治疗组与对照组,每组30例。治疗方法:对照组给予西医常规治疗;治疗组在西医常规治疗基础上加用益气活血复方中药(由人参、黄芪、红花、丹参、三七、益母草、葶苈子七味药物组成),每日1剂,日三次,治疗组与对照组的观察时间均为1个月。评定治疗前后两组患者的中医证候积分、Lee氏心衰疗效积分、明尼苏达生活质量评分、6 min步行距离及NT-pro BNP水平并详细记录。分别测定两组患者治疗前后心功能收缩性指标(EF值)的变化情况。注意观察记录患者治疗期间的生命体征、症状变化和不良反应等情况。结果:1.一般资料:经统计学分析比较,治疗前两组患者的一般情况:如性别、年龄、病程、心功能分级、基础疾病分布等均无统计学差异,两组患者的疗效指标中医证候积分、Lee氏心衰疗效积分、明尼苏达生活质量评分、心功能收缩性指标(EF值)、6 min步行距离及NT-pro BNP水平等方面,均没有显著性差异(P0.05),具有可比性。2.中医证候积分:治疗组与对照组治疗前后组内比较,两组P值均=0.000㩳0.01,故治疗组与对照组治疗后均较治疗前有效;治疗组与对照组治疗后组间进行比较,P=0.0000.05,有统计学意义,故治疗后治疗组的中医证候积分变化优于对照组。3.心衰疗效积分:治疗后治疗组和对照组心衰疗效积分的显效率,有效率,无效率,恶化率构成比比较,有统计学意义(P=0.0180.05)。说明治疗后治疗组的心衰疗效积分较对照组明显改善。4.明尼苏达生活质量量表积分:治疗前后两组组内明尼苏达生活质量量表积分比较均有显著性差异(P=0.000㩳0.01),说明治疗组与对照组均能使患者的生活质量提高;治疗后两组比较(P=0.000㩳0.01),说明治疗组改善患者明尼苏达生活质量量表积分的效果明显优于对照组。5.心脏收缩功能指标(EF值):治疗前后两组组内EF值比较,P均0.05,有统计学差异,说明治疗后,治疗组与对照组的心脏收缩功能均提高;治疗后,两组EF值比较,P0.01,故治疗组较对照组心脏收缩功能明显改善。6.6min步行距离:两组治疗前后组内6min步行距离比较,治疗组和对照均有显著性差异(P0.01);治疗后,治疗组与对照组比较(P0.01),有显著性差异。7.NT-proBNP水平:两组治疗前后组内NT-proBNP水平比较,治疗组和对照均有显著性差异(P0.01);治疗后,治疗组与对照组比较(P0.01),有显著性差异。说明治疗后NT-pro BNP水平明显降低,且治疗组明显优于对照组。结论:1.益气活血复方联合西医常规基础治疗与单纯西医常规基础治疗慢性心衰均有效。2.益气活血复方联合西医常规基础治疗较单纯西医常规基础治疗对慢性心衰患者疗效更显著。3.益气活血复方可明显改善气虚血瘀型慢性心衰患者临床症状,提高患者生存质量,改善患者心脏收缩功能。4.益气活血复方无不良反应及毒副作用,安全有效,值得临床推广应用。
[Abstract]:Objective: the purpose of this study is to study the clinical curative effect of Yiqi Huoxue Decoction on patients with chronic heart failure of qi deficiency and blood stasis. By observing the changes of the patients before and after Yiqi Huoxue Decoction, the clinical effect of Yiqi Huoxue compound test in patients with chronic heart failure. The pathogenesis and essence of Chan Mingyi gas activating blood circulation in the treatment of chronic heart failure. The treatment to provide new ideas and methods the Chinese medicine for the treatment of chronic heart failure. Materials and methods: the study object is from March 2015 to March 2016 in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine or hospitalized patients, were included in the cardiac function of chronic heart failure for class II or III, TCM syndrome type of qi deficiency and blood stasis type 60 patients met the inclusion criteria, according to the random number table method will be included in the 60 patients were randomly divided into treatment group and control group, 30 cases in each group. The treatment methods: the control group was treated with routine western medicine; treatment The treatment group based on routine treatment of Western medicine combined with traditional Chinese medicine Yiqi Huoxue Decoction (composed of ginseng, astragalus root, safflower, Danshen, 37, motherwort, Tinglizi seven drugs), 1 daily, three times a day, the treatment group and the control group the observation time was 1 months. The evaluation before and after treatment of TCM syndrome two groups of patients with integral, integral of Lee's heart failure curative effect, quality of life score in Minnesota, 6 min walking distance and NT-pro BNP level and detailed records. Two groups of patients before and after treatment of heart systolic function indexes were measured (EF). To observe the changes of vital signs were recorded during the treatment, changes of symptoms and adverse reactions etc. RESULTS: 1. general information: statistical analysis and comparison, the general situation of the two groups of patients before treatment, such as gender, age, course of disease, heart function classification, there was no significant difference of the distribution of disease, TCM curative effect index of two groups of patients The syndrome integral, integral of Lee's heart failure curative effect, quality of life score in Minnesota, systolic heart function index (EF), 6 min walking distance and NT-pro BNP level, there were no significant differences (P0.05), which can be integral than TCM Syndromes of.2.: treatment group and control group before and after treatment group in comparison, two groups of P were =0.000? 0.01, the treatment group and control group after treatment than before treatment; treatment group compared with the control group after treatment group P=0.0000.05, control group had statistical significance,.3. is integral with heart failure after treatment of TCM syndrome integral change is better than that of treatment group: treatment after the treatment group and the control group of heart failure curative effect integral significant efficiency, efficiency, efficiency, the rate of deterioration of the constituent ratio of comparison was statistically significant (P=0.0180.05). After the treatment of heart failure integral the efficacy of the treatment group than the control group significantly improved the quality of life scale.4. Minnesota Score: two groups in Minnesota quality of life scale scores before and after treatment were significantly different (P=0.000? 0.01), indicating that the treatment group and control group were able to improve the quality of life of patients; the two groups after treatment (P=0.000? 0.01), indicating that the treatment group to improve the patients quality of life scores of Minnesota the effect was significantly better than the control group.5. systolic function index (EF) before and after treatment in the two groups: EF value, P was 0.05, there was significant difference, after treatment, the systolic function of treatment group and control group were improved; after treatment, two groups of EF value, P0.01, the treatment group compared with the control group, the systolic function improved significantly.6.6min walking distance: two groups before and after treatment 6min walking distance between the treatment group and the control were significantly different (P0.01); after treatment, the treatment group compared with controls (P0.01), there was significant difference in water.7.NT-proBNP Ping: comparison of two groups before and after treatment NT-proBNP, treatment group and control were significantly different (P0.01); after treatment, the treatment group compared with controls (P0.01), there was significant difference. The results showed that NT-pro BNP significantly decreased after treatment, and the treatment group was significantly better than the control group. Conclusion: 1. Yiqihuoxue compound combined with conventional therapy of Western medicine and simple western medicine therapy of chronic heart failure were effective.2. Yiqi Huoxue Decoction Combined with western medicine therapy compared with conventional therapy of Western Medicine on the patients with chronic heart failure were significantly more.3. Yiqihuoxue compound can significantly improve clinical symptoms in patients with chronic heart failure of Qi deficiency and blood stasis, improve the quality of life of patients, improve the cardiac systolic function.4. patients with Yiqi Huoxue decoction has no adverse reactions and side effects, safe and effective, worthy of clinical application.

【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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