疏肝解郁方治疗肝郁气滞型室性早搏的临床疗效评价研究

发布时间：2018-03-28 01:30

本文选题：疏肝解郁方　切入点：肝郁气滞　出处：《山东中医药大学》2016年硕士论文

【摘要】：目的:本试验旨在观察疏肝解郁方治疗肝郁气滞型室性早搏的临床疗效,探究其作用机制,评价其治疗效果及安全性,拟为临床治疗室性早搏提供更加安全有效的方法。方法:按照纳入和排除标准选取2015年1月至2016年1月于山东中医药大学附属第一医院心内科门诊及综合内科病房住院病例60例,随机分为试验组与对照组,各30例,所选病例均符合西医室性早搏诊断标准,中医辨病为心悸病,辩证为肝郁气滞证,两组患者的一般情况无统计学差异。对照组运用稳心颗粒治疗,试验组在稳心颗粒治疗基础上加服疏肝解郁方,水煎服,日一剂,分早、晚两次餐后半小时温服,试验为期4周。4周后进行临床疗效评定。分别于治疗前、后行一般检查项目:体温、呼吸频率、血压、心率、肝功、肾功、血脂、血糖等检查,观察两组患者治疗前后的室性早搏发作总次数、动态心电图有效率判定、中医症状严重程度、单项症状疗效判定、中医证候积分变化、中医总疗效等,进行分析、对比,从而评价疗效及安全性。结果:经过4周治疗后,对比两组临床疗效,试验组在改善室性早搏发作总次数、动态心电图有效率判定方面显著优于对照组,两组间差异有统计学意义(P0.01);两组患者在中医症状严重程度、单项症状疗效判定、中医证候积分变化、中医总疗效对比上,试验组优于对照组,两组间差异有统计学意义(P0.05);总体比较,显示试验组各项临床疗效均优于对照组。两组患者在用药前后肝、肾功能等安全性指标未见明显异常。结论:结果显示疏肝解郁方能有效改善肝郁气滞型室性早搏患者的临床症状,对比单纯的中成药治疗,试验组在减少患者室性早搏发作次数,改善患者心悸、胸闷等症状以及相关检查指标方面疗效显著。其相关机制可能为改善心肌细胞代谢、降低细胞及细胞自律性、增加心肌血供、改善血管内皮功能等。患者在试验周期中未出现不良反应,各项安全指标检测未见异常,说明疏肝解郁方具有良好的耐受性及安全性,值得进一步应用及推广。
[Abstract]:Objective: to observe the clinical effect of Shugan Jieyu recipe in treating ventricular premature beats with stagnation of liver and qi, to explore its mechanism, and to evaluate its therapeutic effect and safety. To provide a more safe and effective method for clinical treatment of ventricular premature beats. Methods: according to the criteria of inclusion and exclusion, we selected the outpatient department of cardiology and general internal medicine of the first affiliated hospital of Shandong university of traditional Chinese medicine from January 2015 to January 2016. 60 inpatients, The patients were randomly divided into the experimental group and the control group with 30 cases each. All the selected cases were in accordance with the diagnostic criteria of western medicine for ventricular premature beats, the TCM differentiation was palpitation, and the dialectical was the syndrome of stagnation of liver-qi. There was no statistical difference between the two groups. The control group was treated with Wenxin granule, and the experimental group was treated with Shugan Jieyu recipe, water decoction, one dose per day, early and half an hour after two meals in the experimental group. The clinical efficacy was evaluated after 4 weeks. Before and after treatment, general examination items were performed: body temperature, respiratory frequency, blood pressure, heart rate, liver function, kidney function, blood lipid, blood sugar, etc. The total number of ventricular premature beats before and after treatment, the effective rate of dynamic electrocardiogram, the severity of TCM symptoms, the curative effect of single symptoms, the changes of TCM syndromes integral and the total curative effects of TCM were observed. Results: after 4 weeks of treatment, compared with the two groups, the experimental group was significantly better than the control group in improving the total number of ventricular premature beats and determining the effective rate of ambulatory electrocardiogram. The difference between the two groups was statistically significant (P 0.01). The patients in the two groups were superior to the control group in the severity of TCM symptoms, the determination of the curative effect of individual symptoms, the changes of TCM syndromes integral, and the comparison of the total curative effects of TCM. The difference between the two groups was statistically significant (P 0.05). The overall comparison showed that the clinical efficacy of the experimental group was better than that of the control group. Conclusion: the results show that Shugan Jieyu prescription can effectively improve the clinical symptoms of patients with liver stagnation and qi stagnation type ventricular premature beats, compared with simple traditional Chinese medicine treatment, The experimental group was effective in reducing the number of ventricular premature beats, improving palpitation, chest tightness and related examination indexes. The related mechanism may be to improve the metabolism of cardiomyocytes and decrease the cellular and cellular automaticity. Increase myocardial blood supply, improve vascular endothelial function and so on. Patients did not have adverse reactions in the trial cycle, no abnormal detection of various safety indicators, indicating that Shugan Jieyu prescription has good tolerance and safety, worthy of further application and promotion.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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