心康饮对冠心病心力衰竭伴利尿剂抵抗患者的临床研究

发布时间：2018-03-30 05:10

本文选题：冠心病　切入点：利尿剂抵抗　出处：《湖南中医药大学》2016年硕士论文

【摘要】：目的:观察心康饮治疗冠心病慢性心力衰竭利尿剂抵抗(心肾阳虚、宗气下陷证)的临床疗效。方法:采用配对设计及开放型单向质反应序贯设计,选取符合冠心病心力衰竭伴利尿剂抵抗诊断,且中医辨证属心肾阳虚、宗气下陷证的患者18例,配对成2组,治疗组9例,对照组9例。在西医抗心衰治疗基础上,分别给予与心康饮(治疗组)或芪苈强心胶囊(对照组)口服,疗程两周,以每24h尿量的变化情况判定试验的有效性,并据此绘制序贯试验图;同时观察比较两组患者治疗前后及两组间,每24小时尿量、NT-pro BNP值、LVEF值、LVFS值、心功能分级、中医证候积分的变化及安全性疗效情况。结果:1.序贯试验治疗组病例中除第4例无效外,余均为有效,实验至第7例时,实验线触及上边界线(p0.01),故接受该药;对照组病例中除第3例、第4例及第7例无效外,余均有效,但实验至最大估计样本量第9例时,仍未触及上边界线(p0.01),故拒绝该药。2.治疗后第一周平均每24h尿量值均不同程度的增加,与治疗前相比,差异均有统计学意义(P0.05);治疗后第1天至第2周末,两组之间比较差异有统计学意义(P0.05);提示两组均有利尿作用,但治疗组优于对照组。3.NT-pro BNP值与治疗前相比均不同程度的减小,差异有统计学意义(P0.05);治疗后两组之间比较,差异有统计学意义(P0.05)。4.LVEF值、LVFS值与治疗前相比较均不同程度升高,差异均有统计学意义(P0.05);治疗后两组间比较,差异均有统计学意义(P0.05)。5.治疗后两组间心功能分级比较,差异有统计学意义(p0.05)。6.中医证候积分与治疗前比较,差异具有统计学意义(p0.05);治疗后两组间比较,差异有统计学意义(P0.05)。结论:从序贯设计上(定性),心康饮对改善心肾阳虚、宗气下陷证冠心病利尿剂抵抗疗效显著,从两组自身前后对照及配对设计上(定量),心康饮、芪苈强心胶囊对利尿剂抵抗均有疗效,且心康饮疗效更显著,可在短期内明显增加患者24h尿量;两组均能降低NT-pro BNP水平,提高LVEF、LVFS值,改善心功能分级,能从整体上改善患者的临床症状,如心悸、气短、面肢浮肿、尿少、畏寒肢冷等表现,且心康饮疗效显著;两者安全有效,无严重不良反应。
[Abstract]:Objective: to observe the clinical effect of Xinkang decoction in the treatment of diuretic resistance (deficiency of heart and kidney yang, syndrome of qi depression) in patients with coronary heart disease. Eighteen patients with heart failure and diuretic resistance diagnosed according to coronary heart disease and syndrome differentiation of heart and kidney yang and depression of qi were selected and matched into two groups: treatment group (n = 9) and control group (n = 9). On the basis of western medicine anti-heart failure treatment, the patients were divided into two groups: treatment group (n = 9) and control group (n = 9). They were given orally with Xinkang Yin (treatment group) or Qiliqiangxin capsule (control group) for two weeks. The efficacy of the test was determined by the change of urine volume per 24 hours, and the sequential test map was drawn accordingly. At the same time, before and after treatment and between the two groups, the NT-pro BNP value, LVEF value and cardiac function grade were observed and compared between the two groups. Results: 1. In the sequential trial group, except the fourth case was invalid, all the other cases were effective. In the 7th case, the experimental line reached the upper boundary line and p0.01, so it was accepted. In the control group, except the third case, the fourth case and the seventh case were ineffective, but the experiment was up to the 9th case of the maximum estimated sample size. The above boundary line was still not reached, so the drug was rejected. 2. The mean urine volume per 24 hours after treatment increased to different degrees, and the difference was statistically significant compared with that before treatment, from the first day to the second week after treatment, there was a significant difference in urine volume between the first day and the second week after treatment, and the difference was significant between the first day and the second week after treatment. The difference between the two groups was statistically significant (P 0.05), indicating that both groups had diuretic effect, but the value of NT-pro BNP in the treatment group was better than that in the control group, and the difference was statistically significant (P 0.05). The difference was statistically significant (P 0.05). 4. LVEF and LVFS were significantly higher than those before treatment (P 0.05), and there were significant differences between the two groups after treatment (P 0.05). After treatment, there were significant differences between the two groups in cardiac function grading, and there was no significant difference between the two groups after treatment, and there was no significant difference between the two groups (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05). The difference was statistically significant (P 0.05). The difference between TCM syndromes and pre-treatment was statistically significant (P 0.05), and the difference between the two groups was statistically significant (P 0.05). Conclusion: from the sequential design (qualitative analysis, Xinkang Yin can improve the deficiency of heart and kidney yang), The effect of diuretic resistance to coronary heart disease in Zongqi depression syndrome was significant, and the therapeutic effect of Xinkangyin and Qiliqiangxin capsule on diuretic resistance was more significant than that of control group before and after control and matched design (quantitative, Xinkang Yin, Qiliqiangxin capsule), and the effect of Xinkangyin was more significant. Both groups could decrease the level of NT-pro BNP, increase the value of LVEF BNP, improve the classification of cardiac function, and improve the clinical symptoms of the patients, such as palpitation, shortness of breath, edema of face limb, less urine, cold cold of cold limb, etc. Xinkangyin was effective and safe, and had no serious adverse reactions.
【学位授予单位】：湖南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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