“扶阳理论”指导下加味四逆汤治疗慢性心衰（心肾阳虚型）的临床观察

发布时间：2018-04-14 16:15

本文选题：慢性心衰 + 吴氏扶阳理论　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:本研究以吴氏“扶阳理论”为指导,研究总结吴氏运用扶阳理论治疗慢性心衰的经验,系统观察吴氏经验方——加味四逆汤治疗慢性心衰(心肾阳虚型)患者的临床疗效及中医证候的改善情况,通过BNP、心功能分级、心衰积分、6MWD、心脏超声等相关指标客观的评价加味四逆汤的有效性及安全性。方法:选63例符合纳入标准的病例,用数字随机分组法分成治疗组32例和对照组31例。对照组予西医基础治疗(ACEI或ARB、β受体阻滞剂、醛固酮拮抗剂,必要时选用利尿剂及强心类药物),治疗组在西医基础治疗上加用加味四逆汤,疗程为2个月。对两组患者的临床综合疗效、NYHA心功能分级、心衰积分、6MWD、LVEF、BNP、中医证候积分进行比较并用统计学软件做出科学的疗效评价。结果:本课题所研究的两组患者治疗前一般资料、中医证候积分、心功能分级、心衰积分、6MWD、LVEF、BNP以及安全性指标均无差异(P0.05),具有可比性。两组患者临床综合疗效比较,有显著性差异(P=0.007),治疗组优于对照组。在临床症状方面:(1)中医证候疗效:治疗组的有效率为96.9%,对照组的有效率为77.4%,两组相比,统计学有差异(P=0.020),治疗组优于对照组。(2)单项症状积分:治疗组心悸、气短、乏力、动则气喘、身寒肢冷、尿少、浮肿、腹胀症状上与治疗前相比有显著性差异,其P值均0.05;对照组在心悸、气短、乏力、动则气喘、尿少、浮肿症状上与治疗前比有显著性差异,其P值0.05。且运用加味四逆汤的治疗组能更好的改善心悸、气短、乏力、身寒肢冷、浮肿、腹胀这些症状,P0.05,统计学有差异,尤其是身寒肢冷与腹胀,P0.01,有显著性差异。(3)Lee氏心衰积分:两组患者的心衰积分均有所明显下降(P0.01),且治疗组的有效率为96.9%,对照组的有效率为83.4%,治疗组的疗效优于对照组(P=0.047)。在心功能方面:两组均能明显改善心功能(P0.01),经治疗后,治疗组的有效率为93.8%,对照组的有效率为71.0%,两组相比有差异(P=0.006),治疗组的疗效优于对照组。在运动耐力方面:两组均能不同程度增加6分钟步行距离,与治疗前比较有统计学意义(P0.01),且治疗组优于对照组(P=0.042)。理化指标方面:(1)LVEF:两组均能提高LVEF,与治疗前比较有统计学意义(P0.01),两组治疗后相比,P=0.0150.05,说明治疗组对提高LVEF效果更明显。(2)BNP:两组均能不同程度降低BNP,治疗前后比较有显著性差异,P均0.01,且两组治疗后相比较有差异(P=0.015),治疗组优于对照组。安全性指标:两组患者在治疗前后安全性指标(ALT、AST、Cr、UREA)无明显异常,无统计学意义(P0.05)。结论:吴氏经验方——加味四逆汤能进一步改善慢性心衰(心肾阳虚型)患者的症状、心功能以及提高6分钟步行距离,提高LVEF、降低BNP。并且此方组方严谨,紧扣病机,长期服用无毒副作用,安全有效,值得临床推广使用。
[Abstract]:Objective : To evaluate the efficacy and safety of Wu ' s experience in the treatment of chronic heart failure ( heart - kidney - yang deficiency ) by using Wu - shi ' s theory of Fuyang . Methods : Sixty - three patients with chronic heart failure ( heart - kidney - yang deficiency type ) were evaluated by using digital random grouping method . The results showed that the effective rate was 96.9 % in the treatment group and 77.4 % in the control group . ( 2 ) Individual symptom score : the treatment group was palpitation , short breath , hypodynamia , dynamic asthma , cold limbs cold , oliguria , edema , abdominal distension symptoms had significant difference compared with that before treatment , the P value was 0 . 05 ; the control group can better improve palpitation , shortness of breath , asthenia , cold limbs cold , edema , abdominal distension , P0.05 , statistics difference , especially the cold limbs cold and abdominal distension , P0.01 , there is significant difference . ( 3 ) Lee ' s heart failure score : the heart failure score of the two groups decreased significantly ( P0.01 ) , the effective rate of the treatment group was 93.9 % , the effective rate of the control group was 83.4 % , the effective rate of the treatment group was better than that of the control group ( P = 0.006 ) . ( 2 ) BNP : There was significant difference between the two groups ( P = 0 . 01 , P = 0 . 015 ) , and there was no significant difference between the two groups ( P = 0.015 ) . Conclusion : Wu ' s experience formula _ Jiawei Sini Decoction can further improve the symptoms , cardiac function and improve the 6 - minute walk distance in patients with chronic heart failure ( heart - kidney - yang deficiency ) , improve LVEF and decrease BNP .

【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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