强心胶囊对阳虚痰瘀互结型老年慢性心衰BNP的影响

发布时间：2018-04-15 16:38

本文选题：慢性心力衰竭 + 强心胶囊　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:观察强心胶囊对阳虚痰瘀互结型老年慢性心衰BNP的影响及临床疗效。方法:将60例中医辨证为阳虚痰瘀互结型的老年慢性心衰患者随机分为治疗组和对照组,每组病例数为30例。对照组采用根据2014年《中国心力衰竭诊断和治疗指南》制定的常规西药组治疗,治疗组则在常规西药组基础上加用强心胶囊治疗。两组疗程均为14天。疗程结束后对两组患者进行治疗前、治疗后血浆BNP水平、心功能分级疗效、6min步行试验、中医症候疗效、中医单项症候积分、明尼苏达心力衰竭生活质量评分方面的观察比较。结果:1.血浆BNP水平的比较:治疗组和对照组病例治疗后血浆BNP值分别为338.41±156.51pg/ml和455.29±266.02pg/ml,两组之间比较,差异有统计学意义(P0.05);治疗组治疗后血浆BNP值下降510.15±353.07pg/ml,对照组治疗后血浆BNP值下降404.22±310.98pg/ml,差异有统计学意义(P0.05)。治疗后较治疗前血浆BNP水平的降低方面,治疗组优于对照组;2.心功能分级疗效、6min步行试验、明尼苏达心力衰竭生活质量评分的比较:两组病例治疗后较治疗前,在心功能分级疗效、6min步行试验、明尼苏达心力衰竭生活质量评分方面均有改善(P0.05),治疗组的改善情况优于对照组;3.中医症候积分比较:治疗组治疗后中医症候疗效积分、中医症候单项积分均较本组治疗前下降(P0.05),且治疗组治疗后患者心悸、乏力、气短、动则气喘、畏寒肢冷、咯痰、面浮肢肿、脘腹胀满、咯痰、烦躁不安、汗出、尿少伴胸腹水、头晕目眩、面色晦暗、皮肤瘀斑、口干症状的中医症候疗效积分、中医症候单项积分低于对照组(P0.05);4.两组病例安全性指标评价:一般生命体征(如血压、心率等),尿、粪常规,血常规(HGB、RBC、WBC),肝肾功(ALT、AST,UREA、SCR),电解质(Na、K、Cl),心肌酶(CK、CK-MB、LDH、)及肌钙蛋白(c Tn T),血脂(TC、TG、LDL-C、HDL-C),心电图ST-T改变,胸片心胸比等(P0.05),差异无统计学意义。结论:治疗组在降低老年慢性心衰患者血浆BNP水平,改善心功能,增加6分钟步行距离,改善生活质量,改善心悸、乏力、气短、动则气喘、咯痰、面浮肢肿、畏寒肢冷等中医症状方面均优于对照组。可见,强心胶囊治疗阳虚水瘀互结型老年慢性心力衰竭的临床疗效确切,其对降低血浆BNP水平的效果较为明显,提示强心胶囊可能有抑制血浆BNP的释放的作用,从而抑制神经内分泌系统的过度激活,阻碍心室重构的发展进程,进而达到治疗老年慢性心衰的目的。
[Abstract]:Objective: to observe the effect and clinical effect of Qiangxin capsule (QXC) on senile chronic heart failure (BNP) with Yang deficiency and phlegm stasis.Methods: 60 elderly patients with chronic heart failure were randomly divided into treatment group and control group with 30 cases in each group.The control group was treated with conventional western medicine according to the guidelines for the diagnosis and treatment of Heart failure in China in 2014, while the treatment group was treated with Qiangxin capsule on the basis of routine western medicine.The course of treatment was 14 days in both groups.Before and after the treatment, the plasma BNP level, cardiac function grading efficacy, 6 minutes walking test, TCM symptom effect, TCM single symptom score and Minnesota heart failure quality of life score were observed and compared.The result is 1: 1.Comparison of plasma BNP levels: plasma BNP levels were 338.41 卤156.51pg/ml and 455.29 卤266.02 PG / ml in the treatment group and control group, respectively.The plasma BNP decreased by 510.15 卤353.07pg / ml in the treatment group and 404.22 卤310.98pg / ml by the control group (P 0.05).The decrease of plasma BNP level after treatment was better in the treatment group than in the control group.Comparison of cardiac function grading efficacy with 6-minute walking test and Minnesota heart failure quality of life score: patients in the two groups had 6 min walking test after treatment and 6 min walking test before and after treatment.The score of quality of life in Minnesota heart failure was improved (P 0.05), and the improvement in the treatment group was better than that in the control group (P 0.05).Comparison of TCM symptom score: treatment group after treatment TCM symptom curative effect integral, TCM symptom single integral compared with this group before treatment decreased P0.05A, and treatment group after treatment patients palpitation, fatigue, shortness of breath, movement is asthma, cold cold limbs, phlegm, phlegm, the treatment group after the treatment of patients with palpitation, fatigue, shortness of breath, movement, cold limbs, phlegm,Facial floating limb swelling, abdominal distention, phlegm, fidgety, sweating, dizziness, dizziness, dark complexion, skin ecchymosis, dry mouth symptom, TCM symptom single score were lower than that of control group (P 0.05).The evaluation of general vital signs (such as blood pressure, heart rate, urine, fecal routine, routine blood routine, blood routine test, liver and kidney function, ALTASTASTUREAEAA SCRN, electrolytes, Nactinia, CK-MBLDHH) and cardiac troponin C Tn Tn, serum lipids, TGG, HDL-C, changes of ST-T in electrocardiogram (ECG), the changes of ST-T in ECG, and the changes of ST-T in electrocardiogram (ECG), the changes of ST-T, and the changes of ST-T in the two groups were also analyzed, and the results showed that there were no significant differences between the two groups in terms of safety index (such as blood pressure, heart rate, urine and feces).The chest radiographs had no significant difference (P 0.05).Conclusion: the treatment group can reduce plasma BNP level, improve cardiac function, increase walking distance for 6 minutes, improve life quality, improve palpitation, fatigue, shortness of breath, dyspnea, sputum and floating limb swelling in elderly patients with chronic heart failure.Cold limbs and other TCM symptoms were better than the control group.It can be seen that Qiangxin capsule is effective in the treatment of senile chronic heart failure with Yang deficiency and blood stasis, and it has obvious effect on reducing plasma BNP level, suggesting that Qiangxin capsule may have the effect of inhibiting the release of plasma BNP.Thus inhibit the excessive activation of the neuroendocrine system, block the development of ventricular remodeling, and then achieve the purpose of treatment of chronic heart failure in the elderly.
【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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