益气活血方治疗肺动脉高压所致右心衰竭（气虚血瘀型）的临床研究

发布时间：2018-05-21 01:03

本文选题：肺动脉高压 + 右心衰竭　；参考：《山东中医药大学》2016年硕士论文

【摘要】：目的:通过对益气活血方治疗肺动脉高压(pulmonary hypertension,简称PH)导致的右心衰竭气虚血瘀证的临床研究,观察其对PH导致的右心衰竭的肺动脉收缩压,血Pro-BNP,右室射血分数,心功能分级,六分钟步行试验的影响及用药安全性。方法:采用随机、开放、对照的方法,根据纳入病例标准,选取60例由肺动脉高压导致右心衰竭的患者,随机分成2组,西药对照组和中药治疗组(治疗组),不改变平素生活习惯,西药对照组30例,给予西药常规治疗:地高辛0.125mg po qd,呋噻米片20mg po qd,螺内酯片20mg po qd,西地那非25mg po tid。中药治疗组则在西药常规治疗的基础上加用中药益气活血方,日一剂,早晚分服。两组均给予2个疗程(4周一个疗程)治疗后,观察患者治疗前后肺动脉收缩压,血Pro-BNP,右室射血分数,心功能分级,六分钟步行试验的变化,从而进行疗效评定。结果:1.心功能方面,两组对比显示右心功能,治疗组和西药对照组在治疗后都有明显改善,但治疗组的改善优于西药对照组,治疗组和西药对照组差异有统计学意义,说明治疗组可明显提高右室射血分数;2.在肺动脉高压方面:心脏彩超示两组患者在治疗后肺动脉高压都有降低,但治疗组降低幅度高于西药对照组,两组差异有统计学意义,但差距较小;3.Pro-BNP在治疗后,两组患者都有明显降低,治疗组优于西药对照组;4.六分钟步行试验结果治疗前后比较:治疗后两组患者步行距离都有增加,治疗组优于西药对照组,两组结果有统计学差异。5.中医症候疗效比较中,治疗组患者显效12例,有效16例,无效2例,加重0例,总有效率93.99%,西药对照组显效4例,有效22例,无效4例,加重0例,总有效率83.33%,治疗组有效率高于对照组;中医症候积分通过秩和检验治疗组优于对照组,有统计学意义。6.心衰疗效比较中:治疗组显效14例,有效14例,无效2例,加重0例,总有效率93.33%,对照组显效6例,有效20例,无效4例,加重0例,总有效率86.67%,治疗组有效率优于对照组,心衰中医积分通过秩和检验治疗组优于对照组。7.在心功能分级方面,两组患者治疗后均有改善,治疗组改善优于对照组,但差距并不明显。结论:益气活血法在治疗PH所致右心衰竭的治疗中,能显著的改善症状,明显的降低肺动脉高压、Pro-BNP水平,提高六分钟步行试验值改善患者心功能,是治疗PH所致右心衰竭的不容忽视的方法。
[Abstract]:Objective: To observe the clinical study of qi deficiency and blood stasis syndrome of right heart failure caused by pulmonary hypertension (PH) in the treatment of pulmonary artery systolic pressure, blood Pro-BNP, right ventricular ejection fraction, cardiac function classification, six minute walking test and the safety of drug use. According to the standard of random, open and controlled, 60 patients with right heart failure caused by pulmonary artery hypertension were randomly divided into 2 groups, the western medicine control group and the traditional Chinese medicine treatment group (treatment group), which did not change the plain living habits, and the western medicine control group were 30 cases, which were given the western medicine routine treatment: digoxin 0.125mg Po QD, furothim slice 20mg Po QD, Spironolactone Tablets 20mg Po QD, sildenafil 25mg Po tid. traditional Chinese medicine treatment group on the basis of traditional Chinese medicine treatment with traditional Chinese medicine Yiqi Huoxue recipe, day one dose, morning and evening. The two groups were given 2 courses of treatment (4 Monday courses) treatment, observe the systolic pressure of pulmonary artery, blood Pro-BNP, right ventricular ejection fraction, heart function classification, six points before and after treatment. The results of the change of the clock walking test were evaluated. Results: 1. in the heart function, the two groups showed the right heart function, the treatment group and the western medicine control group improved obviously after the treatment, but the improvement of the treatment group was better than the western medicine control group. The difference between the treatment group and the western medicine control group was statistically significant, indicating that the treatment group could obviously improve the right ventricular ejection. Blood fraction; 2. in pulmonary arterial hypertension: heart color ultrasound showed that two groups of patients had lower pulmonary arterial pressure after treatment, but the reduction in the treatment group was higher than that in the western medicine control group. The difference between the two groups was statistically significant, but the gap was small. After the treatment, the two groups were significantly reduced, the treatment group was better than the western medicine control group, and the 4. six minutes walk in the treatment group. Test results before and after treatment: after treatment, the two groups of patients' walking distance increased, the treatment group was better than the western medicine control group, the two groups had statistical difference in.5. syndrome, the treatment group showed 12 cases, effective 16 cases, invalid 2 cases, 0 cases aggravated, the total effective rate was 93.99%, the western medicine control group was 4 cases, 22 cases effective, 4 cases ineffective, The total effective rate was 0, the total effective rate was 83.33%, the effective rate of the treatment group was higher than the control group; the TCM syndrome score was better than the control group through the rank sum test. There was significant effect in.6. heart failure in the treatment group: 14 cases were significantly effective in the treatment group, 14 cases were effective, 2 cases were invalid, 0 cases were aggravated, the total effective rate was 93.33%, the control group was 6 cases, 4 cases were invalid, 4 cases null and 0, and total aggravation. The effective rate was 86.67%, the efficiency of the treatment group was better than the control group. The TCM score of the heart failure through the rank sum test was better than the control group.7. in the heart function classification, the two groups were improved after treatment, the treatment group was better than the control group, but the gap was not obvious. Conclusion: the beneficial Qi live blood method can be significant in the treatment of right heart failure in the treatment of PH. To improve the symptoms, obviously reduce the pulmonary hypertension, Pro-BNP level, and improve the six minute walk test value to improve the heart function of the patients, it is not a neglecting method for the treatment of right heart failure caused by PH.
【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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