益气通阳活血方对冠心病慢性心力衰竭患者疗效观察，及对患者NT-proBNP、hs-CRP的影响

发布时间：2018-06-17 21:35

本文选题：冠心病慢性心力衰竭 + RAAS系统　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:1、在常规标准化治疗的基础上,联合使用益气通阳活血方对冠心病慢性心力衰竭(CHF)患者的临床症状的改善效果。2、观察益气通阳活血方对冠心病慢性心力衰竭患者机体内NT-proBNP、hs-CRP水平的影响。3、初步探讨益气通阳活血方对冠心病慢性心力衰竭患者干预作用的机制,探索中医治疗冠心病慢性心力衰竭的有效方法。方法:选取无锡市中医医院住院部2016.01--2016.12月收治的60例明确诊断为冠心病慢性心力衰竭的患者,且辨证为心肺气虚、血瘀饮停,分成对照组和治疗组。两组患者都给予规范化的西医标准治疗,并恰当合理的使用利尿剂、ACEI、ARB、β阻剂等西药。而治疗组患者在规范化西药标准治疗的同时配合使用益气通阳活血方(本方包括黄芪30克、党参10克、桂枝10克、干姜5克、当归10克、川芎10克、赤芍10克、茯苓15克、丹参20克、白术10克、甘草3克,由无锡市中医院制剂室统一配置,每天早晚2次服用,入院当天开始服用中药,连续2周)。2周后对患者临床症状的变化进行比较与分析,同时,测量两组患者入院24小时内及入院2周时机体hs-CRP、NT-proBNP的水平,然后进行统计分析比较。结果:1、两组入院2周后中医临床症状均有所减轻,总有效率是70.0%,对照组和治疗组治疗的有效率分别是53.3%、86.7%,两组差异存在明显的统计学意义(P0.05)。2、治疗组入院2周后NYHA心功能分级的有效率是86.6%,对照组的有效率是53.3%,治疗组治疗有效率大于对照组,存在明显的统计学差异(P0.05)。3、治疗组入院2周后Lee氏心衰积分的有效率是76.7%,对照组总有效率是50.0%,治疗组总有效率大于对照组,对比两组差异,存在明显的统计学意义(P0.05)。4、2周后,治疗组与对照组明尼苏达生活质量表下降幅度平均值分别为35.400±21.937、14.700±20.40,治疗组积分下降要比对照组多,差异显示统计学意义(P0.05)。5、2周后,治疗组与对照组hs-CRP治疗前后减少幅度平均值分别为13.967± 18.785,0.620±16.128,治疗组下降幅度大于对照组(P0.05)。6、2周后、治疗组与对照组NT-proBNP水平下降幅度平均值分别为4777.333±7489.795、1214.367±3652.951,治疗组下降幅度大于对照,差异显示统计学意义(P0.05)。结论:1、本次研究显示,冠心病CHF时候,在单纯西医标准化治疗的基础上配合使用益气通阳活血方治疗,更能有效减轻临床症状、改善心功能。2、本次研究表明,联合益气通阳活血方较单纯运用西药治疗更能有效降低冠心病CHF患者hs-CRP水平,这可能是益气通阳活血方能抑制机体的炎症反应,从而有效改善患者预后。3、本次研究表明,在单纯运用西药治疗上加用益气通阳活血方更能有效降低冠心病CHF患者NT-proBNP水平,这可能是益气通阳活血方可以加强冠心病CHF患者心肌的收缩力,改善心肌的收缩与舒张功能,从而有效延长心肌代偿-失代偿的时间,改善预后。
[Abstract]:Objective: 1, on the basis of conventional standardized treatment, Effect of combined use of Yiqi Tongyang Huoxue recipe on the improvement of clinical symptoms in patients with chronic heart failure of coronary heart disease. 2. To observe the effect of Yiqi Tongyang Huoxue recipe on NT-proBNPHs-CRP level in patients with chronic heart failure of coronary heart disease. Mechanism of the intervention effect of Yiqi Tongyang Huoxue recipe on patients with chronic Heart failure of Coronary Heart Disease, To explore the effective method of TCM in the treatment of chronic heart failure of coronary heart disease. Methods: sixty patients with chronic heart failure of coronary heart disease were selected and divided into control group and treatment group from June 2016.01-December 2016.The patients were divided into control group and treatment group with syndrome differentiation of deficiency of heart and lung qi and stopping of blood stasis drink. The patients in both groups were given standardized western medicine treatment, and appropriate and rational use of ACEIARB, 尾 -blocker and other western medicine. While the patients in the treatment group were treated with the standardized western medicine standard in combination with Yiqi Tongyang Huoxue recipe (this prescription included 30 grams of Astragalus, 10 grams of Codonopsis, 10 grams of Guizhi, 5 grams of dry ginger, 10 grams of Angelica sinensis, 10 grams of Chuanxiong, 10 grams of Radix Paeoniae Alba, 15 grams of Poria cocos, Salvia miltiorrhiza 20 grams, Atractylodes macrocephala 10 grams, Glycyrrhiza uralensis 3 grams, by Wuxi traditional Chinese medicine hospital preparation room unified configuration, every morning and evening take 2 times, start to take Chinese medicine on the day of admission. After 2 weeks and 2 weeks in succession, the changes of clinical symptoms of the patients were compared and analyzed. At the same time, the levels of NT-proBNP were measured within 24 hours of admission and 2 weeks after admission, and then compared statistically. Results two weeks after admission to the hospital, the clinical symptoms of traditional Chinese medicine in the two groups decreased somewhat. The total effective rate was 70.0. the effective rate of treatment in the control group and the treatment group was 53.3 and 86.7, respectively. The difference between the two groups was statistically significant (P 0.05). The effective rate of NYHA cardiac function grading was 86.6 in the treatment group and 53.3 in the control group two weeks after admission. The effective rate of treatment was higher than that of control group. The effective rate of Lee's heart failure score in the treatment group was 76.70.The total effective rate in the control group was 50.0.The total effective rate in the treatment group was higher than that in the control group. The mean value of the decrease of quality of life in the treatment group and the control group was 35.400 卤21.937 卤14.700 卤20.40, respectively. The score of the treatment group decreased more than that of the control group, and the difference was statistically significant after 2 weeks. The mean decrease amplitude of hs-CRP in treatment group and control group was 13.967 卤18.785n0.620 卤16.128.After 2 weeks after treatment, the decreasing amplitude of hs-CRP in treatment group was greater than that in control group (P 0.05). The average value of NT-proBNP in treatment group and control group was 4777.333 卤7489.795n 1214.367 卤3652.951respectively. The decrease of NT-proBNP in treatment group was higher than that in control group. The difference was statistically significant (P 0.05). Conclusion: 1, this study shows that the treatment of coronary heart disease CHF combined with the use of Yiqi Tongyang Huoxue recipe on the basis of simple western medicine standardized treatment can effectively alleviate clinical symptoms and improve cardiac function .2.This study shows that The combination of Yiqi Tongyang Huoxue recipe can effectively reduce the level of hs-CRP in CHF patients with coronary heart disease, which may be that Yiqi Tongyang Huoxue recipe can inhibit the inflammatory reaction of the body and thus effectively improve the prognosis of the patients. The combination of Yiqi Tongyang Huoxue decoction and Yiqi Tongyang Huoxue recipe can effectively reduce the level of NT-proBNP in CHF patients with coronary heart disease. This may be that Yiqi Tongyang Huoxue recipe can enhance the contractility of myocardium and improve the systolic and diastolic function of myocardium in CHF patients with coronary heart disease. Thus effectively prolong the time of myocardial compensation-decompensation and improve the prognosis.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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