养心息风汤治疗COPD及肺心病心律失常的临床研究

发布时间：2018-06-24 01:09

本文选题：养心息风汤 + 慢性阻塞性肺疾病　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：通过观察养心息风汤对慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病(简称肺心病)并发室上性早搏患者的临床疗效(包括症状、体征的改善及理化指标的评估)。深化中医药对COPD合并肺心病室上性早搏的病因病机认识。通过观察养心息风汤治疗肺心病并发室上性早搏的作用,进一步拓展了中医药治疗室上性早搏的方法。方法：将符合纳入标准的60例患者采用随机化对照的临床试验方案研究,随机分为治疗组(西医常规治疗+养心息风汤)和对照组(西医常规治疗组+普罗帕酮)。每组30例,疗程均为14天。治疗期间记录患者临床症状及体征变化,进行评分。并在治疗前后进行动态心电图检查,血常规、肝肾功能、二便常规等理化检查。比较两组治疗前后的临床疗效、室上性早搏减少率进行有有效性判定,比较两组肝肾功能变化以进行安全性评定。临床观察结束后,采用SPSS13.0行统计学分析。结果：1、临床疗效：①治疗组临床症状改善指数平均0.7301±0.1879,对照组疗效指数平均为0.5867±0.1756,两组疗效指数相比较有显著异常,有统计学意义(P0.05)。②经治疗,在症状体征改善方面,对照组显效11例,有效15例,无效4例,总有效率58.67%；治疗组显效12例,有效15例,无效3例,总有效率73.01%,两组总有效率相比存在显著性差异,有统计学意义(P0.05)。2、动态心电图变化：治疗组及对照组治疗前后早搏减少率相比较,其差异均存在统计学意义。对照组治疗后室上性早搏数平均为2864.87±2740.83,治疗组早搏数平均为1335.20±1895.87,两组早搏减少数相比较有显著性异常,有统计学意义(P0.05)。3、安全性比较：两组患者治疗期间未发现明显不良反应,治疗前后肝肾功能指标对比无明显差异。结论：1、近期疗效比较：治疗组与对照组在治疗前后临床疗效存在差异,提示养心息风汤与西医常规治疗在COPD合并肺心病并发室上性早搏近期疗效方面,养心息风汤对其临床症状的改善优于西药普罗帕酮治疗方案。2、动态心电图变化相比较：两组治疗室上性室上性早搏均有明显疗效。治疗组与对照组在治疗前后临床疗效存在差异,提示养心息风汤对控制COPD合并肺心病室上性早搏作用优于单纯西医治疗方案。3、安全性评估：本研究未见药物不良反应,可进一步开发剂型,以供临床药物试验。
[Abstract]:Objective: to observe the clinical effect of Yangxinxufeng decoction (YXXR) on patients with chronic obstructive pulmonary disease (COPD) complicated with chronic pulmonary heart disease (Cor pulmonale) complicated with supraventricular premature beats (SVPB), including the improvement of symptoms, signs and the evaluation of physical and chemical indexes. To deepen the understanding of the etiology and pathogenesis of superventricular premature beats in COPD complicated with cor pulmonale. By observing the effect of Yangxinxinxinfeng decoction in the treatment of pulmonary heart disease complicated with supraventricular premature beat, the method of traditional Chinese medicine for treatment of supraventricular premature beat was further expanded. Methods: sixty patients who met the inclusion criteria were randomly divided into two groups: the treatment group (western medicine routine treatment) and the control group (western medicine routine treatment group, propafenone group). 30 cases in each group were treated for 14 days. The changes of clinical symptoms and signs were recorded and scored during treatment. Dynamic electrocardiogram (ECG), blood routine, liver and kidney function, routine examination and so on were performed before and after treatment. The clinical effect, supraventricular premature beat reduction rate and liver and kidney function were compared before and after treatment in the two groups to evaluate the safety. After clinical observation, SPSS 13.0 was used for statistical analysis. Results the clinical symptom improvement index of the treatment group was 0.7301 卤0.1879, and that of the control group was 0.5867 卤0.1756. There was significant difference between the two groups (P0.05) in the improvement of symptoms and signs. In the control group, there were 11 cases of remarkable effect, 15 cases of effective effect, 4 cases of ineffective, total effective rate of 58.67 cases, 12 cases of remarkable effect, 15 cases of effective and 3 cases of failure in treatment group, and the total effective rate was 73.01%. There was a significant difference between the two groups in total effective rate. There was statistical significance (P0.05) .2. dynamic electrocardiogram changes: treatment group and control group before and after treatment of premature beat reduction rate, the difference was statistically significant. The average number of supraventricular premature beats in the control group was 2864.87 卤2740.83, and that in the treatment group was 1335.20 卤1895.87.The decrease of premature beats in the two groups was significantly abnormal (P0.05) .3The safety comparison: no significant adverse reactions were found in the two groups during the treatment period. There was no significant difference in liver and kidney function before and after treatment. Conclusion: compared with control group, there is a difference in clinical effect between treatment group and control group before and after treatment, suggesting that Yangxinxinfeng decoction and routine western medicine are effective in the treatment of COPD complicated with cor pulmonale complicated with supraventricular premature beat. The improvement of clinical symptoms of Yangxinxinfeng decoction was better than that of propafenone. The changes of dynamic electrocardiogram were compared: the two groups had obvious curative effect on supraventricular premature beats. The difference of clinical effect between the treatment group and the control group before and after treatment indicated that Yangxinxinxufeng decoction was superior to western medicine in the control of superventricular premature beats in COPD complicated with cor pulmonale. The safety evaluation: there was no adverse drug reaction in this study. Dosage forms can be further developed for clinical drug trials.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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