温心稳律汤治疗缓慢性心律失常的临床研究及对心率变异性影响

发布时间：2018-10-31 19:11

【摘要】：目的:1.研究和观察温心稳律汤治疗缓慢性心律失常(心肾阳虚,血脉瘀阻型)患者的临床疗效;2.将24h-ECG平均心率、最慢心率及心率变异性(SDNN、SDANN、RMSSD)以及血清TG、TC、LDL-C作为疗效评判指标;3.为了今后临床上更为安全、广泛的使用温心稳律汤,也在本实验中设入一些安全性指标检测的环节。方法:1.根据西医诊断标准和中医诊断标准将60例住院和(或)门诊病人划分为研究组和对照组(各30例/组,18-80岁,男女不限)。2.研究组在西医标准化治疗原有基础疾病的同时予以自拟方温心稳律汤(水煎剂)治疗,对照组则在西医标准化治疗原有基础疾病的同时予参松养心胶囊(中成药)。2组均以4周作为一疗程。3.将24h-ECG平均心率、最慢心率及心率变异性(SDNN、SDANN、RMSSD)以及血清TG、TC、LDL-C等在治疗前后的数据进行统计学比较。4.收集所有数据,绘成病例资料表格。所有数据用SPSS17.0进行统计学分析:以“—xE±s”表示数据,配对资料t检验用于检测每组治疗前后变化,独立样本t检验用于对治疗前后两组之间的比较,p0.05表示差异有统计学意义,p0.01则差异具有显著统计学意义。结果:1.研究组的治疗前、后对比:治疗后24h-ECG平均心率、最慢心率及心率变异性(SDNN、SDANN、RMSSD)均有改善;血清TG、TC、LDL-C数值明显下降,具有显著统计学意义(P0.01)。2.对照组的治疗前、后对比:治疗后24h-ECG平均心率、最慢心率及血清TG、TC、LDL-C均有改善(P0.01或P0.05),具有统计学意义;心率变异性(SDNN、SDANN、RMSSD)虽有所改变,但无统计学意义(P0.05)。3.研究组、对照组的治疗后数值对比:治疗后研究组24h-ECG平均心率较对照组升幅更为显著(P0.01);中医临床症状积分的改善程度也是研究组更显著(P0.05);两组的最慢心率都得以提升,但是结果为研究组优(P0.01);心率变异性(SDNN、SDANN、RMSSD)均有改善,研究组疗效更优(P0.01);两组血清TG,TC和LDL-C平均下降,研究组下降更明显(P0.01);60例患者均未出现严重不良反应。结论:温心稳律汤可以显著的提升心肾阳虚、血脉瘀阻型缓慢性心律失常患者的24h平均心率、最慢心率,改善心率变异性(SDNN、SDANN、RMSSD),中成药参松养心胶囊具有良好的双向抗心律失常作用,既可以治疗缓慢性心律失常,也对各型早搏有着很好的疗效,但是经过本研究证实温心稳律汤治疗缓慢性心律失常比中成药参松养心胶囊更为明显,并且温心稳律汤还可以降低血清中TG,TC,LDL-C的指数,改善临床症状。根据相关安全性指标的检测,显示安全性能够得到肯定,无相关肝肾损害,无严重不良反应,可以大量运用于临床。
[Abstract]:Objective: 1. To study and observe the clinical effect of Wenxinstability decoction on slow arrhythmia (deficiency of heart and kidney yang, blood stasis type); 2. The mean heart rate, the slowest heart rate, heart rate variability (SDNN,SDANN,RMSSD) and serum TG,TC,LDL-C were taken as the effective indexes. 3. In order to be more safe in clinic in the future, Wenxinshinyue decoction is widely used, and some safety indexes are also included in this experiment. Methods: 1. According to the diagnostic criteria of western medicine and traditional Chinese medicine, 60 inpatients and / or outpatients were divided into study group and control group (30 cases / group, 18-80 years old, male and female) 2. 2. The study group treated the original basic diseases with the standard of western medicine at the same time, it was treated with Wenxinzinglu decoction (water decoction), a self-made prescription. The control group was treated with Shensong Yangxin capsule (traditional Chinese patent medicine) while the original basic diseases were treated by western medicine standardization. The two groups were treated with 4 weeks as a course of treatment. The mean heart rate, slowest heart rate, heart rate variability (SDNN,SDANN,RMSSD) and serum TG,TC,LDL-C before and after treatment were compared statistically. 4. 4. Collect all the data and draw the case data form. All the data were analyzed statistically by SPSS17.0: the data were represented by "-xE 卤s", the paired data t test was used to detect the changes before and after treatment, and the independent sample t test was used to compare the two groups before and after treatment. The difference between p0.05 and p0.01 was statistically significant. The result is 1: 1. Before and after treatment, the mean heart rate, the slowest heart rate and the heart rate variability (SDNN,SDANN,RMSSD) of the study group were improved. Serum TG,TC,LDL-C decreased significantly (P0.01). Control group before and after treatment: the average heart rate of 24h-ECG, the slowest heart rate and serum TG,TC,LDL-C were improved after treatment (P0.01 or P0.05). Heart rate variability (SDNN,SDANN,RMSSD) changed, but not statistically significant (P0.05). After treatment, the average heart rate of 24h-ECG in the study group was significantly higher than that in the control group (P0.01), and the improvement of TCM clinical symptom score was more significant in the study group (P0.05). The slowest heart rate was increased in both groups, but the results were excellent in study group (P0.01), improved in heart rate variability (SDNN,SDANN,RMSSD), and better in treatment group (P0.01). Serum TG,TC and LDL-C decreased significantly in both groups, especially in the study group (P0.01), and no serious adverse reactions were found in 60 patients. Conclusion: Wenxinstability decoction can significantly improve the heart rate, the slowest heart rate and improve the heart rate variability (SDNN,SDANN,RMSSD) in patients with heart-kidney yang deficiency and blood stasis type bradyarrhythmia. Shensong Yangxin capsule, a traditional Chinese patent medicine, has a good two-way anti-arrhythmia effect, which can not only treat bradyarrhythmia, but also have a good curative effect on various types of premature beats. However, this study confirmed that Wenxinshuilu decoction in the treatment of slow arrhythmia is more obvious than the traditional Chinese patent medicine Shensongyangxin capsule, and Wenxinshuiyu decoction can also reduce the index of TG,TC,LDL-C in serum and improve clinical symptoms. According to the detection of related safety indexes, the safety can be confirmed, no damage of liver and kidney, no serious adverse reactions, and can be used in clinic.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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