益气养阴通络法治疗射血分数保存的心力衰竭的临床研究

发布时间：2018-11-14 13:58

【摘要】：目的观察益气养阴通络法治疗射血分数保存的心力衰竭(气阴两虚血瘀证)的临床疗效,为中医药治疗本病提供一种新思路。方法本研究99例病例均选取自山西省中医院心病科门诊及住院部确诊的气阴两虚血瘀型射血分数保存的心力衰竭患者。将99例符合纳入标准的病例随机分为A、B、C三组,三组均予常规西药基础治疗,A组在此基础上予八味通络颗粒与通脉养心丸联合治疗,B组予通脉养心丸联合常规西药治疗,C组仅进行常规西药治疗,疗程均为8周。结果1.治疗后A组较B、C组:中医症状疗效、中医症状总积分比较均有显著差异(P0.05),具体证候比较A组较C组均有显著性差异(P0.01或P=0.01);2.A组、B组较治疗前生存质量量表计分有显著差异(P0.01),C组较治疗前比较,无统计学差异(P0.05),A组较B、C组改善明显(P0.05);3.NYHA心功能疗效分级评价,结果显示三组治疗后存在显著性差异(P0.01),且A组总有效率及显效率均优于B、C组;4.A组治疗后与B、C组比较:超声心动图指标“E、A、E/A、IVRT”均有显著差异(P0.05),A组治疗后较治疗前指标“E、A、E/A、IVRT、DCTe”均有所改善(P0.05);5.经治疗,三组NT-pro BNP情况较治疗前均有显著性差异(P0.05),治疗后三组间存在统计学差异(P=0.05),A组相较于C组有统计学差异(P0.05);6.治疗后三组6min步行距离较治疗前均有统计学差异(P0.05),且三组间相比差异非常显著(P0.01),A组治疗后步行距离与B、C组相比,明显优于其余两组(P0.05),B组较C组改善程度较高(P0.05);7.治疗后A组血流变指标“全血低、中、切粘度”较其治疗前均有显著差异(P0.05),较B、C组均有显著差异(P0.05);8.全部病例治疗前后体征及心电图未见明显异常,所测得血、尿、便常规,肝功、肾功等结果较其治疗前无明显差异(P0.05)。结论益气养阴通络法能改善射血分数保存的心力衰竭(气阴两虚血瘀证)患者的症状、体征,可降低患者血液NT-pro BNP水平,显著增加患者六分钟步行试验步行距离,较大程度改善患者生存质量,对患者血流变指标也有一定程度改善作用。
[Abstract]:Objective to observe the clinical effect of nourishing qi and nourishing yin and dredging collaterals in treating heart failure (qi and yin deficiency and blood stasis syndrome) preserved by ejection fraction, and to provide a new way for traditional Chinese medicine to treat this disease. Methods Ninety-nine patients with heart failure were selected from Department of Heart Disease Department of traditional Chinese Medicine of Shanxi Province and inpatient department. Ninety-nine patients who met the inclusion criteria were randomly divided into three groups. The three groups were treated with routine western medicine. Group A was treated with Ba-Wei Tongluo granule and Tongmai Yangxin Pill on this basis. Group B was treated with Tongmai Yangxin pill combined with conventional western medicine, group C was treated with routine western medicine only for 8 weeks. Result 1. After treatment, there were significant differences in the curative effect of TCM symptoms and the total score of TCM symptoms between group A and group C (P0.05), and there were significant differences in specific syndromes between group A and group C (P0.01 or P0.01). 2. There was significant difference in quality of life scale score between group A and group B (P0.01), C group compared with pre-treatment group, there was no significant difference (P0.05), A group was significantly improved than BUC group (P0.05); The results showed that there was significant difference between the three groups after treatment (P0.01), and the total effective rate and effective rate of group A were better than those of group C. 4.Compared with group B C after treatment, there were significant differences in echocardiographic indexes (P 0.05) between group A and group B (P 0.05) after treatment compared with group B (P 0.05) after treatment, there was no significant difference between group A and group B (P > 0.05). DCTe was improved (P0.05). 5. After treatment, the NT-pro BNP in the three groups were significantly different from those before treatment (P0.05), and there were statistical differences between the three groups after treatment (P < 0.05) compared with group C (P0.05). After treatment, the walking distance of 6min in the three groups was significantly higher than that in the other two groups (P0.05), and the difference between the three groups was very significant (P0.01), A group compared with BPC group, significantly better than the other two groups (P0.05). The improvement of group B was higher than that of group C (P0.05). 7. After treatment, the hemorheological index of group A was lower than that of group A (P 0.05), while the viscosity of whole blood was lower than that of group B (P 0.05), and that of group C was significantly higher than that of group B (P 0.05). The signs and electrocardiograms of all cases were not abnormal before and after treatment, the results of blood, urine, stool routine, liver function, renal function and so on were not significantly different from those before treatment (P0.05). Conclusion the method of nourishing qi and nourishing yin and dredging collaterals can improve the symptoms and signs of patients with heart failure (qi and yin deficiency and blood stasis syndrome) preserved by ejection fraction, decrease the level of NT-pro BNP in patients' blood, and increase the walking distance of six minutes' walking test. The quality of life was improved to some extent, and the hemorheological index was improved to some extent.
【学位授予单位】：山西省中医药研究院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【相似文献】