R541.6
目的:观察益气强心汤联合美托洛尔治疗慢性心力衰竭(CHF)气虚血瘀证的临床疗效。方法:选取 84 例 CHF 气虚血瘀证患者,按随机数字表法分为对照组与治疗组各 42 例。对照组给予美托洛尔治疗,治疗组在对照组基础上联合益气强心汤治疗,2 组均连续治疗 3 个月。比较 2 组治疗前后中医证候积分、心功能指标、心肌损伤标志物水平及临床疗效。结果:治疗后,2 组胸闷、喘促、水肿及气短积分均较治疗前降低(P<0.05),治疗组上述 4 项中医证候积分均低于对照组(P<0.05)。治疗后,2 组射血前期/左心室射血时间比值(PEP/LVET)、总外周阻力(TPR)均较治疗前降低(P<0.05),治疗组 PEP/LVET、TPR 均低于对照组(P<0.05);2 组每搏出量(SV)、心输出量(CO)、心脏指数(CI)、左室射血分数(LVEF)均较治疗前升高(P<0.05),治疗组 SV、CO、CI 及 LVEF 均高于对照组(P<0.05)。治疗后,2 组 N-末端脑钠肽前体(NT-proBNP)、心型脂肪酸结合蛋白(H-FABP)水平均较治疗前降低(P<0.05),治疗组 NT-proBNP、H-FABP 水平均低于对照组(P<0.05)。治疗组总有效率为 80.95%,高于对照组的 57.14%(P<0.05)。结论:益气强心汤联合美托洛尔治疗 CHF 气虚血瘀证,可有效改善患者的临床症状,逆转心肌受损情况,保护心功能,临床疗效优于单纯使用美托洛尔治疗。
Abstract:Objective:ToobservetheclinicaleffectofYiqiQiangxintangcombinedwithmetoprololforchronicheartfailure (CHF)withqideficiencyandbloodstasissyndrome. Methods:Atotalof 84 casesofCHFpatientswithqideficiencyandblood stasissyndromewereselectedanddividedintothecontrolgroupandthetreatmentgroupaccordingtotherandomnumber tablemethod,42 casesineachgroup.Thecontrolgroupwastreatedwithmetoprolol,andthetreatmentgroupwas additionallytreatedwithYiqiQiangxintangbasedonthetreatmentofthecontrolgroup.Bothgroupswerecontinuously treatedforthreemonths.TheChinesemedicinesyndromescores, heartfunctionindexes, levelsofmyocardialinjury markers,andclinicaleffectwerecomparedbetweenthetwogroups. Results:Aftertreatment,thescoresofoppressionin thechest,panting,edema,andshortnessofbreathinthetwogroupsweredecreasedwhencomparedwiththosebefore treatment(P<0.05),andthefourChinesemedicinesyndromescoresaboveinthetreatmentgroupwerelowerthanthosein thecontrolgroup(P<0.05).Aftertreatment,theratioofpreejectionphrasetoleftventricularejectiontime(PEP/LVET)and totalperipheralresistance(TPR)inthetwogroupsweredecreasedwhencomparedwiththosebeforetreatment(P<0.05), andthetwoindexesaboveinthetreatmentgroupwerelowerthanthoseinthecontrolgroup(P<0.05).Aftertreatment, cardiacstrokevolume(SV),cardiacoutput(CO),cardiacindex(CI),andleftventricularejectionfraction(LVEF)inthetwo groupswereincreasedwhencomparedwiththosebeforetreatment(P<0.05),andthefourindexesaboveinthetreatment groupwerehigherthanthoseinthecontrolgroup(P<0.05).Aftertreatment,levelsofNterminalproBtypenatriureticpeptide (NT-proBNP)andheart-typefattyacid-bindingprotein(H-FABP)inthetwogroupsweredecreasedwhencomparedwith thosebeforetreatment(P<0.05),andthetwolevelsinthetreatmentgroupwerelowerthanthoseinthecontrolgroup(P< 0.05).Thetotaleffectiveratewas 80.95%inthetreatmentgroup,higherthanthatof 57.14%inthecontrolgroup(P<0.05). Conclusion:InthetreatmentofCHFwithqideficiencyandbloodstasissyndrome,thetherapyofYiqiQiangxintang combinedwithmetoprololcaneffectivelyimproveclinicalsymptoms,reversemyocardialdamageandprotecttheheart function.Theclinicaleffectisbetterthanthatofsimpleapplicationofmetoprolol.
孙虎豪,王军伟,詹君华.益气强心汤联合美托洛尔治疗慢性心力衰竭气虚血瘀证临床研究[J].新中医,2021,53(8):51-54