中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015年
5期
492-495
,共4页
充血性心力衰竭,慢性%中医证候%宣导三焦%泻肺豁痰%活血利水%三焦壅塞%痰瘀水停
充血性心力衰竭,慢性%中醫證候%宣導三焦%瀉肺豁痰%活血利水%三焦壅塞%痰瘀水停
충혈성심력쇠갈,만성%중의증후%선도삼초%사폐활담%활혈이수%삼초옹새%담어수정
Chronic congestive heart failure%Traditional Chinese medicine syndrome%Xuandao Sanjiao%Xiefei Huotan%Huoxue Lishui%Sanjiao obstruction%Phlegm and blood stasis and fluid-retention
目的 观察宣导三焦、泻肺豁痰、活血利水法治疗慢性充血性心力衰竭(CHF)的临床疗效.方法 将60例辨证属三焦壅塞、痰瘀水停证的心功能Ⅲ~Ⅳ级CHF患者按随机数字表法分为中西医结合治疗组和对照组,每组30例.对照组采用西药常规治疗;中西医结合治疗组在常规治疗基础上加用宣导三焦、泻肺 豁痰、活血利水方药宣导泻肺饮(组成:葶苈子20 g,莱菔子15 g,泽泻15 g,桑白皮15 g,杏仁10 g,川厚朴10 g, 猪苓30 g,陈皮10 g,当归12 g,川木通6 g等)100 mL,每日2次;两组疗程均为8周.观察两组治疗前后心功能疗效、中医症状积分疗效,以及两组治疗前后左室射血分数(LVEF)、左室短轴缩短率(LVFS),6 min步行试验(6MWT),血浆N末端B型钠尿肽前体(NT-proBNP)、糖类抗原125(CA125)及生长分化因子-15(GDF-15) 水平,并评价治疗过程中药的安全性和不良反应.结果 治疗后中西医结合治疗组心功能疗效、中医症状积分疗效均明显高于对照组〔心功能疗效:86.7%(26/30)比63.3%(19/30),中医症状积分疗效:83.3%(25/30)比60.0%(18/30),均P<O.05〕.两组治疗后LVEF、LVFS、6MWT均较治疗前明显增高,NT-proBNP、CA125及GDF-15水平均较治疗前明显降低,且中西医结合治疗组改善程度优于对照组〔LVEF:0.486±0.073比0.458±0.071;LVFS:(25.0±3.5)%比(23.8±3.0)%;6MWT(m):310.7±42.6比298.4±38.2;NT-proBNP(ng/L):345.6±76.2比426.7±83.9;GDF-15(ng/L):923.3±187.3比1 026.7±201.6;CA125(U/L):58.72±7.62比65.56±9.16;均P<0.05〕.两组均未出现低血压,均未见肝肾功能损害或加重.结论 宣导三焦、泻肺豁痰、活血利水法可改善三焦壅塞,痰瘀水停型CHF患者的心功能,改善中医症状积分,增加LVEF、LVFS及6MWT,降低血浆GDF-15、CA125及NT-proBNP水平.
目的 觀察宣導三焦、瀉肺豁痰、活血利水法治療慢性充血性心力衰竭(CHF)的臨床療效.方法 將60例辨證屬三焦壅塞、痰瘀水停證的心功能Ⅲ~Ⅳ級CHF患者按隨機數字錶法分為中西醫結閤治療組和對照組,每組30例.對照組採用西藥常規治療;中西醫結閤治療組在常規治療基礎上加用宣導三焦、瀉肺 豁痰、活血利水方藥宣導瀉肺飲(組成:葶藶子20 g,萊菔子15 g,澤瀉15 g,桑白皮15 g,杏仁10 g,川厚樸10 g, 豬苓30 g,陳皮10 g,噹歸12 g,川木通6 g等)100 mL,每日2次;兩組療程均為8週.觀察兩組治療前後心功能療效、中醫癥狀積分療效,以及兩組治療前後左室射血分數(LVEF)、左室短軸縮短率(LVFS),6 min步行試驗(6MWT),血漿N末耑B型鈉尿肽前體(NT-proBNP)、糖類抗原125(CA125)及生長分化因子-15(GDF-15) 水平,併評價治療過程中藥的安全性和不良反應.結果 治療後中西醫結閤治療組心功能療效、中醫癥狀積分療效均明顯高于對照組〔心功能療效:86.7%(26/30)比63.3%(19/30),中醫癥狀積分療效:83.3%(25/30)比60.0%(18/30),均P<O.05〕.兩組治療後LVEF、LVFS、6MWT均較治療前明顯增高,NT-proBNP、CA125及GDF-15水平均較治療前明顯降低,且中西醫結閤治療組改善程度優于對照組〔LVEF:0.486±0.073比0.458±0.071;LVFS:(25.0±3.5)%比(23.8±3.0)%;6MWT(m):310.7±42.6比298.4±38.2;NT-proBNP(ng/L):345.6±76.2比426.7±83.9;GDF-15(ng/L):923.3±187.3比1 026.7±201.6;CA125(U/L):58.72±7.62比65.56±9.16;均P<0.05〕.兩組均未齣現低血壓,均未見肝腎功能損害或加重.結論 宣導三焦、瀉肺豁痰、活血利水法可改善三焦壅塞,痰瘀水停型CHF患者的心功能,改善中醫癥狀積分,增加LVEF、LVFS及6MWT,降低血漿GDF-15、CA125及NT-proBNP水平.
목적 관찰선도삼초、사폐활담、활혈이수법치료만성충혈성심력쇠갈(CHF)적림상료효.방법 장60례변증속삼초옹새、담어수정증적심공능Ⅲ~Ⅳ급CHF환자안수궤수자표법분위중서의결합치료조화대조조,매조30례.대조조채용서약상규치료;중서의결합치료조재상규치료기출상가용선도삼초、사폐 활담、활혈이수방약선도사폐음(조성:정력자20 g,래복자15 g,택사15 g,상백피15 g,행인10 g,천후박10 g, 저령30 g,진피10 g,당귀12 g,천목통6 g등)100 mL,매일2차;량조료정균위8주.관찰량조치료전후심공능료효、중의증상적분료효,이급량조치료전후좌실사혈분수(LVEF)、좌실단축축단솔(LVFS),6 min보행시험(6MWT),혈장N말단B형납뇨태전체(NT-proBNP)、당류항원125(CA125)급생장분화인자-15(GDF-15) 수평,병평개치료과정중약적안전성화불량반응.결과 치료후중서의결합치료조심공능료효、중의증상적분료효균명현고우대조조〔심공능료효:86.7%(26/30)비63.3%(19/30),중의증상적분료효:83.3%(25/30)비60.0%(18/30),균P<O.05〕.량조치료후LVEF、LVFS、6MWT균교치료전명현증고,NT-proBNP、CA125급GDF-15수평균교치료전명현강저,차중서의결합치료조개선정도우우대조조〔LVEF:0.486±0.073비0.458±0.071;LVFS:(25.0±3.5)%비(23.8±3.0)%;6MWT(m):310.7±42.6비298.4±38.2;NT-proBNP(ng/L):345.6±76.2비426.7±83.9;GDF-15(ng/L):923.3±187.3비1 026.7±201.6;CA125(U/L):58.72±7.62비65.56±9.16;균P<0.05〕.량조균미출현저혈압,균미견간신공능손해혹가중.결론 선도삼초、사폐활담、활혈이수법가개선삼초옹새,담어수정형CHF환자적심공능,개선중의증상적분,증가LVEF、LVFS급6MWT,강저혈장GDF-15、CA125급NT-proBNP수평.
Objective To observe the clinical effect of Xuandao Sanjiao, Xiefei Huotan and Huoxue Lishui traditional Chinese medicine (TCM) methods for treatment of patients with chronic congestive heart failure (CHF). Methods Sixty patients with CHF and cardiac function Ⅲ or Ⅳ (NYHA Ⅲ or Ⅳ) accompanied by TCM syndrome of Sanjiao obstruction, phlegm and blood stasis and fluid-retention were randomly divided into two groups: combined TCM and western medicine treatment group and control group, 30 cases in each group. The patients in control group were treated by western medicine; the patients in TCM and western medicine treatment group were treated by conventional western medicine and additionally Xuedao Xiefei decoction including drugs for Xuandao Sanjiao, Xiefei Huotan, Huoxue Lishui (ingredients: Semen Lepidii 20 g, Semen Raphani 15 g, Rhizoma Alismatis 15 g, Cortex Mori 15 g, Armeniacae Semen 10 g, magnolia bark 10 g, Polyporus 30 g, Pericarpium Citri Reticulatae 10 g, Radix Angelicae Sinensis 12 g, Clematidis Amandii 6 g, etc) 100 mL, 2 times a day. The therapeutic course was 8 weeks in both groups. Heart function, TCM symptom scores, and left ventricular ejection fraction (LVEF), left ventricular fractional shortening rate (LVFS), 6-minute walking test (6MWT), plasma levels of N terminal-B type natriuretic peptide precursor (NT-proBNP), carbohydrate antigen 125 (CA125) and growth differentiation factor-15 (GDF-15) were measured in both groups before and after treatment. And the safety and adverse reactions of drugs were evaluated in the course of treatment. Results After treatment, the heart function and TCM symptom scores in TCM and western medicine treatment group were significantly better or higher than those in the control group [heart function: 86.7% (26/30) vs. 63.3% (19/30), TCM symptoms scores: 83.3% (25/30) vs. 60.0% (18/30), bothP < 0.05]. Compared with those before treatment in both groups, LVEF, LVFS, and 6MWT after treatment were significantly increased, while NT-proBNP, CA125 and GDF-15 levels were obviously lowered, and the degree of improvement in TCM and western medicine treatment group was markedly superior to that in the control group [LVEF: 0.486±0.073 vs. 0.458±0.071, LVFS:(25.0±3.5)% vs. (23.8±3.0)%, 6MWT (m): 310.7±42.6 vs. 298.4±38.2, NT-proBNP (ng/L): 345.6±76.2 vs. 426.7±83.9, GDF-15 (ng/L): 923.3±187.3 vs. 1 026.7±201.6, CA125 (U/L): 58.72±7.62 vs. 65.56±9.16, allP < 0.05]. No hypotension and no damage of liver and kidney function or exacerbation of their dysfunctions were seen. Conclusion The TCM methods of Xuandao Sanjiao, Xiefei Huotan and Huoxue Lishui can improve the situation of Sanjiao obstruction, phlegm and blood stasis and fluid-retention, improve the heart function and TCM symptoms, increase LVEF, LVFS and 6MWT and reduce plasma GDF-15, CA125 and NT-proBNP levels in CHF patients.
