强心温补汤治疗心衰的临床观察研究

马翔　闫霖

【摘要】 目的 觀察西药治疗慢性心力衰竭慢性心衰， （CHF）的基础上加强心温补汤的临床疗效。方法 66例慢性心衰患者， 随机分为治疗组和对照组， 每组33例。对照组应用常规西药治疗， 治疗组在常规西药的基础上联合强心温补汤口服， 疗程为30 d。观察治疗前后两组患者的心衰疗效积分效果、心功能分级效果、心脏超声指标及N末端前体脑钠肽（NT-proBNP）的变化。结果 治疗组患者的心衰疗效积分的总有效率为96.97%、心功能分级的总有效率为93.94%， 均明显优于对照组的81.82%、78.79%， 差异具有统计学意义（P<0.05）。治疗后， 两组患者的左室射血分数（LVEF）和舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值（E/A）均较治疗前明显增加， 左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）较治疗前明显缩小， 差异均具有统计学意义（P<0.05）。两组治疗后的LVEF、LVEDD、LVESD和E/A水平比较， 差异均具有统计学意义（P<0.05）。治疗前两组血浆NT-proBNP比较， 差异无统计学意义（P>0.05）。治疗后两组NT-proBNP水平均明显低于治疗前， 且治疗组较对照组水平更低， 差异具有统计学意义（P<0.05）。结论 强心温补汤治疗慢性心力衰竭有效， 可明显改善心功能分级， 降低血NT-proBNP水平， 且方法简便、安全、无明显毒副作用， 患者依从性较强， 值得临床推广。

【关键词】 强心温补汤；心力衰竭；疗效

DOI：10.14163/j.cnki.11-5547/r.2017.21.003

Clinical observation of Qiangxin Wenbu decoction in the treatment of chronic heart failure MA Xiang， YAN Lin. Shenyang Traditional Chinese Medicine Hospital， Shenyang 110003， China

【Abstract】 Objective To observe the clinical efficacy of Qiangxin Wenbu decoction in the treatment of chronic heart failure （CHF） on the basis of western medicine treatment. Methods A total of 66 chronic heart failure patients were randomly divided into treatment group and control group， with 33 cases in each group. The control group received routine western medicine for treatment， and the treatment group received oral Qiangxin Wenbu decoction on the basis of routine western medicine treatment for 30 d treatment. Observation were made on the change of heart failure efficacy integral， cardiac function classification， cardiac ultrasound index and N-terminal pro-brain natriuretic peptide （NT-proBNP） before and after treatment in two groups. Results The treatment group had total effective rate of heart failure efficacy integral as 96.97%， and total effective rate of cardiac function classification as 93.94%， which were all obviously better than 81.82% and 78.79% in the control group， and their difference had statistical significance （P<0.05）. After treatment， both groups had higher left ventricular ejection fraction （LVEF） and early diastolic mitral flow velocity and late diastolic mitral flow velocity ratio （E/A） than those of before treatment， and significantly smaller left ventricular end diastolic diameter （LVEDD） and left ventricular end systolic diameter （LVESD） than those before treatment. Their difference had statistical significance （P<0.05）. Both groups had statistically significant difference in LVEF， LVEDD， LVESD and E/A level after treatment （P<0.05）. There was no statistically significant difference in plasma NT-proBNP before treatment （P>0.05）. After treatment， both groups had obviously lower NT-proBNP level than that of before treatment， and the treatment group was lower than the control group. Their difference had statistical significance （P<0.05）.Conclusion Qiangxin Wenbu decoction is effective in treating chronic heart failure， and it can significantly improve the cardiac function classification， lower blood NT-proBNP levels. This method is simple and safe without obvious side effects， and patients shows strong compliance. So it is worthy of clinical promotion.

【Key words】 Qiangxin Wenbu decoction； Chronic heart failure； Efficacy

慢性心力衰竭又称慢性充血性心力衰竭， 是很多心血管疾病的最终归宿， 也是常见的死亡原因， 每年呈上升的趋势[1-3]。临床上以左心衰最为常见。经过多年的临床研究中医药治疗慢性心衰的优势得到了大家的认同。本院在西医规范治疗慢性心衰的同时加用强心温补汤， 取得了很好的疗效。观察研究如下。

1 资料与方法

1. 1 一般资料 所选患者来源于2014年12月～2015年12月于本院住院的慢性心衰患者， 共66 例。其中男27例， 女39例；年龄45～74岁， 平均年龄（57.9±8.2）岁；病程0.8～15.0年， 平均病程（7.9±7.1）年。中医辨证分型：心肾气虚、血瘀水停。患者心功能分级（NYHA分级）均属Ⅱ、Ⅲ级。根据随机数字表法将患者分为对照组和治疗组， 各33例。两组患者一般资料比较差异无统计学意义（P>0.05） ， 具有可比性。见表1。观察期间无退出病例。……