温阳理气中药奄包热熨对心肾阳虚心衰患者疲乏状况的影响

徐乃翠　徐晓春　徐萍　张娴

[關键词] 心肾阳虚;心衰;中药奄包;疲乏

[中图分类号] R541.6          [文献标识码] B          [文章编号] 1673-9701（2021）17-0159-04

Impacts of hot medicated compress of TCM package for warming yang and regulating qi on fatigue of patients with yang deficiency of heart and kidney and heart failure

XU Naicui   XU Xiaochun   XU Ping   ZHANG Xian

Department of Cardiology， Hangzhou Hospital of Traditional Chinese Medicine， Hangzhou   310007， China

[Abstract] Objective To observe the impacts of hot medicated compress of traditional Chinese medicine（TCM） package for warming yang and regulating qi on fatigue of patients with yang deficiency of heart and kidney and heart failure. Methods In this research， a total of 93 patients who met the inclusion criteria admitted to the department of cardiology of our hospital from January 2017 to March 2019 were selected prospectively. According to the random number table method， they were divided into group A （n=31）， group B （n=31） and group C （n=31）. Group A was given conventional treatment and nursing for heart failure， group B was combined with hot medicated compress of pure salt package without TCM on the basis of group A， and group C was combined with hot medicated compress of TCM package for warming yang and regulating qi on the basis of group A. Blood BNP was detected and short fatigue scale was used to evaluate the fatigue status of each group. Results After intervention， there was statistically significant difference in BNP between group C and group A （P<0.05）， but there was no statistically significant difference between group A and group B （P>0.05）， and there was no statistically significant difference between group A and group B （P>0.05）. There was statistically significant difference in the change rate of BNP between group C and that in group A and group B （P<0.05）， and there was statistically significant difference between group A and group B （P<0.05）. After intervention， there was statistically significant difference in the scores of fatigue scale between group C and those in group A and group B （P<0.05）， but there was no statistically significant difference between groups A and group B （P>0.05）. There was statistically significant difference in the change rate of fatigue scale scores between group C and that in group A and group B （P<0.05）， but there was no statistically significant difference between group A and group B （P>0.05）. Conclusion The hot medicated compress of TCM package for warming yang and regulating qi can improve the fatigue of patients with heart and kidney yang deficiency and heart failure.

[Key words] Yang deficiency of heart and kidney; Heart failure; traditional Chinese medicine （TCM） package; Fatigue

慢性心力衰竭是由心肌病、血流动力学负荷过重、炎症等造成的心肌结构与功能改变，导致心室充盈及泵血功能低下的慢性疾病，一种以呼吸困难、体液储留和疲乏等为主要表现的临床症状群，是各种心脏疾病的严重阶段，常危及患者生命。而疲乏是心衰患者最常见的并发症状之一，疲乏是一种主观的不悦的症状，包括从疲倦到精疲力竭的各种感受，它所产生的症状常会影响患者的日常生活[1-2]。Joseph等将疲乏与嗜睡进行区分，将疲乏定义为“一种严重的疲惫感，无力感和精疲力竭感，伴随有行为和（或）认知功能受影响”[3]，慢性心力衰竭的疲乏常表现为经常存在的疲劳感觉和由此所引起的日常生活能力的减退。疲乏可能会发生在疾病的任何阶段，且会随着病情的加重而更加严重，甚至造成患者机体功能障碍，严重的疲乏可能还会进一步影响慢性心衰疾病的预后[4-5]。有研究表明运动及呼吸肌锻炼能缓解心衰的疲乏[6-7]，但也有研究表明对严重心衰患者使用运动疗法往往不耐受[8]。多数专家认为心衰以心肾阳虚为本，血脉瘀滞、水饮内停等为标，病位在心，与肾、脾、肺等各脏腑关系密切，慢性心衰中医的辨证分型中心肾阳虚证占60%以上[9]。随着中医理念在临床中的推广，中医护理适宜技术应用于心衰患者受到越来越多的关注。本文通过对CHF患者进行中药奄包热熨，探讨对其疲乏状况的影响，现报道如下。