益气温阳活血利水法辅助西医常规治疗气阳虚衰兼水饮血瘀证慢性心力衰竭患者的疗效评价

Efficacy evaluation of the method of nourishing qi, yang, activating blood and diverting water to assist conventional western medicine in the treatment of chronic heart failure patients with qi-yang deficiency and water-drinking blood stasis syndrome

目的探讨益气温阳活血利水法辅助西医常规治疗气阳虚衰兼水饮血瘀证慢性心力衰竭患者的疗效。方法选取2019年11月~2021年5月我院就诊的慢性心力衰竭患者146例,采用随机数字表法分为常规组和研究组,各73例。常规组给予常规西药治疗,研究组在常规组治疗基础上加用自拟益气温阳活血利水方。比较两组疗效、中医证候积分、心功能[左室短轴缩短率(FS)、左室射血分数(LVEF)、舒张早期最大流速(E峰)/舒张晚期最大流速(A峰)(E/A)]、神经内分泌因子[内皮素(ET)、心房肽(ANP)、血管紧张素-Ⅱ(AT-Ⅱ)]、病情相关指标[N端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、心型脂肪酸结合蛋白(H-FABP)]、6min步行距离及再住院率。结果研究组总有效率95.89%高于常规组(84.93%),差异有统计学意义(P<0.05);治疗后研究组喘息、心悸、气短、乏力积分分别为(1.24±0.35)分、(0.97±0.23)分、(1.36±0.25)分、(1.53±0.17)分,均低于常规组[(2.14±0.27)分、(1.95±0.39)分、(2.24±0.33)分、(2.64±0.21)分],差异有统计学意义(P<0.05);治疗后研究组FS、LVEF、E/A分别为(35.41±3.76)%、(50.47±2.63)%、(0.97±0.15),均高于常规组[(27.24±2.62)%、(45.18±2.29)%、(0.72±0.08)],差异有统计学意义(P<0.05);治疗后研究组ET、ANP、AT-Ⅱ、NT-proBNP、hs-CRP、H-FABP分别为(2.15±0.43)ng/L、(113.73±32.41)ρg/mL、(57.63±17.54)ρg/mL、(379.41±34.76)ρg/mL、(5.73±1.24)mg/L、(24.31±7.62)ρg/mL,均低于常规组[(2.98±0.51)ng/L、(157.97±42.25)ρg/mL、(73.19±20.38)ρg/mL、(617.44±49.63)ρg/mL、(11.58±3.64)mg/L、(34.26±9.57)ρg/mL],差异有统计学意义(P<0.05);6-MWT距离为(475.32±23.63)m,高于常规组[(368.25±19.76)m],差异有统计学意义(P<0.05);治疗后随访6个月,研究组再住院率8.82%,低于常规组(21.21%),差异有统计学意义(P<0.05)。结论益气温阳活血利水法辅助西医常规治疗气阳虚衰兼水饮血瘀证慢性心力衰竭患者疗效确切,可有效减轻临床症状,改善患者心功能,且预后较好。

Objective To explore the efficacy of the method of Yiwen Yang Blood and Water Drainage in the conventional treatment of patients with chronic heart failure with Qi and Yang deficiency and water drinking and blood stasis.Methods A total of 146 patients with chronic heart failure who were treated in our hospital from November 2019 to May 2021 were selected and divided into routine group(n=73) and study group(n=73) by computer random number table method. The routine group was given routine western medicine treatment, while the study group was given the self-made Yiqiwenyang Huoxue Lishui prescription on the basis of the routine group. The curative effect, TCM syndrome score, cardiac function [left ventricular short-axis shortening rate(FS), left ventricular ejection fraction(LVEF), early diastolic maximum flow rate(E peak)/late diastolic maximum flow rate(A peak)ere compared between the two groups( E/A)], neuroendocrine factors [endothelin(ET), atrial peptide(ANP), angiotensin-Ⅱ(AT-Ⅱ)], disease-related indicators [N-terminal probrain natriuretic peptide(NT-proBNP), High-sensitivity C-reactive protein(hs-CRP), heart-type fatty acid-binding protein(H-FABP)], 6-min walking distance and readmission rate.Results The total effective rate of the study group was 95.89% higher than that of the routine group, 84.93%(P<0.05). Compared with the scores of wheezing, palpitations, shortness of breath and fatigue after treatment, the study group was lower than the routine group(P<0.05). Compared with the routine group, the study group had higher FS, LVEF, E/A, lower ET, ANP, AT-Ⅱ, NT-proBNP, hs-CRP, H-FABP, and longer 6-MWT distance(P<0.05);Followed up for 6 months after treatment, the readmission rate of the study group was 8.82% lower than that of the routine group 21.21%(P<0.05).Conclusion Yiwen Yang Blood and Water Drainage Method assists Western medicine in the conventional treatment of patients with chronic heart failure with Qi and Yang deficiency and water drinking blood stasis, which can effectively reduce clinical symptoms, improve patients’ cardiac function, and have a good prognosis.