益气温阳、活血利水法对充血性心力衰竭的辅助治疗作用

Assistant Effect of Therapy of Strengthening Qi,Warming Yang,Activating Blood to Promote Diuresis for Congestive Heart Failure

【目的】研究益气温阳、活血利水中药对常规西药治疗充血性心力衰竭（简称心衰）的协同作用及其对神经内分泌因子的影响。【方法】将心功能为Ⅱ-Ⅳ级，中医辨证属气（阳）虚血瘀兼水饮证的心衰患者70例随机分为西医常规治疗组（简称西药组，28例）和常规治疗加中药组（简称中西药组，42例）。两组均给予地高辛、利尿剂、血管紧张素转换酶抑制剂、β受体阻滞剂等常规抗心衰治疗，中西药组在此基础上给予益气温阳、活血利水中药（药物组成：生黄芪、太子参、仙灵脾、仙茅、葶苈子、益母草、桃仁、茯苓、泽泻、桂枝、炒酸枣仁、甘草）口服治疗，4周为1个疗程。观察两组一临床疗效及治疗前后心功能、神经内分泌因子的变化情况。【结果】中西药组显效24例，有效16例，无效2例，总有效率为95．24％；西药组显效19例，有效4例，无效5例，总有效率为82．14％；两组比较，中西药组疗效优于西药组（P〈0．01）。在心功能变化方面，两组治疗后左室射血分数（EF）、左室短轴缩短率（FS）、心脏指数（CI）等参数与治疗前比较均有显著性差异（P〈0．01），中西药组EF、CI的改善较西药组明显（P〈0．01）。在神经内分泌因子的变化方面，两组治疗后血中的心房肽（ANP）、血管紧张素Ⅱ（AT-Ⅱ）、内皮素（EF）水平均较治疗前下降（P〈0．05），且中西药组较西药组下降更明显（P〈0．05）。【结论】益气温阳、活血利水中药对心衰有辅助治疗作用，其机理可能与其协同西药有效降低血中ANP、AT-Ⅱ、ET等神经内分泌因子水平有关。

[ Objective] To investigate the synergistic action of therapy of strengthening Qi, warming yang, activating blood to promote diuresis on routine western medicine for congestive heart failure （CHF） and to observe its effect on neuroendocrine factors. [ Methods] Seventy CHF patients with cardiac function of grade Ⅱ - Ⅳ which were classified into Qi deficiency and blood stasis complicated with fluid retention, were randomized into groups A （n = 42） and B （n = 28）. Group B received routine treatment with digoxin, diuretics, angiotensin converting enzyme inhibitors and receptor antagonists. Group A additionally received oral use of decoction of herbal medicines of Radix Astragali, Herba Epimedii, Herba Leonuri, Rhizoma Alismatis, etc., which has the actions of strengthening Qi, warming yang, activating blood to promote diuresis. Four weeks constituted one treatment course. The therapeutic effect as well as the changes of cardiac function and neuroendocrine factors before and after treatment was observed. [ Results] In group A, 24 were markedly effective, 16 effective, 2 ineffective and the total effective rate was 95.24%; in group B, 19 were markedly effective, 4 effective, 5 ineffective and the total effective rate was 82.14%. The therapeutic effect in group A was superior to group B （P 〈 0.01）. The cardiac function parameters of ejection fraction （EF）, fractional shortening （b-S） and cardiac index were improved in the two groups as compared with those before treatment （P 〈 0.01）, and the improvement of EF and CI in group A was superior to group B （P 〈 0.01 ）. The neuroendocrine factors of atrial natriuretic peptide （ANP）, angiotensin Ⅱ （AT-Ⅱ）, endothelin （ET） were decreased in the two groups （P 〈 0.05 compared with those before treatment）, in particular in group A （ P 〈 0.05 compared with group B）. [ Conclusion] Herbal medicines with the actions of strengthening Qi, warming yang, activating blood to promote diuresis have an assistant action on the treatment of CHF, and their mechanism may be related to the decrease of neuroendocrine factors of ANP, AT- Ⅱ and ET.