不同剂量温阳强心方治疗慢性充血性心力衰竭的临床疗效及对ANP的影响

Clinical study of Wenyang Qiangxin decoction in different doses on chronic congestive heart failure and effect of it on ANP

目的研究不同剂量温阳强心方对慢性充血性心力衰竭心气(阳)虚、水饮泛滥证患者症状、心功能参数及ANP等的影响。方法将60例慢性充血性心力衰竭心气(阳)虚、水饮泛滥证患者随机分为两组,对照组30例,治疗组30例,两组患者均在控制基础疾病的同时,按慢性心力衰竭西医基础治疗。轻、重剂量组在此基础上分别予温阳强心方:附片用量分别为10、25 g,干姜用量分别为10、25 g,并加用红参、茯苓、甘草等。两组疗程均为3周。观察治疗前后中医临床症状、心功能参数及ANP等的变化。结果 (1)两组患者的临床症状均有明显改善(P<0.01),治疗组症状的改善明显优于对照组(P<0.05)。(2)治疗后两组患者的左室短径缩短率(FS)、射血分数(EF)、舒张早期最大充盈速度(E)、舒张晚期最大充盈速度(A)之比值(E/A)均有提高(P<0.01),治疗组以上指标的升高优于对照组(P<0.05)。(3)治疗后两组心房利钠肽(ANP)、内皮素(ET)、一氧化氮(NO)、去甲肾上腺素(NE)均有降低(P<0.01),治疗组以上指标的降低优于对照组(P<0.05)。结论轻、重剂量组的附片经充分煎煮后无明显不良反应。不同剂量温阳强心方可改善慢性充血性心力衰竭心气(阳)虚、水饮泛滥证患者症状、提高其心功能及降低ANP等。重剂量组疗效优于轻剂量组。重剂量温阳强心方是治疗慢性充血性心力衰竭的有效方剂。

Objective To study the effects of Wenyang Qiangxin decoction（WQD） in light and strong doses on symptoms,heart function and ANP of the patients with chronic congestive heart failure in syndromes of heart yang qi deficiency and damp-water flooding.Methods All 60 patients with the disease and syndrome were randomly divided in-to control group and treatment group,30 patients per group and treated.On the basic treatment with the western medicine,the patients in light and strong doses groups were given WQD re-spectively,monkshood dosage in light and strong doses was 10 g and 25 g,dry ginger was 10g and 25 g respectively,and add red ginseng,Poria,licorice,etc.The treatment lasted 3 weeks.The clinical symptoms,cardiac function parameters and ANP and other changes were measured.Results The clinical symptoms in both groups were significantly improved（P0.01）,which was significantly improved in treatment group than that in control group（P0.05）.After treatment,all the short axis shortening in left ventricular（FS）,ejection fraction（EF）,the ratio（E/A） of maximum early diastolic filling velocity（E） and maximum late diastolic filling velocity（A） in both were increased（P0.01）,all of them in treatment groups were more than that in control group（P0.05）.After the treatment,atrial natriuretic peptide（ANP）,endothelin（ET）,nitric oxide（NO）,norepinephrine（NE） were lower（P0.01）,all of them in the treatment groups were lower than that in control group（P0.05）.Concliusion WQD in both light and strong doses can improve the symptoms of the patients with chronic congestive heart failure in syndromes of heart yang qi deficiency and damp-water flooding,enhance function and reduce ANP;strong dose is better than light dose.The monkshood,in light or strong doses,through lasted decocting,is no obvious adverse reactions,so,the strong dose of WQD is effective therapy for chronic congestive heart failure.