151例慢性心力衰竭血瘀证患者的证、治规律的回顾性分析

A Retrospective Analysis of 151 Cases of Chronic Heart Failure Patients with Blood Stasis Syndrome for Evolution Pattern and Drug Characteristics

目的:探讨慢性心力衰竭(CHF)血瘀证及其兼夹证的演变规律和用药特点。方法:收集中日友好医院中西医结合心内科2005年1月至2007年12月全部资料完整的151例CHF患者病历,采用单中心回顾性病例研究方法分析患者的入院时中医证候要素、辨证分型、心功能分级及首剂中药方药,分析CHF的临床流行病学特点、证候要素、血瘀证兼证在不同心功能分级间的分布规律以及中药用药规律。结果:CHF的中医证候要素有气虚、阴虚、阳虚及血瘀、痰浊、水饮,其中出现频数最多的是血瘀(69.54%),血瘀常兼夹气虚、痰浊。CHF血瘀证亚型与心功能的关系:CHF心功能Ⅱ,Ⅲ,Ⅳ级的中医证型均以气虚血瘀证为主,心功能Ⅱ,Ⅲ级还常见痰瘀互阻证,心功能Ⅳ级还常见血瘀水停证和阳虚血瘀证。中药治疗以活血、益气、利水、化痰为主,活血化瘀中药的应用频率依次为:丹参、当归、川芎、益母草等。结论:血瘀证是CHF最常见证候,病程不同时期常兼夹气虚、阴虚、阳虚、痰浊、水饮,活血化瘀中药应用频率最高,常配合益气、温阳、利水、化痰药。

Objective：To analysis chronic heart failure with blood stasis syndrome of different subtypes,to figure out the distribution of the drug of traditional Chinese medicine（TCM）,so as to guide clinical drug use.Method：The retrospective analysis of 151 patients with chronic heart failure of combining traditional Chinese and western medicine treatment of patients with TCM diagnosis,syndrome type,heart function was classified.Result：The heart and blood stasis are the occurrence and development of important reason and the inevitable result,blood stasis syndrome types of heart failure for main（105 cases,69.54%）;and always with qi,yang deficiemcy.All patients with heart failure,heart function Ⅲ grade most see more,the different stages of the blood stasis subtypes distribution,blood stasis,different phlegm retention and mark the ups and downs of the empirical,this disease is repeated attacks of important reasons.Conclusion：Blood stasis syndrome is the most freguently occured syndrome with qi deficlency,yang deficiency,yin deficienty,phlegm stagnation etc.At different stages.In the treatment of the disease,the herbs for activating blood circulation and eliminating stasis appears to be the highest frequency,often used together with herbs of supplementing qi,alleviating water,warming yang and eliminating phlegm.