苓桂术甘汤联合西药治疗慢性充血性心力衰竭随机平行对照研究

Lingguizhugan Decoction combined with Western Medicine Treatment of Chronic Congestive Heart Failure Randomized Controlled Study

[目的]观察苓桂术甘汤联合西药治疗慢性充血性心力衰竭(CHF)疗效。[方法]使用随机平行对照方法,将90例住院患者按随机数字表随机分为两组。对照组45例改善生活方式,戒烟戒酒,卧床休息、低盐饮食、吸氧、避免重体力劳动及保持大便通畅,及时纠正水电解质紊乱,强心剂、利尿剂、血管紧张素转换酶抑制剂、β-受体阻滞剂及硝酸酯类药物。治疗组45例苓桂术甘汤(茯苓20g,桂枝15g,白术20g,炙甘草15g,黄芪30g,葶苈子20g,桑白皮15g,丹参20g,桃仁15g,泽泻15g),水煎服,浓煎至100mL,1剂/d,早晚口服。西药治疗同对照组。连续治疗2周为1疗程。观测临床症状体征及中医症候积分、心功能分级、LVEF、血浆脑钠肽水平、6min步行试验、不良反应。[结果]治疗组临床显效18例,有效24例,无效3例,总有效率93.33%。对照组临床显效11例,有效25例,无效9例,总有效率80.00%。两组治疗前后LVEF、BNP及6min步行距离分别比较,差异均有显著性意义(P<0.05),治疗后两组间比较,治疗组改善程度优于对照组(P<0.05)。[结论]苓桂术甘汤加味能改善CHF患者中医症候积分及心功能分级,增加左室射血分数及6min步行距离,降低血浆脑钠肽水平,从而进一步改善CHF患者心功能,临床疗效确切。

[Objective] Observed Lingguizhugan decoction combined with western medicine treatment of chronic congestive heart failure（CHF） effect.[Methods] Using randomized controlled method,90 cases of hospitalized patients were randomly divided into two groups randomly.Control group,45 cases improved lifestyle,smoking and drinking,bed rest,low-salt diet,oxygen,avoid heavy manual labor and keep the stool,and promptly correct water and electrolyte disturbance,routine use of digitalis cardiac stimulant,diuretic,angiotensin converting enzyme inhibitors,β-blockers and nitrates.Treatment group 45 cases Lingguizhugan Tang（Fuling 20g,Guizhi 15g,Baizhu 20g,Zhigancao 15g,Huangqi 30g,Tinglizi 20g,Sangbaipi 15g,Danshen 20g,Taoren 15g,Zexie 15g）,concentrated fry 100mL,1 dose/day,orally morning and evening.Western medicine with the control group.Continuous treatment two weeks for a course.Observation of clinical symptoms and signs and symptom scores,functional class,LVEF,plasma brain natriuretic peptide levels,6min walk test,adverse reactions.[Results]Treatment group,18 cases markedly effective in 24 cases,3 cases noneffective,the total efficiency of 93.33%.Clinical control group 11 cases markedly effective,25 cases markedly effective,9 cases noneffective,the total efficiency 80.00%.Before and after treatment LVEF,BNP and 6min walk distance were compared,the differences were statistically significant（P0.05）,after treatment between the two groups,the treatment group demonstrated greater improvement than the control group（P0.05）.[Conclusion]Lingguizhugan decoction can improve symptom scores in patients with CHF and NYHA functional class,left ventricular ejection fraction increased and 6min walking distance,lower plasma brain natriuretic peptide levels,thus further improving cardiac function in patients with CHF,clinical efficacy.