葶苈真武汤联合西药治疗充血性心力衰竭随机平行对照研究

Tinglizi Zhenwu Tang combined with Western Medicine Treatment Congestive Heart failure Randomized Controlled Study

[目的]观察葶苈真武汤联合西药治疗充血性心力衰竭疗效。[方法]使用随机平行对照方法,将120例住院患者按病志号抽签法简单随机分为两组。对照组60例利尿剂:双氢克尿噻,25mg/次,1~3次/d;螺内酯,20mg/次,1~2次/d;或呋塞米(Ⅲ级、Ⅳ级),20mg/次,1~3次/d。血管紧张素转化酶抑制剂卡托普利,12.5mg^25mg/次,1~3次/d。洋地黄类(Ⅲ级、Ⅳ级):地高辛,0.125mg/次,1次/d;根据情况西地兰0.2~0.4mg+5%葡萄糖250m L,静注。血管扩张剂:硝酸异山梨酯,10mg/次,3次/d;根据情况联合硝酸甘油,5~10mg/次,1次/d,共注射1~5d。吸氧:间断吸氧,3-4L/h,根据情况吸氧,3-4L/h;注意电解质,必要时补钾;注意24h尿量治疗。治疗组60例葶苈真武汤(葶苈子30g,附片先煎30min、红参各15g,黄芪30g,白术、茯苓各15g,丹参12g;咳嗽甚加紫菀、杏仁各10g;喘甚加苏子、五味子各10g;心悸加龙骨、牡蛎各20g;瘀血重加桃仁15g,红花12g;浮肿重加车前子、泽泻各10g);1剂/d,水煎300m L,早中晚口服,100m L/次;西药治疗同对照组。连续治疗14d为1疗程。观测指临床症状、BNP、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效32例,有效27例,无效1例,死亡0例,总有效率98.33%。对照组显效20例,有效26例,无效12例,死亡2例,总有效率76.67%。治疗组疗效优于对照组(P<0.01)。脑钠肽值两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]葶苈真武汤联合西药治疗充血性心力衰竭疗效满意,无严重不良反应,值得推广。

[Objective]To observe Tinglizi Zhenwutang combined with western medicine treatment of congestive heart failure treatment.[Methods]Randomized parallel controlled method,120 cases of hospitalized patients by disease Zhi No.lottery method is simple and randomly divided into two groups.The control group 60 cases Diuretics： Hydrochlorothiazide,25mg/times,1 to 3 times/d;spironolactone,20mg/times,1 to 2 times/d;or furosemide（Ⅲ grade,Ⅳ grade）,20mg/time,1-3 times/d.Angiotensin converting enzyme inhibitors captopril,12.5mg^25 mg/times,1 to 3 times/d.Digitalis（gradeⅢ,gradeⅣ）：digoxin,0.125mg/second,1/d;according to the patient＇s condition cedilanid 0.2~0.4 mg＋5% 250 m L glucose intravenously.Vasodilators： isosorbide dinitrate,10mg/time,3 times/d;according to the joint nitroglycerin,5 ~ 10mg/times,1 times/d,a total injection of 1~5d.Oxygen： intermittent oxygen,3-4L/h,depending on the circumstances oxygen,3-4L/h;note electrolytes,potassium,if necessary;Note 24 h urine therapy.Treatment group,60 patients Tinglizi Zhenwu Tang（Tinglizi 30 g,Fupian,Hongshen 15 g,Huangqi 30 g,Baizhu,Fuling 15 g,Danshen 12g;cough even add Ziyuan,Xingren 10g;asthma and Suzi,Wuweizi 10g;palpitations plus Longgu,Muli 20g;bleeding heavier Taoren 15 g,Honghua 12g;edema heavier Cheqianzi,Zexie 10g）;1/d,decoction 300 m L,early in the evening oral,100 m L/times.Western medicine with the control group.14 d for a course of continuous treatment.It refers to clinical observation,BNP,adverse reactions.Continuous treatment course of treatment,to determine efficacy.[Results]The treatment group 32 cases,effective 27 cases,ineffective in 1 case,0 cases of death,the total efficiency of 98.33%.The control group 20 cases markedly effective in 26 cases,12 cases,2 deaths,the total efficiency of 76.67%.Treatment group than the control group（P0.01）.BNP values improved in both groups（P0.01）,the treatment group than the control group improved（P0.01）.[Conclusion]Zhen Wu Tang combined with Western medicine treatment of congestive heart failure satisfactory effect,no serious adverse reactions,is worth promoting.