桂枝甘草汤联合真武汤加味对慢性心力衰竭患者血管内皮功能的影响

Effects of Guizhi-gancao decoction combined with Zhenwu decoction on vascular endothelial function in patients with chronic cardiac failure

目的观察桂枝甘草汤联合真武汤加味对慢性心力衰竭(CHF)患者血管内皮功能的影响。方法将76例CHF患者随机分为2组,对照组35例予常规西医治疗,治疗组41例在对照组治疗基础上加用桂枝甘草汤联合真武汤加味治疗。2组均治疗1个月后统计临床疗效,并观察2组治疗前后心排血量(CO)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、舒张早期流速峰值(EPFV)/舒张晚期流速峰值(APFV)(E/A)比值、血浆内皮素1(ET-1)、一氧化氮(NO)及肱动脉反应性充血状态下血管内径、血流量变化。结果治疗组总有效率90.24%,对照组总有效率71.43%,2组总有效率比较差异有统计学意义(P<0.05),治疗组疗效优于对照组。治疗组治疗后CO、LVEF、E/A均较本组治疗前升高,LVEDD、LVESD均降低(P<0.05),且改善情况均优于对照组(P<0.05)。对照组治疗后CO较本组治疗前升高,LVEDD降低(P<0.05)。2组治疗后CO、LVEF、LVEDD、LVESD及E/A组间比较差异均有统计学意义(P<0.05)。2组治疗后肱动脉血管内径及血流量均明显增加,ET-1活性降低,NO升高(P<0.05),且治疗组改善优于对照组(P<0.05)。结论桂枝甘草汤联合真武汤加味治疗CHF疗效确切,并能改善心功能及血管内皮功能。

Objective To observe the effects of Guizhi- gancao decoction combined with Zhenwu decoction on vascular endothelial function in patients with chronic cardiac failure（ CHF）. Methods 76 subjects with CHF were randomly divided into two groups. 35 subjects in control group were treated by routine western therapy. 41 subjects in treatment group were treated by Guizhi- gancao decoction combined with Zhenwu decoction on the basis of control group treatment. The curative effect was evaluated one month after treatment in two groups. The cardiac output（ CO）,left ventricular ejection fraction（ LVEF）,left ventricular end diastolic diameter（ LVEDD）,left ventricular end systolic diameter（ LVESD）,E / A ratio,ET- 1,NO and the changes of blood vessel diameter and flow volume of reactive hyperemia in brachial artery before and after treatment were observed in two groups. Results The total effective rate in treatment and control group was 90. 24% and 71. 43% respectively,with statistical differences（ P〈0.05）. The CO,LVEF and E / A after treatment in treatment group were increased,and the LVEDD and LVESD were decreased（ P〈0. 05）,the improvements in treatment group were superior to those in control group（ P〈0. 05）. The CO after treatment in control group was increased,and the LVEDD was decreased（ P〈0. 05）. There were statistical differences on CO,LVEF,LVEDD,LVESD and E / A after treatment between two groups（ P〈0. 05）. The blood vessel diameter and flow volume of reactive hyperemia in brachial artery after treatment were obviously increased in two groups,and the activity of ET- 1 was decreased,NO activity was increased（ P〈0. 05）,the improvements in treatment group were superior to those in control group（ P〈0. 05）. Conclusion Guizhi- gancao decoction combined with Zhenwu decoction has exact effect on the treatment of CHF,can effectively improve cardiac function and vascular endothelial function.