苓桂术甘汤治疗低氧性肺动脉高压的临床疗效研究

Clinical Effects of Lingguizhugan Decoction in the Treatment of Hypoxic Pulmonary Hypertension

目的探讨苓桂术甘汤治疗低氧性肺动脉高压(HPH)的临床疗效。方法选取2013年5月—2015年8月到兰州大学第二医院就诊的HPH患者96例,采用随机数字表法分为对照组(n=44)和试验组(n=52)。对照组患者采用常规治疗,试验组患者在常规治疗的基础上服用苓桂术甘汤,两组患者平均治疗时间为(12±2)d。比较两组患者治疗前后的血清N端脑利钠肽前体(NT-pro BNP)水平、心肺功能指标、血气分析指标、中医证候积分,以及中医证候疗效和不良反应发生情况。结果治疗前两组患者血清NT-pro BNP水平比较,差异无统计学意义(P>0.05);治疗后试验组患者血清NT-pro BNP水平低于对照组,差异有统计学意义(P<0.05);治疗后两组患者血清NT-pro BNP水平均低于治疗前,差异有统计学意义(P<0.05)。治疗前两组患者心排血量(CO)、左心室射血分数(LVEF)、肺动脉压比较,差异无统计学意义(P>0.05);治疗后试验组患者CO、LVEF高于对照组,肺动脉压低于对照组,差异有统计学意义(P<0.05);治疗后两组患者CO、LVEF均高于治疗前,肺动脉压均低于治疗前,差异有统计学意义(P<0.05)。治疗前两组患者p H、血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)比较,差异无统计学意义(P>0.05)。治疗后两组患者p H比较,差异无统计学意义(P>0.05);试验组患者Pa O2高于对照组,Pa CO2低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者p H与治疗前比较,差异均无统计学意义(P>0.05);Pa O2均高于治疗前,Pa CO2均低于治疗前,差异有统计学意义(P<0.05)。治疗前两组患者中医证候积分比较,差异无统计学意义(P>0.05);治疗后试验组患者中医证候积分低于对照组,差异有统计学意义(P<0.05);治疗后两组患者中医证候积分均低于治疗前,差异有统计学意义(P<0.05)。试验组患者中医证候疗效优于对照组,差异有统计学意义(P<0.05)。两组患者均无明显不良反应发生。结论苓桂术甘汤治疗HPH的临床疗效确切,可缓解患者低氧状态,利于患者预后。

Objective To investigate the clinical effects of Lingguizhugan decoction in the treatment of hypoxic pulmonary hypertension （HPH） . Methods 96 HPH patients who received treatment in Lanzhou University Second Hospital from May 2013 to August 2015 were selected and divided into control group （n =44） and experimental group （n =52） by using random number table method. The control group was treated with conventional therapy, based on which the experimental group took Lingguizhugan decoction. The average time of therapy of patients in two groups was （12 ±2） d. Serum N -terminal pro brain natriuretic peptide （NT-proBNP） level, hearts and lungs function indices, blood gas analysis, TCM symptom scores, and efficacy of TCM syndrome and occurrence of adverse reactions among patients in two groups before and after treatment were compared. Results Serum NT-proBNP levels of patients in two groups before treatment were not significantly different （P 〉0. 05 ） ; after treatment, serum NT-proBNP level of patients in experimental group was significantly lower than that in control group （P 〈 0. 05 ） ; serum NT-proBNP levels of patients in two groups after treatment were significantly lower than those before treatment （P 〈 0. 05 ）. There was no significant difference in cardiac output （CO） , left ventricular ejection fraction （LVEF） and pulmonary artery pressure of patients in two groups before treatment （ P 〉 0. 05 ） ; after treatment, CO and LVEF of patients in experimental group were significantly higher than those in control group, while pulmonary artery pressure in experimental group was lower than that in control group （ P 〈 0. 05 ） ; both CO and LVEF of patients in two groups after treatment were significantly lower than those before treatment, while pulmonary artery pressure after treatment was lower than that before treatment （ P 〈 0.05 ） . pH, partial pressure of blood oxygen （ PaO2 ） and arterial partial pressure of carbon dioxide （ PaCO2 ） of patients in two groups before treatment were not significantly different （ P 〉 0.05 ） . pH of patients in two groups was not significantly different （P 〉 0. 05 ） ; PaO2 of patients in experimental group was significantly higher than that in control group, while PaCO2 was lower than that in control group （ P 〈 0. 05 ） . pH of patients in two groups after treatment and before treatment was not significantly different （ P 〉 0.05 ） ; PaO2 in two groups was significantly higher than that before treatment, PaCO2 was significantly lower than that before treatment （P 〈 0.05 ） . There was no significant difference in TCM symptom scores of patients in two groups before treatment （P 〉 0. 05） ; after treatment, TCM symptom scores of patients in experiment group were significantly lower than those in control group （ P 〈 0. 05 ） ; TCM symptom scores of patients in two groups after treatment were significantly lower than those before treatment （ P 〈 0. 05 ） . Efficacy of TCM syndrome of patients in experiment group was better than that in control group （ P 〈 0.05） . Patients in two groups had no obvious adverse reaction. Conclusion Conclusion Lingguizhugan decoction has precise clinical effects on the treatment of HPH, and can remit patients＇ hypoxic condition. It benefits prognosis of patients.