中西医结合治疗慢性心力衰竭伴利尿剂抵抗35例临床观察

Efficacy of integrated traditional Chinese and Western medicine therapy in treatment of chronic heart failure with diuretic resistance: a report of 35 cases

目的:观察真武汤合丹参饮加减联合多巴胺、呋塞米治疗慢性心力衰竭伴利尿剂抵抗的临床疗效。方法:将69例慢性心力衰竭伴利尿剂抵抗的患者随机分成两组,对照组34例采用多巴胺联合呋塞米治疗,治疗组35例在对照组治疗基础上加真武汤合丹参饮加减治疗。结果:心衰症状疗效总有效率治疗组为85.7%,对照组为61.8%,心功能疗效总有效率治疗组为80.0%,对照组为50.0%,组间比较,差异均有统计学意义(P<0.05);两组尿量、体质量治疗前后组内比较及治疗后组间比较,差异均有统计学意义(P<0.05);治疗组低钾最早在第3天出现,对照组在第1天,每天低钾例数治疗组均低于对照组,随着用药时间的延长,治疗组低钾例数增长平缓,对照组例数增长较快。结论:真武汤合丹参饮加减联合多巴胺、呋塞米治疗慢性心衰伴利尿剂抵抗具有较好疗效。

Objective： To observe the clinical efficacy of modified Zhenwu and Danshen decoction combined with dopamine and furosemide in the treatment of chronic heart failure（ CHF） with diuretic resistance. Methods： A total of 69 CHF patients with diuretic resistance were randomly divided into control group（ n = 34） and treatment group（ n = 35）. The control group was treated with dopamine combined with furosemide,while the treatment group was given modified Zhenwu and Danshen decoction in addition to the treatment for the control group. Results： The treatment group and control group had overall response rates for heart failure symptoms of 85. 7% and 61. 8%,respectively,while the overall response rates for cardiac function were 80. 0% and 50. 0%,respectively（ P〈0. 05）.The urine volume and body mass showed significant differences within the same group before and after treatment and between the two groups after treatment（ P〈0. 05）. Hypokalemia occurred on the third day in the treatment group and on the first day in the control group,and the treatment group had fewer hypokalemia cases each day than the control group. Over the course of medication,the treatment group had a slow increase in hypokalemia cases,while the control group had a relatively rapid increase. Conclusion： Zhenwu and Danshen decoction combined with dopamine and furosemide have satisfactory efficacy in the treatment of CHF with diuretic resistance.