60例慢性心力衰竭患者综合治疗的中西药用药分析

Analysis of combined therapy of Traditional Chinese and Western Medicines in 60 cases of chronic heart failure

目的:回顾性分析中西医结合治疗慢性心力衰竭60例患者的临床资料,探讨慢性心力衰竭的中医诊断及证候、用药规律和治疗方案特点。方法:利用医院的HIS系统和电子病历系统,采集2014年1-12月某三甲医院中西医结合心内科慢性心力衰竭患者的信息,对其诊断、证候要素、中西药使用情况、中药人日均剂量与住院天数的相关性进行分析。结果:60例慢性心力衰竭患者的中医病名以心衰病为主,中医证候要素以气虚、血瘀、痰凝、阴虚、阳虚为主。使用频数位居前5位的中药是黄芪、柴胡、甘草、党参、茯苓;日均剂量位居前5位的中药是:黄芪、山萸肉、茯苓、葶苈子、党参;中成药主要以肾康注射液、生脉注射液、参附注射液、复方鲜竹沥、感冒清热颗粒为主;西药治疗主要以β受体阻滞剂、利尿剂、醛固酮受体拮抗剂为主,血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)+β受体阻滞剂+醛固酮受体拮抗剂(金三角)三药联用的使用频率较低。结论:西药治疗应结合患者年龄、肾功能、疾病的情况等因素加强"金三角"药物的使用;通过对中药种类、使用频数及日均用量分析,归纳出CHF的基本治疗规律:益气养阴、活血化瘀、祛痰平喘、温阳利水;根据用药规律可知补气药是治疗心衰的主要有效药物,治疗CHF在注重补气、祛湿、利水的同时更要注重整体合参,辨病与辨证相结合,结合临床经验对中药用量进行适当的加减,为以后临床研究提供经验。

Objective： To conduct a retrospective analysis on 60 patients with chronic heart failure （CHF） treated by traditional Chinese medicine （TCM） in order explore the characteristics of TCM diagnoses and syndromes, medication rules and treatment plans of CHF. Methods： Data of CHF patients hospitalized in Department of Combine traditional Chinese and western medicine of cardiology from January to December in 2014 were collected. The diagnoses, characteristics of TCM syndromes, treatments （both Western and Chinese medicine）, the average daily dose of Chinese herbal medicine and the correlation between the days of hospitalization were investigated and analyzed using HIS system and electronic medical records system of our hospital. Results： TCM syndrome elements were given priority to qi deficiency, blood stasis, Tan Ning, Yin deficiency and Yang deficiency. Top five mostly frequently used Chinese medicines were Astragalus, Bupleurum, licorice, Codonopsis, Poria. Top five Chinese medicines with highest average daily dose were Astragalus, Codonopsis, Poria, Fructus Corni, Roripa montana. Traditional Chinese medicine injection mainly included Shen Kang injection, Raw pulse and Shen fu injection. Western medicine treatments mainly were beta-blockers, diuretics, aldosterone receptor antagonist. The frequency of ACEI/ARB ＋ β-blocker ＋ aldosterone receptor antagonist （Golden Triangle） was relatively low. Conclusion： Western medication should consider patient age, renal function, disease and other factors to strengthen the ＂Golden Triangle＂ drug use. Through the analysis of the types of Chinese medicine and daily consumption, the basic treatment rules of CHF were summarized as follows： tonifying qi and yin,promoting blood circulation for removing blood stasis, eliminating phlegm and relieving asthma and warming yang for diuresis. According to medication rules, we could conclude that qi medicine was the main effective treatment of heart failure, and treatment of CHF focused on tonifying qi, eliminating dampness, and diuresis. Attention should be paid to the overall combination, disease differentiation and syndrome combination, combined with clinical experience on the amount of traditional Chinese medicine to provide experience for future clinical research.