参松养心胶囊联合螺内酯治疗慢性心力衰竭的临床研究

Clinical study on Shensong Yangxin Capsules combined with spironolactone in treatment of chronic heart failure

目的探讨参松养心胶囊联合螺内酯片治疗慢性心力衰竭的临床疗效。方法选取2016年2月—2017年2月北京同仁医院收治的慢性心力衰竭患者106例为研究对象,所有患者随机分为对照组和治疗组,每组各53例。对照组口服螺内酯片,40 mg/次,1次/d。治疗组在对照组的基础上口服参松养心胶囊,4粒/次,3次/d。两组患者均连续治疗1个月。观察两组的临床疗效,比较两组的心电图指标、心率变异性指标、心功能指标、血清N端前脑钠肽(NT-pro BNP)和超敏C-反应蛋白(hs-CRP)水平。结果治疗后,对照组和治疗组的总有效率分别为69.81%、86.79%,两组比较差异有统计学意义(P<0.05)。治疗后,两组QT离散度(QTd)、校正QT离散度(QTcd)和QRS显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组全程窦性心搏NN间期的标准差(SDNN)、全程每5分钟NN间期平均值的标准差(SDANN)、全部相邻NN之差的均方根(r MSSD)和相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)均显著升高,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标明显高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组左心室射血分数(LVEF)显著升高,而左室舒张末期内径(LVEDD)显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组NT-pro BNP和CRP水平显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论参松养心胶囊联合螺内酯片治疗慢性心力衰竭具有较好的临床疗效,可改善心功能,降低心率变异性,安全性较好,具有一定的临床推广应用价值。

Objective To study the clinical effect of Shensong Yangxin Capsules combined with Spironolactone Tablets in treatment of chronic heart failure. Methods Patients （106 cases） with chronic heart failure in Beijing Tongren Hospital from February 2016 to February 2017 were randomly divided into control and treatment groups, and each group had 53 cases. Patients in the control group were po administered with Spironolactone Tablets,40 mg/time,once daily.Patients in the treatment group were po administered with Shensong Yangxin Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 1 month. After treatment, the clinical efficacies were evaluated, and electrocardiographic indexes, heart rate variability indexes, heart function indexes, NT-proBNP, and CRP levels in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 69.81% and 86.79%, respectively, and there was difference between two groups （P 〈 0.05）. After treatment, QTd, QTcd, and QRS in two groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P 〈 0.05）. After treatment, SDNN, SDANN, rMSSD, and PNN50 in two groups were significantly increased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups （P 〈 0.05）.After treatment, the LVEF in two groups were significantly increased, but the LVEDD in two groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups （P 〈 0.05）. After treatment, the levels of NT-proBNP and CRP in two groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P 〈 0.05）. Conclusion Shensong Yangxin Capsules combined with Spironolactone Tablets has clinical curative effect in treatment of chronic heart failure, can improve heart function, decrease heart rate variability, with good safety, which has a certain clinical application value.