厄贝沙坦联合黄芪保心汤治疗扩张型心肌病疗效观察

Therapeutic Effect of Irbesartan Combined with Huangqi Baoxin Decoction on Dilated Cardiomyopathy

目的:观察厄贝沙坦联合黄芪保心汤治疗扩张型心肌病的临床疗效。方法:将132例扩张型心肌病患者采用随机数字表法分为治疗组和对照组,每组66例。对照组采用厄贝沙坦治疗,治疗组在对照组治疗基础上加用黄芪保心汤治疗,方药组成:黄芪50 g,党参30 g,丹参15 g,当归15 g,桂枝6 g,水蛭15 g,白芥子15 g,麦冬15 g,五味子12 g,甘草10 g。观察治疗前后两组患者心功能分级、血清AngⅡ水平、醛固酮水平、心脏超声波和中医证候疗效情况。结果:治疗10周后,治疗组患者醛固酮和AngⅡ水平显著高于对照组,差异均有统计学意义(P<0.05);治疗20周后,对照组患者醛固酮与AngⅡ水平均升高,且显著高于治疗组,差异均有统计学意义(P<0.05);治疗组患者左室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左室收缩末期内径(left ventricular end systolic diameter,LVESD)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短分数(left ventricular fraction of shortening,FS)等改善情况均明显优于对照组,差异有统计学意义(P<0.05);治疗组患者心功分级为Ⅰ-Ⅱ级人数显著高于对照组,差异有统计学意义(P<0.05);治疗组患者心功能分级为Ⅳ级人数明显低于对照组,差异有统计学意义(P<0.05);治疗组中医证候疗效有效率93.94%显著高于对照组83.33%,差异有统计学意义(P<0.05)。结论:厄贝沙坦联合黄芪保心汤治疗扩张型心肌病可有效改善患者心功能,提高临床疗效。

Objective： To study the clinical effect of irbesartan combined with Huangqi Baoxin decoction in the treatment of dilated cardiomyopathy. Methods： 132 cases of patients were randomly divided into 2 groups. 66 cases of the routine group were given the irbesartan treatment,66 cases of the study group were given irbesartan combined with Huangqi Baoxin decoction treatment,and the composition： Huangqi（ Astragalus Membranaceus） 50 g,Dangshen（ Codonopsis） 30 g,Danshen（ Salvia Miltiorrhiza） 15 g,Danggui（ Angelica Sinensis） 15 g,Guizhi（ Cassia Twig） 6 g,Shuizhi（ Leech） 15 g,Baijiezi（ White Mustard Seed） 15 g,Maidong（ Radix Ophiopogonis） 15 g,Wuweizi（ Schisandra Chinensis） 12 g,Gancao（ Liquorice） 10 g. Cardiac function classification serum,Ang Ⅱlevel,aldosterone level,cardiac ultrasound,TCM syndrome curative effect of two groups were compared before and after treatment.Results： After 10 weeks of treatment,aldosterone and Ang Ⅱ level of patients in the study group were significantly higher than those of the routine group,the difference had statistical significance（ P 〈0. 05）; After 20 weeks of treatment,aldosterone and Ang II level of patients in the routine group were sharply increased,and significantly higher than those of the study group,the difference had statistical meaning（ P 〈0. 05）; Improvements of left ventricular end diastolic dimension（ LVEDD）,left ventricular end systolic diameter（ LVESD）,left ventricular ejection fraction（ LVEF）,left ventricular fraction of shortening（ FS） of patients in the study group were significantly better than those of the routine group,the difference had statistical points（ P 〈0. 05）; Number of patients with grade Ⅰ-Ⅱ cardiac function in the study group was significantly higher than that of the routine group,the difference had statistical significance（ P〈 0. 05）; Number of patients with grade Ⅳ cardiac function in the study group was significantly lower than that of the routine group,the difference had statistical significance（ P〈 0. 05）; The efficiency rate of TCM syndrome curative effect of the study group of 93. 94% was significantly higher than that of the routine group 83. 33%,the difference had statistical significance（ P 〈0. 05）. Conclusion： Irbesartan combined with Huangqi Baoxin decoction in the treatment of dilated cardiomyopathy can effectively improve heart function,and enhance therapeutic effect.