中西医结合治疗慢性充血性心力衰竭临床观察

Clinical Observation of Integrated Chinese and Western Medicine Therapy for Chronic Congestive Heart Failure

目的:观察中西医结合治疗慢性充血性心力衰竭的临床疗效。方法:将124例慢性充血性心力衰竭气阴两虚兼血瘀证患者随机分为治疗组和对照组各62例。对照组予常规方案治疗,治疗组在对照组基础上用生脉化瘀方治疗。2组均连续治疗6周。比较2组治疗前后的心功能指标[左心室射血分数(LVEF),舒张早期最大血流速度/舒张晚期最大血流速度(E/A)]、中医证候评分、血清内皮素(ET)、脑利钠肽(BNP)及治疗后的临床疗效。结果:治疗后,治疗组总有效率95.16%,高于对照组的80.65%,差异有统计学意义(P<0.05)。2组LVEF和E/A均较治疗前升高(P<0.01);治疗组LVEF和E/A均高于对照组(P<0.01)。2组心悸、气短、乏力、口干、自汗、盗汗评分均较治疗前降低(P<0.01);治疗组上述症状评分均低于对照组(P<0.01)。2组血清ET和BNP水平均较治疗前降低(P<0.01);治疗组血清ET和BNP水平均低于对照组(P<0.01)。结论:中西医结合治疗慢性充血性心力衰竭疗效显著,并优于单纯西药治疗,下调血清ET和BNP水平可能是作用机制之一。

Objective：To observe the clinical effect of integrated Chinese and western medicine therapy for chronic congestive heart failure.Methods：Divided 124 cases of patients with chronic congestive heart failure with syndrome of both yin-qi deficiency and blood stasis into the treatment group and the control group randomly,62 cases in each group.The control group was given the routine treatment,while the treatment additionally received Shengmai Huayu Prescription for treatment.The treatment for both groups lasted for6 weeks.Compared the indexes of cardiac function[[left ventricular ejection fraction（LVEF）,peak early diastolic velocity/peak late diastolic velocity（E/A）],scores of syndrome and symptom in Chinese medicine,serum endothelin（ET）and brain natriuretic peptide（BNP）of both groups before and after treatment as well as the clinical effect after treatment.Results：After treatment,the total effective rate was 95.16%in the treatment group,being higher than 80.65%in the control group,difference being significant（P〈0.05）.LVEF and E/A in both groups were higher thanthose before treatment（P〈0.01）;LVEF and E/A in the treatment group were higher than those in the control group（P〈0.01）.Scores of palpitation,shorthness of breath,hypodynamia,dry mouth,spontaneous perspiration and night sweat in both groups were respectively lower than those before treatment（P〈0.01）;each score above in the treatment group was all lower than that in the control group（P〈0.01）.The levels of serum ET and BNF in both groups were all lower than those before treatment（P〈0.01）;the levels of serum ET and BNF in the treatment group were all lower than those in the control group（P〈0.01）.Conclusion：Integrated Chinese and western medicine therapy has a significant effect in treating chronic congestive heart failure,which is better than the simple treatment with western medicine,and one of the functional mechanism may be the down-regulation of levels of ET and BNP.