桂枝人参汤合肾气丸治疗慢性心力衰竭阳虚血瘀水停证40例

Guizhi Renshen Decoction and Shenqi Pills in the Treatment of Chronic Heart Failure of Syndrome of Yang Deficiency and Blood Stasis Fluid Stagnation for 40 Cases

目的通过观察联合应用经方"桂枝人参汤合肾气丸加味"温阳活血利水,治疗慢性心力衰竭阳虚血瘀水停证的临床疗效及安全性,分析总结其作用机理,以资经方在心衰领域的临床应用的参考。方法纳入符合中西医诊断标准病例80例,采用随机对照试验1∶1方法分为治疗组、对照组。对照组予西药规范化治疗慢性心力衰竭及原发病;治疗组在对照组西药治疗基础上联合"桂枝人参汤合肾气丸加味"治疗;2组患者均分别治疗21 d。在中医证候积分、6 min步行距离、BN P水平、心功能分级方面观察、评价2组患者治疗前后的疗效。结果在缓解症状、提高活动耐力、改善心功能的上述各项观察指标中,2组治疗前后比较差异有统计学意义(P均<0.05);2组治疗后比较差异有统计学意义(P均<0.05),治疗组疗效评价均优于对照组。结论治疗组联合应用经方"桂枝人参汤合肾气丸加味",在阳虚血瘀水停证型的慢性心力衰竭治疗中疗效优于对照组,初步认为治疗安全性较好。

Objective To assess the efficacy and safety o f a traditional Chinese medicine decoction Guizhi Ginseng decoction combined with Shenqi pills for chronic heart failure, which called syndrome of yang deficiency and blood stasis fluid stagnation in TCM. The decoction is prepared following the principle of Wenyang Huoxue Lishui in TCM. We also aim to explore its action mechanism to provide reference for clinicians. Methods Eighty eligible patients were randomly assigned into treatment group and control group. Patients in the control group received standard western medication. Patients in the treatment group received Guizhi Renshen decoction and Shenqi pills in addition to standard medication. The treatment duration in both groups was 21 days. The measured outcomes included the TCM syndrome scores, 6 minutes walking distance, serum level of Brain natriuretic peptide（ BNP）, and heart function grading. Results Compared with baseline status, patients in both groups achieved relief in symptoms,enhancement in activity endurance and improvement in cardiac function after treatment（ P〈0.05）. The difference between the two groups after treatment was also statistically significant, and there was a beneficial effect in favor of the treatment group（ P 〈0.05）.Conclusion Adding Guizhi Ginseng decoction combined with Shenqi pills to standard western medication can achieve better treatment effect for patients with chronic heart failure.