冬芪五苓汤加减及超滤治疗对老年慢性心力衰竭急性失代偿期病人心肾功能的影响

Effect of Dongqi Wuling Decoction and Extracorporeal Ultrafiltration on Heart and Renal Function in Elderly Patients with Decompensated Acute Attack of Chronic Heart Failure

目的观察冬芪五苓汤加减及血液超滤对老年慢性心力衰竭急性失代偿期病人心肾功能的影响。方法将49例慢性心力衰竭急性失代偿期老年住院病人分为中药治疗组与血液超滤组,在常规西药治疗的基础上,中药治疗组配合使用益气养阴、活血利水中药冬芪五苓汤加减治疗;血液超滤组配合血液超滤治疗。观察两组治疗前后心功能分级、N端脑钠肽前体(NT-proBNP)、肾小球滤过率估算值(eGFR)的变化。结果中药治疗组和血液超滤组治疗后NT-proBNP较治疗前均明显下降(P<0.01),分别下降(33.2±33.8)%、(41.1±25.5)%,但组间下降百分数比较差异无统计学意义(P>0.05);两组治疗前后eGFR差异无统计学意义(P>0.05),两组eGFR下降百分数比较差异无统计学意义(P>0.05);中药治疗组或血液超滤组治疗前后心功能改善总有效率分别为84.6%、91.3%,两组比较差异无统计学意义(P>0.05)。结论在常规西药治疗的基础上,配合以益气养阴、活血利水为法的中药复方冬芪五苓汤加减或血液超滤治疗,均能明显改善心功能、降低NT-proBNP,同时不会引起eGFR下降。

Objective To observe the effect of Dongqi Wuling decoction （DWD） and extracorporeal ultrafiltration on heart and renalfunction in elderly patients with decompensated acute attack of chronic heart failure （DAACHF）.Methods Forty nine elderly patientswith DAACHF were randomly divided into two groups：DWD group treated with DWD,and extracorporeal ultrafiltration group treatedwith extracorporeal ultrafiltration in the basis of routine treatment.The cardiac function,N terminal pro – B type natriuretic peptide（NT proBNP） and estimated glomerular filtration rate （eGFR） were observed before and after the treatment.Results The NT proB -NP level decreased significantly in DWD group and extracorporeal ultrafiltration group after the treatment （P 〈0.01）,and the percent -age of NT proBNP decline were （33.2±33.8）% and （41.1±25.5）%,respectively.There was no significant difference in the percent -age of NT proBNP decline between two groups （P 〉0.05）.There was no significant difference in eGFR between two groups beforeand after treatment （P 〉0.05）.There was no significant difference in the percentage of eGFR decline between the two groups （P 〉0.05）.The total effective rate of cardiac function improvement before and after treatment was 84.6% and 91.3% in DWD treatmentgroup and extracorporeal ultrafiltration group, respectively.There was no significant difference between the two groups （ P 〉0.05）.Conclusion DWD or extracorporeal ultrafiltration in the basis of routine treatment can significantly improve cardiac function and re -duce NT proBNP in elderly patients with DAACHF,and at the same time,it will not cause eGFR decline.