从阴阳两虚心脉瘀滞证辨治充血性心力衰竭的研究

Study on traditional Chinese medicinal differentiation and treatment based on syndrome of the deficiency of both Yin and Yang and the stagnation of the heart blood vessels(阴阳两虚心脉瘀滞证) for congestive heart failure

目的 :观察养心通脉冲剂治疗充血性心力衰竭 (心衰 )的疗效 ,并探讨其作用机制。方法 :针对充血性心衰阴阳两虚、心脉瘀滞基本病机、病证 ,确立益阴助阳、活血通脉法 ,研制成养心通脉冲剂 ,临床治疗本病6 5例 ,随机设对照组 (西医常规治疗 ) 37例。实验研究建立充血性心衰大鼠模型 ,观察养心通脉冲剂对模型动物的血流动力学和心、肺重量的影响。结果 :临床研究 :总有效率治疗组为 93.85 %,明显优于对照组的 72 .97%(P<0 .0 1) ;用药后心功能改善、心肌耗氧指数下降均值、主证消失率及明显增加尿量等作用 ,治疗组均明显优于对照组 (P<0 .0 5或 P<0 .0 1)。养心通脉冲剂能改善模型大鼠血流动力学和降低心肺指数。结论 :养心通脉冲剂通过增强心肌收缩力、改善心肌能量代谢及心血泵功能 ,增加肾血流量 ,抗氧化等作用 ,达到减轻心肌损伤 ,降低心脏前负荷 ,改善心功能 ,使心衰患者的症状明显改善或消失。

Objective:To study the effect of Yangxin Tongmai granule(养心通脉冲剂) in treating congestive heart failure and to explore its mechanism.Methods:Yangxin Tongmai granule was prepared on the concept that the fundamental pathogenesis of congestive heart failure was the deficiency of both Yin and Yang and the stagnation of the heart blood vessels(阴阳两虚心脉瘀滞证).In clinical research,102 cases diagnosed as congestive heart failure were randomly divided into two groups.In treated group,65 cases were given Yangxin Tongmai granule.In control group,37 cases were treated with western medicine routinely.In experiment research,congestive heart failure rat model was established,and the hemodynamics and the index of heart and lung were observed.Results:The total curative efficiency was 93.85% in the treatment group and 72.97% in control group,there was significant difference between the two groups ( P<0.01).The improvement of cardiac function,the mean value myocardium exponent and the rate of main symptom vanishing in treatment group were also supeior to those of control group.Yangxin Tongmai granule could improve the hemodynamics,and decrease the index of heart and lung.Conclusions: Yangxin Tongmai granule can reinforce myocardium contractility,improve myocardium energy metabolism,reinforce bloodpumping function,increase renal blood flow and antioxidizing,therefore the Yangxin Tongmai granule can relieve the injury of myocardium,decrease heart preload and improve cardiac function.