利水活血温阳方联合西药治疗慢性心力衰竭的疗效及对患者氧化应激、生活质量的影响

Effects of Lishui-huoxue-wenyang recipe combined with western medicine on chronic heart failure and its influences on oxidative stress and quality of life of patients

目的观察利水活血温阳方联合西药治疗慢性心力衰竭(CHF)疗效及对患者氧化应激、生活质量的影响。方法将80例CHF患者随机分为2组。对照组40例予血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)、β受体阻滞剂、醛固酮受体拮抗剂所组成的"金三角"基本治疗方案治疗;治疗组40例在对照组治疗基础上加服利水活血温阳方。2组均连续治疗24周。比较2组疗效,观察2组治疗前后心脏超声指标[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)及舒张早期流速峰值(EPFV)/舒张晚期流速峰值(APFV)(E/A)]及6 min步行距离变化,氧化应激指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)及丙二醛(MDA)]变化,明尼苏达心力衰竭生活质量问卷调查量表(MLHFQ)评分变化。结果治疗组总有效率95.00%,对照组总有效率70.00%,治疗组疗效优于对照组(P<0.05)。2组治疗后LVEF、E/A及6 min步行距离均较本组治疗前提高(P<0.05),LVEDD、LVESD均较本组治疗前缩小(P<0.05);治疗后治疗组LVEF、E/A及6 min步行距离均高于对照组(P<0.05),LVEDD、LVESD均低于对照组(P<0.05)。2组治疗后SOD、GSH-Px、CAT均较本组治疗前升高(P<0.05),MDA均较本组治疗前降低(P<0.05);治疗后治疗组SOD、GSH-Px、CAT均高于对照组(P<0.05),MDA低于对照组(P<0.05)。2组治疗后MLHFQ评分均较本组治疗前降低(P<0.05),治疗组治疗12周MLHFQ评分低于本组治疗8周(P<0.05),治疗24周MLHFQ评分低于本组治疗12周(P<0.05)。治疗后治疗组MLHFQ评分低于对照组治疗同期(P<0.05)。结论利水活血温阳方联合西药治疗CHF,可明显提高患者心脏功能与运动耐力,降低氧化应激水平,改善患者生活质量。

Objective To observe the clinical effects of Lishui-huoxue-wenyang recipe combined with western medicine on chronic heart failure(CHF)and its influences on oxidative stress and quality of life of patients.Methods 80 patients with CHF were randomly divided into two groups.40 cases in control group were treated with angiotensin converting enzyme inhibitor(ACEI)or angiotensin II receptor blockers(ARB),β-blockers,aldosterone receptor antagonist consisting of the"Golden Triangle"treatment regimen.40 cases in treatment group were treated with Lishui-huoxue-wenyang recipe on the basis of the control group treatment,and the two groups were continuously treated for 24 weeks.The clinical efficacy was compared between the two groups.The changes of echocardiographic parameters including left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),and early diastolic flow velocity peak(EPFV)/peak late diastolic velocity(APFV)(E/A),and 6 min walk distance,oxidative stress indicators including superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),catalase(CAT)and malondialdehyde(MDA),and the minnesota heart failure quality of life questionnaire(MLHFQ)before and after treatment were observed in 2 groups.Results There were statistical differences on the total effective rate between the treatment group(95.00%)and control group(70.00%,P<0.05).The clinical efficacy in treatment group was better than that in control group.The LVEF,E/A and 6 min walk distance after treatment were increased in two groups(P<0.05),the LVEDD and LVESD were reduced(P<0.05).The LVEF,E/A and 6 min walk distance after treatment in treatment group were higher than that in control group(P<0.05),and the LVEDD and LVESD were lower(P<0.05).The SOD,GSH-Px and CAT after treatment were increased in two groups(P<0.05),the MDA were reduced(P<0.05).The MLHFQ scores were reduced in two groups(P<0.05).The MLHFQ scores after 12 weeks treatment was lower than after 8 weeks treatment in the treatment group(P<0.05),and which after 24 weeks treatment was lower than lower after 12 weeks treatment(P<0.05).After treatment,the MLHFQ scores in the treatment group was lower than that in the control group at the same time(P<0.05).Conclusion Lishui-huoxue-wenyang recipe combined with western medicine on CHF can significantly improve the patient's cardiac function and exercise tolerance,reduce the level of oxidative stress,and improve the quality of life of patients.