益气强心方联合美托洛尔治疗慢性心力衰竭的临床分析

Therapeutic effects of Yiqiqiangxin prescription combined with metoprolol on chronic heart failure

目的探讨益气强心方联合美托洛尔治疗慢性心力衰竭的临床分析。方法心内科治疗的94例慢性心力衰竭患者,随机分为对照组和观察组,每组47例。2组均给予常规西医治疗,在此基础上,对照组服用美托洛尔治疗,观察组使用益气强心方联合美托洛尔治疗,比较2组患者的疗效、超声心动图各指标变化、各项神经内分泌因子及血浆心肌纤维化指标变化、中医证候积分改善情况。结果观察组治疗总有效率为95. 74%明显高于对照组的78. 72%,差异有统计学意义(P <0. 05);观察组治疗后左心室射血分数(LVEF)、左心室舒张末内径(LVEDd)、左心室收缩末内径(LVEDs)、心输出量(CO)、二尖瓣舒张早期血流峰值速度/二尖瓣舒张晚期血流峰值速度(E/A)、心肌能量消耗(MEE)与对照组相比明显改善,差异有统计学意义(P <0. 05);观察组治疗后醛固酮(ALD)、N-末端脑钠肽前体(NT-proBNP)、心型脂肪酸结合蛋白(H-FABP)、长正五聚蛋白(PTX-3)、超敏C蛋白(hs-CRP)、血浆Ⅲ型胶原前肽(PⅢP)、层粘连蛋白(LN)与对照组相比明显降低,差异有统计学意义(P <0. 05);观察组治疗后胸痛胸闷、口唇青紫、静脉怒张、自汗咳嗽、颜面灰暗、畏寒肢冷等中医证候积分明显低于对照组,差异有统计学意义(P <0. 05)。结论益气强心方联合美托洛尔治疗慢性心力衰竭疗效显著,能有效改善左心功能,抑制心肌纤维化和心肌细胞损伤,促进心脏泵血功能的恢复,具有积极的临床意义。

Objective To investigate the therapeutic effects of Yiqiqiangxin prescription combined with metoprolol on chronic heart failure.Methods A total of 94 patients with chronic heart failure who were treated in our hospital from November 2016 to November 2017 were randomly divided into control group(n=47)and observation group(n=47).The patients in both groups were treated by conventional western drugs,on this basis,the patients in control group were treated by oral metoprolol,however,the patients in observation group were treated by Yiqiqiangxin prescription combined with metoprolol.The clinical curative effects,the changes of echocardiography indexes,neuroendocrine factor and plasma myocardial fibrosis indexes,the TCM symptom scores were observed and comapred between the two groups.Results The effective rate in observation group was 95.74%,which was significantly higher than that(78.72%)in control group(P<0.05).After treatment the left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd),left ventricular systolic diameter at the end of the(LVEDs),cardiac output(CO),mitral valve early diastolic blood flow peak velocity/late mitral diastolic blood flow peak velocity(E/A),myocardial energy(MEE)in observation group were significantly improved,as compared with those in control group(P<0.05).Moreover the levels of aldosterone(ALD),N-terminal brain natriuretic peptide precursor(NT-proBNP),heart type fatty acid binding protein(H-FABP),and five proteins(PTX-3),allergic protein C(hs-CRP),plasmaⅢtype collagen peptide(PⅢP),laminin(LN)in observation group were significantly decreased,as compared with those in control group(P<0.05).In addition the TCM symptom scores including chest tightness,chest pain oral bruising,venous engorgement,spontaneous sweating,cough,facial surface murky grey,chilly and cold limbs in observation group were significantly lower than those in control group(P<0.05).Conclusion Yiqiqiangxin prescription combined with metoprolol in treatment of chronic heart failure can obtain obvious curative effects,which can effectively improve left heart function,inhibit myocardial fibrosis and myocardial cell damage,promote the recovery of heart pump function,therefor,it has positive clinical significance.