丹蛭通脉组方联合肝素钠注射液治疗中低危急性肺栓塞的中医证候积分变化及对右心功能的影响

Clinical efficacy of Danzhi Tongmai recipe in the treatment of low or intermediate risk acute pulmonary embolism and its effect on right heart function

目的观察丹蛭通脉组方联合肝素钠注射液治疗中低危急性肺栓塞(APE)的中医证候积分变化及对右心功能的影响。方法将60例APE患者按照随机数字表法分为2组。对照组30例予肝素钠注射液治疗;治疗组30例在对照组治疗基础上应用丹蛭通脉组方治疗,疗程14 d。2组患者均坚持口服华法林钠片,按时监测国际标准化比值(INR)。观察2组治疗前后中医证候积分及右心功能指标变化。结果 2组治疗后气短、胸痛、心悸、咳嗽、疲倦乏力积分均较本组治疗前降低(P <0. 05),且治疗组气短、胸痛、咳嗽积分均低于对照组(P <0. 05)。2组治疗后右心室舒张期横径/左心室舒张期横径(RVDD/LVDD)、肺动脉收缩压(PASP)、心肌作功指数(MPI)、N端脑钠肽前体(NT-pro BNP)均较本组治疗前降低(P <0. 05),右心室面积变化分数(RVFAC)、右心室游离壁三尖瓣环收缩期位移(TAPSE)均较本组治疗前升高(P <0. 05)。治疗后治疗组PASP、MPI、NT-pro BNP均低于对照组(P <0. 05),RVFAC、TAPSE均高于对照组(P <0. 05)。2组治疗后凝血酶原时间(PT)均较本组治疗前升高(P <0. 05)。结论丹蛭通脉组方联合肝素钠注射液可改善中低危APE患者右心功能,明显降低中医证候气短、胸痛、咳嗽积分,且不增加出血风险。

Objective To observe the clinical effects of Danzhi Tongmai recipe in the treatment of low or intermediate risk acute pulmonary embolism (APE) and its effect on right heart function.Methods 60 patients with APE were divided into two groups according to the random number table method.30 cases in control group were treated by heparin sodium injection.30 cases in treatment group were treated by Danzhi Tongmai recipe on the basis of the control group.The course of treatment was 14 days.The Warfarin sodium tablets were taken orally in both groups,and the international standardized ratio of prothrombin time (INR) was monitored on time.The changes of TCM syndrome score and right ventricular function index were observed before and after treatment in the two groups.Results After treatment,the TCM syndrome scores of shortness of breath,chest pain,palpitation,cough and fatigue in the two groups were lower than those in the group before treatment (P<0.05).After treatment,the TCM syndrome scores of shortness of breath,chest pain and cough in the treatment group were lower than those in the control group (P<0.05).After treatment,the right ventricular/left ventricular diastolic transverse diameter ratio (RVDD/LVDD),pulmonary systolic pressure (PASP),myocardial work index (MPI),and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the two groups were lower than those in the group before treatment (P<0.05).The right ventricular area change fraction (RVFAC) and right ventricular free wall tricuspid annulus systolic displacement (TAPSE) in both groups were higher than those before treatment (P<0.05).After treatment,PASP,MPI and NT-proBNP in the treatment group were lower than those in the control group (P<0.05),and RVFAC and TAPSE were higher than those in the control group (P<0.05).After treatment,the PT in two groups were higher than those in the group before treatment(P<0.05).Conclusion Danzhi Tongmai recipe can improve right heart function in patients with low or intermediate risk APE,significantly reduce TCM syndrome scores of shortness of breath,chest pain and cough,and does net increase the risk of bleeding.