动态检测Pro-BNP评估参附注射液对急性左心衰不同中医证型治疗效果

Dynamic Detection of pro-BNP to Evaluate Therapeutic Effect of Shenfu Injection on Different Traditional Chinese Medicine Syndromes of Acute Left Heart Failure

目的:通过动态检测B型钠尿肽前体(Pro-BNP)水平评估参附注射液治疗不同证型急性左心衰患者的临床效果。方法:采用随机数字表法将160例急性左心衰患者随机分为治疗组和对照组,再将2组进行中医辨证分型,对照组给予常规药物治疗,治疗组则在对照组的基础上应用参附注射液治疗,通过对比2组患者急诊入院时、入院后24 h和72 h血浆Pro-BNP水平对治疗效果进行评估。结果:从总体来看,治疗组治疗有效率、Pro-BNP下降幅度与对照组相比,差异皆有统计学意义(P<0.05);从各个证型来看,参附注射液治疗阳虚喘脱型效果最佳,阳虚水泛型次之,而痰浊阻肺型最差;从BNP下降趋势来看,下降幅度由大到小依次为阳虚喘脱证>阳虚水泛证>痰浊壅肺证,尤其是在治疗72h后,阳虚喘脱型血浆Pro-BNP水平下降更明显,痰浊壅肺证患者2组无明显差异。结论:参附注射液治疗不同证型急性左心衰患者效果有差异,临床上应该辨证施治,效果会更确切。

Objective:To investigate the clinical effect of Shenfu injection in the treatment of patients with acute left heart failure with different syndromes by detecting the level of dynamic Pro-BNP. Methods:A total of 160 patients with acute left heart failure were divided into treatment group and control group by random number table method. Traditional Chinese Medicine syndrome differentiation was performed in the two groups. The control group was given conventional drug treatment, while the treatment group was applied Shenfu injection on the basis of the control group. The therapeutic effects were evaluated by comparing the plasma Pro-BNP levels at admission, 24 and 72 hours after hospitalization. Results:Overall, the effective treatment rate and Pro-BNP decreased in the treatment group compared with the control group, the difference was statistically significant(P<0.05). From the perspective of each syndrome type, compared with the control group, the effect of the Shenfu injection treatment of yang deficiency and asthmatic is the best, Yang deficiency water syndrome is the second, and phlegm obstruction of lung syndrome is the worst. The decline trend of plasma Pro-BNP level from high to low is Yang Asthenia Syndrome > Yang deficiency water syndrome > phlegm obstruction of lung syndrome, especially after 72 hours of treatment, the level of Pro-BNP in Yang Asthenia asthmatic type plasma was more obvious, but there was no significant difference between the two groups in phlegm obstruction of lung syndrome. Conclusion:The effect of Shenfu injection in the treatment of patients with acute left heart failure of different syndromes is different. Clinically, it should be treated with syndrome differentiation, and the effect will be more accurate and obvious.