活血通腑法治疗肺心病失代偿期的临床研究

Clinical Study on Treatment of Decompensated Pulmonary Heart Disease with Therapy of Activating Blood and Unblocking Bowels

【目的】观察活血通腑法对慢性肺源性心脏病(肺心病)失代偿期患者的疗效。【方法】将纳入研究的60例慢性肺心病失代偿期患者随机分为治疗组和对照组,每组各30例。对照组给予西医常规综合方案治疗(包括氧疗、支气管舒张剂、小剂量利尿剂和抗感染治疗等),治疗组在对照组的基础上加用自拟活血通腑方治疗,疗程为14 d。观察2组患者治疗前后动脉血气分析[氧分压(PaO2)和二氧化碳分压(PaCO2)]、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)]、B型钠尿肽(BNP)及心脏彩超肺动脉收缩压(PASP)的变化情况,并根据治疗前后证候积分的变化情况评价2组患者的临床证候疗效。【结果】(1)治疗14 d后,治疗组的总有效率为100.0%,对照组为76.7%,治疗组的临床证候疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的PaO2水平均较治疗前提高,PaCO2水平均较治疗前降低(P<0.05),且治疗组在提高PaO2水平和降低PaCO2水平方面均优于对照组(P<0.05)。(3)治疗后,2组患者TNF-α和IL-8水平均治疗前降低(P<0.05),且治疗组对TNF-α和IL-8水平的降低作用均明显优于对照组(P<0.05)。(4)治疗后,2组患者PASP和BNP水平均较治疗前改善(P<0.05),且治疗组对PASP和BNP水平的改善作用均明显优于对照组(P<0.05)。【结论】活血通腑法治疗慢性肺心病失代偿期患者的疗效确切,既能有效改善患者的临床症状和血气分析指标,又能通过降低肺动脉高压和减轻右心负荷而改善心衰,并且对于TNF-α、IL-8等炎性因子有明显降低作用。

Objective To observe the effect of therapy of activating blood and unblocking bowels on patients with decompensated chronic pulmonary heart disease(DCPHD). Methods Sixty DCPHD patients were randomly divided into treatment group and control group, 30 cases in each group. The two groups were treated with routine comprehensive western medicine treatment covering oxygen therapy,bronchodilator,small-dose diuretic,and anti-infective treatment. And additionally, the treatment group was given oral use of self-prescribed herbal recipe with the actions of activating blood and unblocking bowels. The treatment for the two groups lasted 14 days. Before and after treatment,arterial blood gas analysis parameters of partial pressure of oxygen(PaO2)and partial pressure of carbon dioxide(PaCO2),inflammatory factors of tumor necrosis factor-α(TNF-α)and interleukin-8(IL-8),B-type natriuretic peptide(BNP),and pulmonary artery systolic pressure(PASP)showed by echocardiography in the two groups were observed. The scores of traditional Chinese Medicine(TCM)symptoms were observed before and after treatment for the evaluation of clinical efficacy in the two groups. Results(1)After treatment for 14 days,the total effective rate of the treatment group was 100.0% and that of the control group was 76.7%,indicating that the treatment group had stronger efficacy on TCM symptoms than the control group, the difference being statistically significant(P<0.05).(2)After treatment,Pa O2 was increased and PaCO2 was decreased in the two groups(P<0.05 compared with those before treatment), and the effect on increasing PaO2 and on decreasing PaCO2 in the treatment group was superior to that in the control group(P<0.05).(3)After treatment, TNF-α and IL-8 levels were decreased in the two groups(P<0.05 compared with those before treatment),and the effect on decreasing TNF-α and IL-8 levels in the treatment group was superior to that in the control group(P<0.05).(4)After treatment, PASP and BNP levels were improved in the two groups(P<0.05 compared with those before treatment), and the improvement in the treatment group was superior to that in the control group(P<0.05).Conclusion Therapy of activating blood and unblocking bowels exerts certain efficacy for the treatment of DCPHD,which is effective on relieving clinical symptoms and improving blood gas analysis parameters,reducing pulmonary artery hypertension and relieving right heart load for improving heart failure,and decreasing the levels of inflammatory factors TNF-α and IL-8.