温阳利水化瘀方联合西医常规疗法治疗慢性充血性心力衰竭阳虚血瘀证临床研究

Clinical Study on Wenyang Lishui Huayu Prescription Combined with Western Routine Therapy for Treatment of Chronic Congestive Heart Failure with Yang Deficiency and Blood Stasis Syndrome

目的观察温阳利水化瘀方联合西医常规疗法治疗慢性充血性心力衰竭(CHF)阳虚血瘀证患者的临床疗效,及对血管张力和心肌重构的影响。方法采用随机数字表法将89例CHF患者分为联合组45例和西药组44例。西药组予“金三角”标准方案;联合组在西药组基础上加用温阳利水化瘀方,每日1剂,每日2次,口服。2组均连续治疗1个月。观察2组治疗前后6min步行试验、中医症状积分、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及血清脑利钠肽(BNP)、内皮素(ET)水平,监测2组不良反应。结果联合组总有效率为71.1%(32/45),西药组为50.0%(22/44),联合组明显优于西药组(P<0.05)。与本组治疗前比较,2组治疗后6min步行试验距离增加,LVEF提高,LVEDD、LVESD缩短,中医症状积分下降,血清BNP、ET水平下降(P<0.05,P<0.01);2组治疗后比较,联合组6min步行距离、各项心功能指标、中医症状积分及血清BNP、ET水平明显优于西药组(P<0.05,P<0.01)。联合组未见明显不良反应。结论温阳利水化瘀方联合西医常规疗法治疗CHF阳虚血瘀证患者可提高临床疗效,改善血管张力和心肌重构。

Objective To observe the clinical efficacy of Wenyang Lishui Huayu Prescription combined with Western routine therapy for the treatment of chronic congestive heart failure(CHF)with yang deficiency and blood stasis syndrome and its effects on vascular tone and myocardial remodeling.Methods Totally 89 patients with CHF were divided into combined group(45 cases)and Western medicine group(44 cases)according to random number table method.The Western medicine group was given the“Golden Triangle”of standard scheme therapy;while the combined group was given Wenyang Lishui Huayu Prescription on the basis of the Western medicine group,one dosage a day,twice a day,orally.Treatment for both groups lasted for one month.The distance of 6 min walk test,TCM symptom scores,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),serum brain natriuretic peptide(BNP)and endothelin(ET)before and after treatment in both groups were observed.Adverse reactions of both groups were monitored.Results The total effective rate was 71.1%(32/45)in the combined group and 50.0%(22/44)in the Western medicine group The combined group was significantly better than the Western medicine group(P<0.05).Compared with before treatment,the distance of 6 min walk test of both groups increased,LVEF increased,LVEDD and LVESD shortened after treatment;The TCM symptom scores decreased;The serum BNP and ET levels decreased(P<0.01).After treatment,the 6-minute walking distance,the above-mentioned cardiac function indexes,TCM symptom scores and serum BNP and ET levels in the combined group were significantly better than those in the Western medicine group(P<0.05,P<0.01).No significant adverse reactions were observed in the combined group.Conclusion Wenyang Lishui Huayu Prescription combined with Western routine therapy for the treatment of CHF with yang deficiency and blood stasis syndrome can improve clinical efficacy,improve vascular tone and myocardial remodeling.