祛痰通阳汤结合西医常规疗法对慢性心力衰竭患者心功能及心室重构的影响

Effect of Qutan-Tongyang decoction on cardiac function and myocardial remodeling in patients with chronic heart failure

目的探讨祛痰通阳汤对慢性心力衰竭患者心功能及心室重构的影响.方法将符合入选标准的96例慢性心力衰竭患者采用随机数字表法分为2组,每组48例.对照组采用西医常规疗法治疗,治疗组在对照组基础上加服祛痰通阳汤.2组均治疗4周.以彩色多普勒超声检测仪检测左心室收缩末内径(left ventricular end systolic diameter,LVESD)、左心室舒张末内径(left ventricular end diastolic diameter,LVEDD)、左室射血分数(left ventricular ejection fraction,LVEF)心功能指标,以及室间隔舒张末期厚度(ventricular septal thickness,IVST)、左心室后壁舒张末期厚度(left ventricular posterior wall thickness,LVPWT)、左心室质量指数(left ventricular mass index,LVMI)心室重构指标;采用ELISA法检测血清脑钠肽(brain natriuretic peptide,BNP)、血管生成素2(angiotensin 2,Ang2),评价临床疗效,记录不良反应.结果治疗组总有效率为89.6%(43/48)、对照组为72.9%(35/48),2组比较差异有统计学意义(χ^2=4.376,P=0.036).治疗后,治疗组LVESD[(45.12±3.02)mm比(48.05±3.11)mm,t=4.683]、LVEDD[(52.24±3.65)mm比(56.79±4.15)mm,t=5.704]均低于对照组(P<0.01),LVEF[(46.79±3.88)%比(41.52±3.04)%,t=7.407]均高于对照组(P<0.01);IVST[(7.13±0.63)mm比(8.02±0.71)mm,t=6.496]、LVPWT[(8.15±0.58)mm比(8.62±0.75)mm,t=3.434]、LVMI[(97.65±6.28)g/m^2比(112.26±8.47)g/m^2,t=9.600]均低于对照组(P<0.01);血清BNP[(120.21±19.87)ng/L比(188.95±24.18)ng/L,t=15.217]、Ang2[(252.52±53.74)pg/ml比(330.39±60.85)pg/ml,t=6.645]水平均低于对照组(P<0.01).治疗期间,对照组不良反应发生率为6.3%(3/48)、治疗组为10.4%(5/48),2组比较差异无统计学意义(χ^2=0.545,P=0.460).结论祛痰通阳汤结合西医常规疗法可有效改善慢性心力衰竭患者的心功能,抑制心室重构,且安全性较好.

Objective To explore the effect of Qutan-Tongyang decoction on cardiac function and myocardial remodeling in patients with chronic heart failure.Methods According to the random table method,96 patients with chronic heart failure were divided into the control group(n=48)and the research group(n=48).The patients in the control group were treated with conventional treatment,and the patients in the research group were treated with Qutan-Tongyang decoction on the basis of the control group.Two groups of patients were treated for 4 weeks.The clinical total effective rate of two groups of patients after treatment was counted.The LVESD,LVEDD,LVEF,IVST,LVPWT,LVMI,BNP,Ang2 were determined respectively before and after treatment.In addition,the adverse reaction incidence of two groups of patients were observed.Results The total effective rate of research group was 89.58%(43/48),while the total effective rate of control group was 72.92%(35/48),the difference between two groups was statistically significant(χ^2=4.376,P=0.036).After treatment,the LVESD(45.12±3.02 mm vs.48.05±3.11 mm,t=4.683),LVEDD(52.24±3.65 mm vs.56.79±4.15 mm,t=5.704),IVST(7.13±0.63 mm vs.8.02±0.71 mm,t=6.496),LVPWT(8.15±0.58 mm vs.8.62±0.75 mm,t=3.434),LVMI(97.65±6.28 g/m^2 vs.112.26±8.47 g/m^2,t=9.600),BNP(120.21±19.87 ng/L vs.188.95±24.18 ng/L,t=15.217),Ang2(252.52±53.74 pg/ml vs.330.39±60.85 pg/ml,t=6.645)of the research group were significantly lower than those of the control group(P<0.05),while the LVEF(46.79%±3.88%vs.41.52%±3.04%,t=7.407)of the research group were significantly higher than the control group(P<0.05).During treatment,there was no significantly difference of adverse reaction rates of the two groups(χ^2=0.545,P=0.460).Conclusions The clinical curative effect of Qutan-Tongyang decoction on the basis of conventional treatment for the treatment of chronic heart failure is significantly,which can significantly improve cardiac function and inhibit cardiac remodeling.It has the high security of the curative effect.