加味苓甘五味姜辛汤联合西医常规用药治疗慢性肺源性心脏病合并右心衰临床研究

Clinical Study on Modified Linggan Wuwei Jiangxin Tang Combined with Routine Western Therapies for Chronic Pulmonary Heart Disease Complicated with Right-sided Heart Failure

目的:研究加味苓甘五味姜辛汤联合西医常规疗法对慢性肺源性心脏病(CPHD)合并右心衰患者的疗效,以及对血浆N末端B型钠尿肽前体(NT-proBNP)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)水平的影响。方法:选取CPHD合并右心衰患者80例,按随机数字表法分为观察组和对照组各40例。对照组采用西医常规治疗,包括吸氧、强心、利尿、控制感染和解痉平喘等方法,观察组在对照组基础上给予加味苓甘五味姜辛汤口服。治疗前后检测比较2组患者心输出量(CO)、每搏输出量(SV)、右房压(RAP)、右室压(RVP)、氧分压(PO2)、二氧化碳分压(PCO2)、血浆ApoA、ApoB、NT-proBNP水平、中医证候评分、不良反应以及临床疗效。结果:观察组总有效率为92.50%,显著高于对照组75.00%,差异有统计学意义(P<0.05)。治疗前,2组心功能各项指标水平比较,差异无统计学意义(P>0.05)。治疗后,2组CO和SV水平较治疗前升高,RAP和RVP水平较治疗前降低;且观察组CO和SV水平高于对照组,RAP和RVP水平低于对照组;差异均有统计学意义(P<0.05)。治疗前,2组PO2和PCO2水平比较,差异无统计学意义(P>0.05)。治疗后,2组PO2水平较治疗前升高,PCO2水平较治疗前降低;且观察组PO2水平高于对照组,PCO2水平低于对照组;差异均有统计学意义(P<0.05)。治疗前,2组血浆相关指标比较,差异无统计学意义(P>0.05)。治疗后,2组ApoA水平较治疗前升高,NT-proBNP和ApoB水平较治疗前降低;且观察组ApoA水平高于对照组,NT-proBNP和ApoB水平低于对照组;差异均有统计学意义(P<0.05)。治疗前,2组中医证候评分比较,差异无统计学意义(P>0.05)。治疗后,2组中医证候评分较治疗前降低(P<0.05),且观察组中医证候评分低于对照组(P<0.05)。观察组不良反应发生率为20.00%,对照组为12.50%,2组比较,差异无统计学意义(P>0.05)。结论:采用加味苓甘五味姜辛汤联合西医常规用药治疗CPHD合并右心衰患者,疗效显著,能够有效改善心功能和临床症状,并能降低血浆NT-proBNP和ApoB水平,提高ApoA水平,不会增加用药风险,值得临床应用。

Objective:To study the curative effect of modified Linggan Wuwei Jiangxin tang combined with routine western therapies for chronic pulmonary heart disease(CPHD)complicated with right-sided heart failure,and their effect on levels of N-terminal prohormone of brain natriuretic peptide(NT-proBNP),apolipoprotein A(ApoA)and apolipoprotein B(ApoB)in plasma.Methods:A total of 80 cases of patients with CPHD complicated with right-sided heart failure were divided into the observation group and the control group according to the random number tablet method,40 cases in each group.The control group was given routine western medicine therapies such as oxygen inhalation and methods for strengthening heart,diuresis,controlling infection as well as arresting convulsions and calming panting;the observation group was additionally treated with oral administration of modified Linggan Wuwei Jiangxin tang based on the treatment of the control group.Before and after treatment,the cardiac output(CO),stroke volume(SV),right atrial pressure(RAP),right ventricular pressure(R VP),partial pressure of oxygen(PO2),partial pressure of carbon dioxide(PCO2),the levels of ApoA,ApoB and NT-proBNP in plasma,and the Chinese medicine syndrome scores in the two groups were detected and compared;the clinical effect was compared.Results:The total effective rate was92.50%in the observation group,significantly higher than that of 75.00%in the control group,the difference being significant(P<0.05).Before treatment,there was no significant difference being found in the comparison of level of each index of heart function in the two groups(P>0.05).After treatment,when compared with those before treatment,the levels of CO and SV in the two groups were increased and the levels of RAP and RVP were decreased;the levels of CO and SV in the observation group were higher than those in the control group,and the levels of RAP and RVP were lower than those in the control group;differences being significant(P<0.05).Before treatment,there was no significant difference being found in the comparison of the levels of PO2 and PCO2 in the two groups(P>0.05).After treatment,the levels of PO2 in the two groups were increased when compared with those before treatment and the levels of PCO2 were decreased;the level of PO2 in the observation group was higher than that in the control group and the level of PCO2 was lower than that in the control group;differences being significant(P<0.05).Before treatment,there was no significant difference being found in the comparison of the related indexes of plasm in the two groups(P>0.05).After treatment,when compared with those before treatment,the levels of ApoA in the two groups were increased and the levels of NT-proBNP and ApoB were decreased;the level of ApoA in the observation group was higher than that in the control group,and the levels of NT-proBNP and ApoB were lower than that in the control group;differences being significant(P<0.05).Before treatment,there was no significant difference being found in the comparison of the Chinese medicine syndrome scores in the two groups(P>0.05).After treatment,the Chinese medicine syndrome scores in the two groups were decreased when compared with those before treatment(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).There was no significant difference being found in the comparison of the incidence of adverse reactions between the observation group and the control group,which was respectively 20.00%and 12.50%(P>0.05).Conclusion:The therapy of modified Linggan Wuwei Jiangxin tang combined with routine western therapies has significant curative effect in treating patients with CPHD complicated with right-sided heart failure.It can effectively improve the heart function,relieve clinical symptoms,reduce the levels of NT-proBNP and ApoB in plasma and increase the level of ApoA,without any increase in the risk of medication,hence it is worthy of clinical application.