化气活血利水法治疗利尿剂抵抗急性心力衰竭疗效及机制探讨

Curative Effect and Mechanism of Method of Qi-transforming,Blood-invigorating and Urination-promoting for Acute Heart Failure Complicated with Diuretic Resistance

目的:观察化气活血利水法治疗利尿剂抵抗急性心力衰竭患者的疗效。方法:选取利尿剂抵抗急性心力衰竭患者165例,采用随机数字表法随机分为对照组83例和治疗组82例。对照组采用西医常规治疗,治疗组在对照组基础上加用保元汤合血府逐瘀汤加减,连续治疗7 d,观察比较2组血管紧张素Ⅱ(AngⅡ)、醛固酮水平、钠排泄分数、尿量、肾小球滤过率(eGFR)、28天全因死亡率、中医症状疗效评分。结果:治疗前后组内比较,治疗组AngⅡ、醛固酮水平均显著低于治疗前(P<0.05);钠排泄分数、尿量明显高于治疗前(P<0.05)。对照组治疗后尿量明显高于治疗前(P<0.05);AngⅡ、醛固酮水平有升高趋势,eGFR有下降趋势,但差异无统计学意义(P>0.05)。治疗后组间比较,治疗组AngⅡ、醛固酮水平均显著低于对照组(P<0.05);钠排泄分数、尿量明显高于对照组(P<0.05)。对照组统计死亡15例,治疗组死亡6例,治疗组死亡率明显低于对照组(P<0.05)。治疗组及对照组总有效率分别为92.68%、81.93%,2组比较,差异有统计学意义(P<0.05)。结论:化气活血利水法能改善急性心力衰竭并利尿剂抵抗患者的神经内分泌水平,提高利尿应答,提升临床效果。

Objective:To observe the curative effect of the method of qi-transforming,blood-invigorating and urinationpromoting for patients with acute heart failure complicated with diuretic resistance.Methods:A total of 165 patients with acute heart failure complicated with diuretic resistance were randomly divided into the control group and the treatment group according to the random number table method,83 and 82 cases in each group respectively.The control group was treated with conventional western medicine,and the treatment group was additionally treated with modified Baoyuan tang and Xuefu Zhuyu tang based on the treatment of the control group.Both groups were treated for seven days.The levels of AngiotensinⅡ(AngⅡ),aldosterone,fractional excretion of sodium,urine volume,estimated glomerular filtration rate(eGFR),all-cause mortality at 28 days and therapeutic scores of Chinese medicine symptoms were compared.Results:After treatment,the levels of AngⅡand aldosterone were significantly lower than those before treatment(P<0.05),and the fractional excretion of sodium and urine volume were significantly higher than those before treatment(P<0.05).The urine volume in the control group was significantly higher than that before treatment(P<0.05);the levels of AngⅡand aldosterone tended to rise while the level of e GFR tended to drop,there being no significant difference(P>0.05).After treatment,the levels of AngⅡand aldosterone in the treatment group were significantly lower than those in the control group(P<0.05);the fractional excretion of sodium and urine volume were significantly higher than those in the control group(P<0.05).There were fifteen deaths in the control group and six deaths in the treatment group,and the death rate in the treatment group was significantly lower than that in the control group(P<0.05).The total effective rates in the treatment group and the control group were 92.68%and81.93%respectively,the difference being significant(P<0.05).Conclusion:The method of qi-transforming,bloodinvigorating and urination-promoting can improve the level of neuroendocrine of patients with acute heart failure complicated with diuretic resistance,and improve the diuretic response as well as the clinical effect.