强心饮合补阳还五汤加减治疗慢性心力衰竭的临床观察

Clinical observation on modified Qiangxin Decoction combined with Buyang Huanwu Decoction in treating chronic heart failure

目的:探讨强心饮合补阳还五汤加减结合西医常规疗法治疗慢性心力衰竭(CHF)的临床疗效。方法:纳入62例心肾阳虚、瘀水互结证CHF患者,随机分为治疗组32例和对照组30例。对照组患者给予西医常规治疗,治疗组患者在西医常规治疗基础上加用强心饮合补阳还五汤加减口服,两组疗程均为8周。比较两组患者的中医证候疗效、心功能改善疗效,检测两组患者的左室射血分数(LVEF)及血浆B型脑钠肽(BNP)水平,采用明尼苏达心功能不全生存质量量表(MLHFQ)评价所有患者的生活质量。结果:①治疗后,对照组患者的中医证候疗效总有效率为70.0%,治疗组为93.8%,治疗组的疗效优于对照组(P<0.05)。②治疗后,对照组患者的心功能改善疗效总有效率为70.0%,治疗组为90.6%,治疗组的疗效优于对照组(P<0.05)。③治疗后,两组患者的LVEF水平较治疗前明显升高(P<0.05,P<0.01),血浆BNP水平较治疗前明显降低(P<0.01),且治疗组患者的LVEF水平高于对照组(P<0.05)、血浆BNP水平低于对照组(P<0.05)。④治疗后,两组患者的MLHFQ评分较治疗前均明显降低(P<0.01),且治疗组患者的评分低于对照组(P<0.05)。结论:与单用西医常规疗法相比,强心饮合补阳还五汤加减结合西医常规疗法能够更好地改善CHF患者的中医证候和心功能,升高LVEF水平,降低血浆BNP水平,提高患者的生活质量。

Objective: To explore the clinical efficacy of modified Qiangxin Decoction and Buyang Huanwu Decoction combined with conventional western medical therapy in the treatment of chronic heart failure(CHF). Methods: Sixty-two patients of CHF with syndrome of heart-kidney yang deficiency and intermingled blood stasis and water were included and randomly divided into the treatment group(32 cases) and the control group(30 cases). The patients in the control group were treated with conventional western medicine, and the patients in the treatment group were orally treated with modified Qiangxin Decoction and Buyang Huanwu Decoction based on conventional western medicine, with a course of 8 weeks. The efficacy of Chinese medical syndrome and cardiac function improvement were compared between the two groups, the levels of left ventricular ejection fraction(LVEF) and plasma B-type brain natriuretic peptide(BNP) were detected, and the life quality of all patients was evaluated by Minnesota Living with Heart Failure Questionnaire(MLHFQ). Results: ①After treatment, the total effective rates of Chinese medical syndrome were 70.0% in the control group and 93.8% in the treatment group, and the efficacy of the treatment group was better than that of the control group(P<0.05). ②After treatment, the total effective rates of cardiac function improvement were 70.0% in the control group and 90.6% in the treatment group, and the efficacy of the treatment group was better than that of the control group(P<0.05). ③After treatment, the level of LVEF was significantly increased in both groups compared with that before treatment(P<0.05, P<0.01), the level of plasma BNP was significantly decreased compared with that before treatment(P<0.01), and the level of LVEF in the treatment group was higher than that in the control group(P<0.05), the level of plasma BNP in the treatment group was lower than that in the control group(P<0.05). ④After treatment, the MLHFQ score was significantly decreased in both groups compared with that before treatment(P<0.01), and the score of the treatment group was lower than that of the control group(P<0.05). Conclusion: Compared with conventional western medical therapy alone,modified Qiangxin Decoction and Buyang Huanwu Decoction combined with conventional western medical therapy can better improve the Chinese medical syndrome and cardiac function of patients with CHF,increase the level of LVEF,reduce the level of plasma BNP,and enhance the life quality of the patients.