芪参益气滴丸联合西药对慢性心力衰竭易损期患者的临床疗效分析

Clinical effects of Qishen Yiqi Dripping Pills combined with western medicine for patients with heart failure in vulnerable period

目的探讨芪参益气滴丸联合西药对慢性心力衰竭(CHF)易损期患者血流动力学、左心室充盈压及血清胱抑素(CysC)、B型脑钠肽(BNP)的影响。方法选取2017年2月—2019年4月本院收治的83例CHF易损期患者,随机分为观察组(n=42)和对照组(n=41)。对照组采用常规西药治疗,观察组在对照组基础上口服芪参益气滴丸治疗。治疗3个月后,比较2组临床总有效率、中医证候疗效、血流动力学指标[肺毛细血管楔压(PCWP)、肺动脉平均压(MPAP)和中心静脉压(CVP)]、左心室功能指标[左室射血分数(LVEF),二尖瓣瓣尖舒张期早期充盈速度(E)与舒张晚期充盈速度(A)比值(E/A),二尖瓣瓣尖舒张期早期充盈速度与二尖瓣环舒张早期侧间壁最大运动速度(Ea)比值(E/Ea)]、血清CysC、BNP水平及不良反应。结果观察组临床总有效率为97.62%,显著高于对照组82.93%(P<0.05)。观察组中医证候总有效率为95.24%,显著高于对照组80.49%(P<0.05)。治疗后,2组PCWP、MPAP、CVP均显著降低,且观察组上述指标显著优于对照组(P<0.05)。治疗后,2组LVEF均显著升高,E/A、E/Ea均显著降低,且观察组上述指标显著优于对照组(P<0.05)。治疗后,2组血清CysC、BNP水平均显著下降,且观察组CysC、BNP水平显著低于对照组(P<0.05)。治疗3个月内,对照组不良反应发生率为12.20%,观察组不良反应发生率为14.29%。2组不良反应发生率无显著差异(P>0.05)。观察组再住院率为9.52%,显著低于对照组的26.83%(P<0.05)。观察组病死率为2.38%,与对照组的4.88%比较无显著差异(P>0.05)。结论芪参益气滴丸联合西药能改善心力衰竭易损期患者血流动力学指标,降低左心室充盈压和血清CysC、BNP水平,是一种安全、有效的治疗方法。

Objective To investigate the effects of Yiqi Dripping Pills combined with western medicine on hemodynamics,left ventricular filling pressure,serum cystatin(CysC),and B-type natriuretic peptide(BNP)in patients with chronic heart failure(CHF)in vulnerable period.Methods Eighty-three patients with heart failure in the vulnerable period who were admitted to our hospital from February 2017 to April 2019 were randomly divided into observation group(n=42)and control group(n=41).The control group was treated with conventional western medicine,and the observation group was treated with QishenYiqi Dripping Pills on the basis of the control group.After 3 months of treatment,the total effective rate,TCM syndrome efficacy,and hemodynamics[pulmonary capillary wedge pressure(PCWP),mean pulmonary artery pressure(MPAP)and central venous pressure(CVP)],left ventricular function indicators[left ventricular ejection fraction(LVEF),ratio of early(E)and late(A)diastolic filling velocities(E/A)at the tip of mitral valve leaflets,the ratio of E to peak velocity of early diastolic wave of the lateral tricuspid annulus(Ea)(E/Ea)],levels of serum CysC as well as BNP and adverse reactions were compared.Results After treatment,the total clinical effective rate and TCM symptom effective rate of the observation group were significantly higher than those of the control group(97.62%,95.24%vs.82.93%,80.49%,respectively,P<0.05).After treatment,PCWP,MPAP,and CVP in both groups were decreased,and the observation group was better than the control group(P<0.05).After treatment,E/A,and E/Ea were decreased in both groups,but LVEF was increased,and the observation group was better than the control group(P<0.05).After treatment,the serum CysC and BNP levels of the two groups decreased,and the observation group was lower than the control group(P<0.05).Within 3 months of treatment,the incidence of adverse reactions was 12.20%in the control group and 14.29%in the observation group,but no significant difference in the incidence of adverse reactions between the two groups was found(P>0.05).The re-hospitalization rate in the observation group was lower than that in the control group(9.52%vs.26.83%,P<0.05).There was no significant difference in mortality rate between the two groups(2.38%in observation group and 4.88%in the control group,P>0.05).Conclusions Qishen Yiqi Dripping Pills combined with western medicine can improve the hemodynamics,reduce the left ventricular filling pressure,and decrease serum CysC and BNP levels,so it is a safe and effective method for CHF patients in vulnerable period.