温阳利水汤辅助治疗慢性心力衰竭气虚血瘀兼痰饮证的临床研究

A study on treating chronic heart failure of the Qixu Xueyu Tanyin syndrome with the Wenyang Lishui decoction

目的:探讨口服温阳利水汤辅助治疗对慢性心力衰竭(Chronic Heart Failure,CHF)心功能和疾病进展的影响,并观察其对N末端B型利钠肽原(N-terminal pro-B-type Natriuretic Peptide,NT-proBNP)、左心室射血分数(Left Ventricular Ejection Fraction,LEVF)的影响。方法:将125例CHF患者随机分为对照组62例和治疗组63例。对照组常规调整生活方式,如低脂低盐饮食,戒烟,戒酒,减肥,适度活动。治疗组在对照组的基础上加服温阳利水汤,每天1剂。疗程15天,并进行3个月的随访。进行治疗前后美国纽约心脏协会(New York Heart Association,NYHA)心功能评估、6 min步行试验,并采用超声心动图检测LVEF;进行治疗前后Lee氏心衰评分、中医证候评分和明尼苏达心力衰竭生命质量调查(Minnesota Living with Heart Failure Questionnaire,MLHFQ)量表评分;检测治疗前后NT-proBNP、LEVF。结果:治疗组心功能疗效总有效率高于对照组(P<0.05);治疗组中医证候疗效总有效率高于对照组(P<0.01);治疗后治疗组Lee氏心衰评分、中医证候评分、MLHFQ量表评分均低于对照组(P<0.01);治疗后治疗组6 min步行距离长于对照组,LVEF高于对照组(P<0.05);治疗后治疗组NTproBNP水平低于对照组(P<0.05)。结论:在西医常规治疗的基础上,加用温阳利水汤治疗气虚血瘀兼痰饮证CHF患者,能减轻症状,改善心功能,提高患者的生活质量和临床疗效,并能改善疾病进展,稳定病情。

Objective:To investigate the effects of the Wenyang Lishui decoction(温阳利水汤)on the cardiac function and disease progression of CHF,and on NT-proBNP and LEVF.Methods:125 cases were randomly divided into the control group of 62 cases and the treatment group of 63 cases.The control group routinely adjusted their lifestyles,such as low-fat and low-salt diet,quitting smoking,quitting alcohol,losing weight,and exercising moderately.The treatment group was given the Wenyang Lishui decoction more,one dose per day.The course of treatment was 15 days and followed up for 3 months.Results:The total efficiency of cardiac function and TCM syndrome in the treatment group was higher than the control group(P<0.05).Lee’s heart failure score,TCM syndrome score and MLHFQ scale scores in the treatment group after treatment were lower than those in the control group(P<0.01).After treatment,the 6-min walking distance in the treatment group was longer than the control group,and LVEF in the treatment group was higher than the control group(P<0.05).The NT-proBNP level in the treatment group after treatment was lower than the control group(P<0.05).Conclusion:Conventional Western medicine treatment plus the Wenyang Lishui decoction on CHF of the Qixu Xueyu Tanyin syndrome can relieve symptoms,improve heart function,improve patients’life quality and clinical efficacy,ameliorate disease progression,and stabilize the condition.