十味温胆汤联合美托洛尔治疗气阴两虚兼痰浊壅盛心律失常患者心率变异性的影响

Eff ect of Shiwei Wendan Decoction combined with metoprolol on the heart rate variability in arrhythmia patients with the defi ciency of both qi and yin and congestion of turbid phlegm

目的探讨十味温胆汤联合美托洛尔治疗气阴两虚兼痰浊壅盛心律失常患者心率变异性的影响。方法将2018年8月至2020年3月在我院就诊的86例冠心病心律失常(气阴两虚兼痰浊壅盛型)患者随机分为2组,对照组43例给予美托洛尔为主的综合治疗,观察组在对照组的基础上给予十味温胆汤治疗,2组患者均治疗4周。评估2组临床疗效和不良反应发生率,比较2组患者治疗前后心率变异性[RR间期标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻RR间期差值均方根(RMSSD)、相邻NN之差超过50ms百分比(PNN50)]、心功能[左心室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI)]和中医症状积分。结果观察组治疗后有效率93.02%(40/43),明显高于对照组的72.09%(31/43)(P<0.05)。2组治疗后SDNN、SDANN、rMSS、PNN50、LVEF、SV、CI均较治疗前升高(P<0.05),且观察组治疗上述指标升高更为明显(P<0.05);2组治疗后中医症状积分均较治疗前降低(P<0.05),且观察组上述指标降低更为明显(P<0.05)。结论十味温胆汤联合美托洛尔治疗气阴两虚兼痰浊壅盛型心律失常可改善患者心率变异性,提高心功能,降低症状积分,提高治疗有效率,安全性良好,值得临床推广应用。

Objective To investigate the effect of Shiwei Wendan Decoction combined with metoprolol on the heart rate variability in arrhythmia patients with the syndromes of deficiency of both qi and yin and congestion of turbid phlegm.Methods A total of 86 patients with coronary heart disease arrhythmia(with the syndromes of defi ciency of both qi and yin and congestion of turbid phlegm),treated in our hospital from August 2018 to March 2020,were randomly divided into two groups.The patients in the control group were given a comprehensive treatment mainly with metoprolol,while the observation group was treated with Shiwei Wendan Decoction on the basis of the control group.Both groups were treated for 4 weeks.The clinical efficacy and incidence of adverse reactions of the two groups were evaluated,and the scores of the heart rate variability[standard deviation of RR interval(SDNN),mean standard deviation of RR interval(SDANN),root mean square difference of adjacent RR interval(RMSSD),percentage difference of adjacent NN over 50ms(PNN50)],cardiac function[left ventricular ejection fraction(LVEF),stroke output(SV)and Cardiac index(CI)]and TCM symptoms before and after treatment were compared between the two groups.Results The effective rate in the observation group after treatment was 93.02(40/43),which was significantly higher than 72.09%(31/43)in the control group(P<0.05).The SDNN,SDANN,rMSS,PNN50,LVEF,SV,CI in the two groups after treatment were higher than before treatment(P<0.05),and the above indicators of the observation group were increased more signifi cantly(P<0.05).After treatment,the scores of the TCM symptoms in both groups were decreased than those before treatment(P<0.05),and the above indexes in the observation group were more signifi cantly decreased(P<0.05).Conclusion Shiwei Wendan Decoction combined with metoprolol in the treatment of arrhythmia with deficiency of both qi and yin and congestion of turbid phlegm can improve the heart rate variability,improve the heart function,reduce the symptom scores,improve the treatment efficiency and safety,worthy of clinical promotion and application.