中药联合运动康复治疗对老年心力衰竭患者心功能的影响

Effect of Chinese Medicine Combined with Exercise Rehabilitation on Heart Function in Elderly Patients with Heart Failure

目的:探讨中药联合运动康复治疗对老年心力衰竭患者心功能的影响。方法:将82例老年心力衰竭患者按照随机抛硬币法分成2组各41例。对照组给予利尿剂和硝酸酯类等药物治疗,同时给予吸氧和控制水摄入,严格限制钠盐摄入;治疗组在对照组治疗基础上采用中药汤剂联合运动康复治疗。记录2组患者治疗前、治疗后急性生理学及慢性健康状况评分系统(APACHE-Ⅱ)评分、中医证候积分、心功能指标[左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF)]、6 min步行距离;记录治疗期间不良反应及再住院率。结果:2组治疗前APACHE-Ⅱ评分、中医证候积分比较,差异无统计学意义(P>0.05);2组治疗后APACHE-Ⅱ评分、中医证候积分低于治疗前,治疗组治疗后低于对照组,差异有统计学意义(P<0.05)。2组治疗前各项心功能指标比较,差异无统计学意义(P>0.05);2组治疗后LVEDV、LVESV水平低于治疗前,LVEF高于治疗前,且治疗组改善程度优于对照组(P<0.05)。治疗组治疗后6 min步行距离大于对照组,2组治疗后较治疗前明显延长(P<0.05)。2组治疗期间未见明显不良反应,研究期间血尿粪及肝肾功能无明显变化,服药后未见不适情况,治疗期间无因不良反应退出者。治疗组再住院率为9.76%(4/41)低于对照组31.71%(13/41),差异有统计学意义(χ^(2)=6.01,P=0.01)。结论:中医联合运动康复治疗老年心力衰竭患者可更好地改善患者机体状况和临床症状及心功能,延长患者步行距离,降低再住院率。

Objective:To explore the effect of Chinese medicine combined with exercise rehabilitation on the heart function in elderly patients with heart failure.Methods:A total of 82 elderly patients with heart failure were randomly divided into two groups,41 cases in each group.The control group was treated with diuretics and nitrates,and meanwhile given oxygen and the water intake was controlled,and also the sodium intake was strictly restricted.The treatment group was additionally treated with Chinese medicine prescriptions combined with exercise rehabilitation based on the treatment of the control group.The score of Acute Physiology and Chronic Health Evaluation(APACHE-Ⅱ),Chinese medicine syndrome score,the heart function indexes including left ventricular end-systolic volume(LVESV),left ventricular enddiastolic volume(LVEDV),left ventricular ejection fraction(LVEF),and 6 min walking distance were observed before and after treatment in the two groups.Adverse reactions and re-hospitalization rates during treatment were recorded.Results:There was no significant difference in the comparison of the APACHE-Ⅱ score and Chinese medicine syndrome score between the two groups before treatment(P>0.05).After treatment,APACHE-Ⅱ score and Chinese medicine syndrome score in the two groups were lower than those before treatment,while those in the treatment group were lower than those in the control group,the difference being significant(P<0.05).Before treatment,there was no significant difference in the comparison of the heart function indexes between the two groups(P>0.05).After treatment,the levels of LVEDV and LVESV in the two groups were lower than those before treatment,while the LVEF levels were higher than those before treatment,and the improvement in the treatment group was better than that in the control group(P<0.05).The 6 min walking distance after treatment in the treatment group was longer than that in the control group,and the walking distance in the two groups was significantly longer than that before treatment respectively(P<0.05).No obvious adverse reactions were observed during the treatment;no significant changes in blood,urine,feces and the liver and kidney function were observed during the study;no discomfort was observed after taking the drug,and no withdrawal due to adverse reactions was observed during the treatment.The re-hospitalization rate in the treatment group was 9.76%(4/41),less than that of 31.71%(13/41)in the control group,the difference being significant(χ^(2)=6.01,P=0.01).Conclusion:Chinese medicine combined with exercise rehabilitation in elderly patients with heart failure can better improve their body condition,clinical symptoms and heart function,prolong the walking distance,and reduce the re-hospitalization rate.