中西医结合抢救急性心力衰竭患者的临床研究

Clinical study of integrated traditional Chinese and Western medicine in rescuing patients with acute heart failure

目的观察中西医结合治疗在急性心力衰竭(心衰)患者中的应用效果.方法收集平凉市第四人民医院重症医学科收治的42例急性心衰患者的临床资料,根据治疗方法的不同分为西医对照组与中西医结合治疗组,每组各21例.记录并比较两组患者的基础疾病、基本情况、治疗方法以及预后情况.结果西医对照组与中西医结合治疗组患者的基础疾病包括冠心病(每组各9例)、肺心病(每组各4例)、重症心肌炎(每组各8例).西医对照组采用镇静、营养心肌、强心、减轻心脏负荷、抗凝血等西医常规治疗;中西医结合治疗组在西医对照组基础上加用中药治疗.冠心病并发心衰患者,阳气虚者加参附注射液,兼淤血者加水蛭素注射液,气阴两虚者加参麦注射液;肺心病并发心衰患者,气虚者加人参注射液,痰瘀互结、肺气不降者加导痰汤合苏子降气汤加麻黄;重症肺炎并发心衰患者,气虚血瘀者加人参注射液,气阴两虚者加参麦注射液,气虚者加人参注射液.西医对照组患者均连续治疗10 d,抢救成功13例,经过治疗,生命体征平稳,睡眠及饮食尚可,其中精神状态差者4例转科;死亡8例.中西医结合治疗组患者平均连续治疗10 d,抢救成功19例,其中7例呼吸困难,经过治疗生命体征平稳,睡眠及饮食尚可,精神状态差者1例转科;死亡2例.结论与西医常规治疗相比,接受中西医结合治疗的患者抢救成功率更高,稳定性及远期疗效更好,具有明显的优势.

Objective To observe the effect of using integrated traditional Chinese medicine(TCM)and Western medicine(WM)for treatment of patients with acute heart failure(heart failure).Methods The clinical data of 42 patients with acute heart failure admitted to the critical care medicine department of Pingliang Fourth People's Hospital were collected.According to the different treatment methods,they were divided into WM control group and TCM+WM treatment group,with 21 cases in each group.The basic diseases,basic conditions,treatment methods and prognosis of the patients in the two groups were recorded and compared.Results The basic diseases of patients in the WM control group and the TCM+WM treatment group included coronary heart disease(9 cases in each group),pulmonary heart disease(4 cases in each group),and severe myocarditis(8 cases in each group).The WM control group received conventional WM treatments,such as sedation,nourishment of the myocardium,cardiotonic,cardiac load reduction,anticoagulation,etc.;the TCM+WM treatment group was treated with TCM on the basic treatment of the WM control group.For patients with coronary heart disease complicated by heart failure,add Shenfu injection for those with deficiency of Yangqi,add hirudin injection for those with blood stasis,add Shenmai injection for those with deficiency of both Qi and Yin;for patients with pulmonary heart disease complicated by heart failure,ginseng injection was added for those with Qi deficiency,and for patients with mutual accumulation of phlegm and blood stasis and insufficiency of lung Qi,add Daotan decoction and Suzi Jiangqi decoction plus ephedra;for patients with severe pneumonia complicated by heart failure,ginseng injection was added for patients with Qi deficiency and blood stasis,Shenmai injection was used for patients with deficiency of both Qi and Yin and add ginseng injection for patients with Qi deficiency.In the WM control group,all the patients were treated continuously for 10 days,and 13 cases were successfully rescued,after treatment,their vital signs were stable,and their sleep and diet were acceptable,and among them,4 cases with poor mental status were transferred to a related department;8 cases died.All the patients in the TCM+WM treatment group were treated continuously for an average of 10 days,19 cases were successfully rescued,and among them,after treatment,7 cases with dyspnea were getting better,their vital signs were stable,sleep and diet were acceptable,and 1 case with poor mental state was transferred to a related department;2 cases died.Conclusion Compared with conventional WM treatment,the patients receiving integrated TCM and WM treatment have a higher rescue successful rate,and the disease stability and the long-term curative effects are better,so the integrated therapy has an obviously more superior therapeutic effect.