补气泻火宁悸方联合美托洛尔治疗对快速性心律失常气虚火旺证患者心率变异性的影响

Effect of Buqi Xiehuo Ningji Prescription Combined with Metoprolol on Heart Rate Variability for Patients with Tachyarrhythmia of Qi-deficiency Fire-hyperactivity Syndrome

目的:观察补气泻火宁悸方联合美托洛尔治疗对快速性心律失常气虚火旺证患者心率变异性(HRV)的影响。方法:选择2018年9月~2020年10月在我院就诊的快速性心律失常患者68例,辨证为气虚火旺证,随机数表法分为2组,观察组34例选补气泻火宁悸方联合美托洛尔治疗,对照组34例给予美托洛尔进行治疗。比较两组治疗有效率,两组治疗前后HRV指标、心功能指标、血清炎症指标,中医症状积分及用药安全性情况。结果:观察组和对照组快速性心律失常气虚火旺证患者的治疗有效率分别为94.12%和85.29%,比较未见显著差异(P>0.05)。治疗4w,观察组心悸不安、气短乏力和燥热的中医症状积分均显著低于对照组(P<0.05);观察组心功能指标左室射血分数(LVEF)、心脏指数(CI)、每搏量(SV)、水平显著高于对照组(P<0.05);观察组HRV指标相邻5minR-R均值标准差(SDANN)、相邻窦性R-R间期标准差(SDNN)、相邻R-R间期>50ms占正常心动周期比例(PNN50)和相邻R-R间期差值均方根(RMSSD)水平高于对照组(P<0.05)。治疗4w,试验组血清白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组(P<0.05)。治疗期间,观察组和对照组心动过缓、腹泻、倦怠等不良反应发生率分别为8.82%、11.76%,比较未见显著差异(P>0.05)。结论:补气泻火宁悸方联合美托洛尔用于治疗快速性心律失常气虚火旺证患者,可同时改善其心功能和HRV指标,降低中医症状积分和炎症因子水平。

Objective:To explore the effect of Buqi Xiehuo Ningji Prescription combined with Metoprolol on heart rate variability(HRV)for patients with tachyarrhythmia of Qi-deficiency fire-hyperactivity syndrome.Methods:A total of 68 patients with tachyarrhythmia of Qi-deficiency fire-hyperactivity syndrome who were treated in the hospital from September 2018 to October 2020 were enrolled.They were divided into an observation group(34 cases,Buqi Xiehuo Ningji Prescription combined with Metoprolol)and a controlled group(34 cases,Metoprolol)by random number table method.The response rate of treatment,HRV indexes,cardiac function indexes,scores of TCM symptoms and medication safety before and after treatment were compared between the two groups.Results:There was no significant difference in response rate of treatment between the observation group and the controlled group(94.12%vs 85.29%)(P>0.05).After 4 weeks of treatment,scores of TCM symptoms such as palpitation,shortness of breath,fatigue and dryness-heat in the observation group were significantly lower than those in the controlled group(P<0.05).The levels of cardiac function indexes[left ventricular ejection fraction(LVEF),cardiac index(CI),stroke volume(SV)]in the observation group were significantly higher than those in the controlled group(P<0.05),and levels of standard deviation of all 5-min averaged intervals(SDANN),standard deviation of NN intervals(SDNN),percent of the number whose difference between adjacent NN interval are more than 50 ms(PNN50)and root mean square of successive differences(RMSSD)were higher than those in the controlled group(P<0.05).During treatment,there was no significant difference in incidence of adverse reactions(bradycardia,diarrhea,fatigue)between the observation group and the controlled group(8.82%vs 11.76%)(P>0.05).Conclusion:The application of Buqi Xiehuo Ningji Prescription combined with Metoprolol in patients with tachyarrhythmia of Qi-deficiency fire-hyperactivity syndrome can improve cardiac function and HRV indexes,and reduce scores of TCM symptoms.