加减五苓散联合西医常规治疗对慢性心力衰竭(气虚血瘀型)临床疗效观察

Clinical Effect of Modified Wuling Powder(加减五苓散)Combined with Conventional Western Medicine on Patients with Chronic Heart Failure(Qi Deficiency and Blood Stasis Type)

目的观察加减五苓散治疗气虚血瘀型慢性心力衰竭患者的临床疗效。方法选取2020年12月—2021年12月本院80例心力衰竭患者(气虚血瘀型),随机均分为对照组和五苓散组,对照组予以西医常规治疗,五苓散组在对照组基础上予以加减五苓散治疗。观察并比较两组患者的临床疗效以及治疗前后心功能、血流动力学和血清指标水平变化。结果五苓散组的总有效率显著上调(P<0.05)。治疗前两组患者的LVEDD、LVESD以及LVEF水平差异无统计学意义。治疗4周后,五苓散组患者的LVEDD和LVESD相较于对照组显著下调,而LVEF相较于对照组显著上调(P<0.01)。治疗后五苓散组患者的外周血中NT-pro BNP和cTnI水平相较于对照组显著下调;而6MWT水平相较于对照组显著上调(P<0.01)。治疗前两组患者的血流动力学指标均差异无统计学意义(P>0.05)。治疗4周后,五苓散组患者的外周阻力水平相较于对照组显著下调;而心排出量和SV水平相较于对照组显著上调(P<0.01)。治疗前两组患者的心衰积分和MLHFQ差异均无统计学意义(P>0.05)。治疗4周后,五苓散组患者的心衰积分和MLHFQ相较于对照组显著下调(P<0.01)。治疗后五苓散组患者的NYHA心功能分级相较于对照组显著改善(P<0.01)。两组总不良反应发生率差异不具有统计学意义(P>0.05)。结论加减五苓散联合西医常规用药治疗气虚血瘀型心力衰竭能够显著提高临床疗效,改善患者心功能、血流动力学以及心衰血清学指标,且无不良反应增加,临床适宜推广。

Objective To observe the clinical effect of Modified Wuling Powder(加减五苓散)on patients with chronic heart failure of Qi deficiency and blood stasis type.Methods Eighty patients with heart failure(Qi deficiency and blood stasis type)in the hospital from December 2020 to December 2021 were randomly divided into control group and Wuling Powder group.The control group was treated with routine western medicine,and Wuling Powder group was treated with Modified Wuling Powder on the basis of the control group.The clinical efficacy and the changes of cardiac function,hemodynamics and serum indexes before and after treatment were observed and compared between the two groups.Results The total effective rate of Wuling Powder group was significantly up-regulated(P<0.05).There was no significant difference in left ventricular end-diastolic dimension(LVEDd),left ventricular end-systolic dimension(LVESD)or left ventricular ejection fractions(LVEF)between the two groups before treatment.After 4 weeks of treatment,LVEDd and LVESD in Wuling Powder group were significantly lower than those in the control group,while LVEF was significantly higher than that in the control group(P<0.01).After treatment,the levels of N-terminal pro brain natriuretic peptide(NT-proBNP)and cardiac troponin I(cTnI)in peripheral blood of patients in Wuling Powder group were significantly lower than those in the control group.The level of 6MWT was significantly higher than that in the control group(P<0.01).There was no significant difference in hemodynamic indexes between the two groups before treatment(P>0.05).After 4 weeks of treatment,the level of peripheral resistance in Wuling Powder group was significantly lower than that in the control group.Compared with those of the control group,cardiac output and stroke volume(SV)were significantly up-regulated(P<0.01).There was no significant difference in heart failure score or Minnesota Quality of Life Score(MLHFQ)between the two groups before treatment(P>0.05).After 4 weeks of treatment,the heart failure score and MLHFQ in Wuling Powder group were significantly lower than those in the control group(P<0.01).After treatment,the NYHA cardiac function grade in Wuling Powder group was significantly improved compared with that in the control group(P<0.01).There was no sig⁃nificant difference in the incidence of total adverse reactions between the two groups(P>0.05).Conclusion Modified Wuling Powder combined with conventional western medicine in the treatment of heart failure of Qi deficiency and blood stasis type can significantly improve the clinical efficacy,the cardiac function,hemodynamics and serological indexes of heart failure,and there is no increase in adverse reactions.It is suitable for clinical promotion.