茯苓杏仁甘草汤加味联合中药熏洗对心衰伴利尿剂抵抗(气虚血瘀水阻型)患者心功能的影响

Eff ects of modifi ed Fuling Xingren Gancao decoction combined with TCM steaming and douche on the heart function in patients with heart failure complicated with diuretic resistance(syndrome of qi defi ciency,blood stasis and water obstruction)

目的 研究茯苓杏仁甘草汤加味联合中药熏洗对心衰伴利尿剂抵抗(气虚血瘀水阻型)患者心功能的影响。方法 2021年7月-2022年7月保定市第一中医院收治的66例心衰伴利尿剂抵抗(气虚血瘀水阻型)患者随机分为常规西药组(33例)和茯苓杏仁甘草汤组(33例)。常规西药组进行常规西药治疗,茯苓杏仁甘草汤组在常规西药组的基础上采用茯苓杏仁甘草汤加味联合中药熏洗进行治疗,2组均治疗2周。结果 治疗2周后,茯苓杏仁甘草汤组总有效率高于常规西药组(P <0.05);治疗期间,茯苓杏仁甘草汤组日均速尿剂量低于常规西药组(P <0.05)。治疗2周后与治疗前比较,2组中医证候各项积分及血清N末端脑钠肽前体(NT-pro BNP)水平、心功能分级(NYHA)降低,茯苓杏仁甘草汤组低于常规西药组(P <0.05);2组左室射血分数(LVEF)、左室短轴缩短率(LVFS)、6 min步行试验(6MWT)、24 h尿量升高,茯苓杏仁甘草汤组高于常规西药组(P <0.05)。2组治疗期间均未出现电解质紊乱、肝功能损伤、肾功能损害等不良反应。结论 茯苓杏仁甘草汤加味联合中药熏洗对心衰伴利尿剂抵抗(气虚血瘀水阻型)患者进行治疗,可有效降低日均速尿剂量,改善患者中医证候,提高其心功能,促进患者排尿,具有较好的临床疗效,安全性良好。

Objective To study the eff ects of modifi ed Fuling Xingren Gancao decoction combined with traditional Chinese medicine steaming and douche on the heart function in patients with heart failure combined with diuretic resistance(syndrome of qi deficiency,blood stasis and water obstruction).Methods From July 2021 to July 2022,66 patients with heart failure combined with diuretic resistance(syndrome of qi defi ciency,blood stasis and water obstruction)admitted to the Baoding No.1 Hospital of Traditional Chinese Medicine were randomly divided into a conventional western medicine group(33 cases)and a Fuling Xingren Gancao decoction group(33 cases).The conventional western medicine group was treated with conventional western medicine,while the Fuling Xingren Gancao decoction group was treated with the Fuling Xingren Gancao decoction and TCM steaming and douche on that basis,both for 2 weeks.Results After 2 weeks of treatment,the total effective rate of the Fuling Xingren Gancao decoction group was higher than that of the conventional western medicine group(P<0.05).During treatment,the average furosemide dose in the Fuling Xingren Gancao decoction group was lower than that in the conventional western medicine group(P<0.05).After 2 weeks of treatment,the scores of TCM syndromes,levels of serum N-terminal brain natriuretic peptide precursor(NT-proBNP)and NYHA grading were decreased in both groups,and the Fuling Xingren Gancao decoction group was lower than the conventional western medicine group(P<0.05).The levels of LVEF,LVFS,the scores of the 6 min walking test(6MWT)and the 24 h urine volumes were increased in both groups,and the Fuling Xingren Gancao decoction group was higher than the conventional western medicine group(P<0.05).There were no adverse reactions such as electrolyte disturbance,liver function injury and renal function injury during treatment in both groups.Conclusion In the treatment of patients with heart failure complicated with diuretic resistance(syndrome of qi deficiency,blood stasis and water obstruction),the modified Fuling Xingren Gancao decoction combined with TCM steaming and douche can effectively reduce the daily mean furosemide dose,improve the patients'TCM syndromes,improve their heart function,promote urination,having a good clinical efficacy and a good safety.