桂枝甘草龙骨牡蛎汤联合天王补心丹治疗气阴两虚型室性期前收缩临床观察

Clinical observation on treatment of premature ventricular contraction due to deficiency of both qi and yin with Tianwang Buxin Dan and Guizhi Gancao Longgu Muli Decoction

目的探讨天王补心丹联合桂枝甘草龙骨牡蛎汤治疗气阴两虚型室性期前收缩的临床效果。方法选择2018年1月—2020年12月北京中医医院顺义医院心血管内科门诊诊断为室性期前收缩的患者60例,采用随机数字表法分为治疗组、对照组。对照组给予倍他乐克口服,每次12.5 mg或25 mg,2次/d。治疗组在对照组基础上给予天王补心丹加桂枝甘草龙骨牡蛎汤口服,1剂/d。2组1个疗程均为4周。对比2组室性期前收缩疗效、Myerburg分级疗效、中医证候疗效,治疗前后室性期前收缩次数,心率变异性相关指标[全部正常RR间期的标准差(SDNN)、全程相邻RR间期之差的均方根值(rMSSD)、相邻RR间期差值超过50 ms的个数占总窦性心搏个数的百分比(PNN50)],二联律、三联律、成对室性期前收缩次数,中医证候积分,安全性。结果治疗组室性期前收缩总有效率高于对照组(P<0.05)。治疗后,2组室性期前收缩次数均较治疗前减少(P<0.05),且治疗组少于对照组(P<0.05)。治疗后,2组SDNN、rMSSD、PNN50均较治疗前升高(P<0.05),且治疗组优于对照组(P<0.05)。治疗后,2组二联律、三联律、成对室性期前收缩次数均较治疗前减少(P<0.05),治疗组二联律、三联律少于对照组(P<0.05)。治疗组Myerburg分级总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,2组中医证候积分均较治疗前降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗组中医证候总有效率高于对照组(P<0.05)。2组均无不良事件发生。结论天王补心丹联合桂枝甘草龙骨牡蛎汤治疗气阴两虚型室性期前收缩效果优于单纯西药治疗,且未增加不良反应。

Objective To explore the clinical effect of Tianwang Buxin Dan and Guizhi Gancao Longgu Muli Decoction in treating ventricular premature beats due to deficiency of both qi and yin.Methods Sixty cases of ventricular premature beats who were diagnosed from January 2018 to December 2020 were enrolled,and they were divided into treatment group and control group by random number table.The control group was treated with metoprolol tartrate 12.5 mg or 25 mg each time,twice a day,and the treatment group was treated with Tianwang Buxin Dan and Guizhi Gancao Longgu Muli Decoction on the basis of the control group one bag each day.The course of treatment was four weeks in both groups.The curative effect of premature ventricular contractions,Myerburg grading,curative effect of TCM syndrome,the number of premature ventricular contractions before and after treatment,the related indexes of heart rate variability[standard deviation(SDNN)of all normal RR intervals,root mean square value(rMSSD)of the difference between adjacent RR intervals,the percentage of the number of adjacent RR intervals exceeding 50 ms to the total number of sinus beats(PNN50)],bigeminal beats and trigeminal beats,paired premature ventricular contractions,TCM syndrome integral and safety were compared between the two groups.Results The total effective rate of premature ventricular contraction in the treatment group was higher than that in the control group(P<0.05).After treatment,the number of premature ventricular contractions in both groups decreased(P<0.05),and the number in the treatment group was less than that in the control group(P<0.05).After treatment,the levels of SDNN,rMSSD and PNN50 in both groups were higher than that before treatment(P<0.05),and the treatment group was better than the control group(P<0.05).After treatment,bigeminal beats and trigeminal beats and the number of paired premature ventricular contractions were decreased compared with that before treatment(P<0.05),in the treatment group,the number of bigeminal beats and trigeminal beats was less than that in the control group(P<0.05).The overall effective rate of Myerburg grade in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of TCM syndrome in both groups were lower than those before treatment(P<0.05),and the treatment group was lower than that of the control group(P<0.05).There were no adverse events in either group.Conclusion Tianwang Buxin Dan combined with Guizhi Longgu Muli Decoction are more effective than western medicine used only in the treatment of ventricular premature beats without increasing the incidence of adverse events.