复方丹参注射液联合加味复元活血汤治疗冠心病合并急性充血性心力衰竭临床研究

Clinical Study on Compound Danshen Injection Combined with Modified Fuyuan Huoxue Decoction for Coronary Heart Disease Complicated with Acute Congestive Heart Failure

目的:观察在现代医学常规疗法基础上加用复方丹参注射液联合加味复元活血汤治疗冠心病合并急性充血性心力衰竭的疗效。方法:纳入80例冠心病合并急性充血性心力衰竭气虚血瘀证患者作为研究对象,随机分为对照组和观察组各40例。2组均予现代医学常规对症支持治疗,观察组加用复方丹参注射液联合加味复元活血汤治疗。2组均连续治疗1个月。治疗前后检测血管内皮功能指标[内皮素-1 (ET-1)、血管紧张素Ⅱ(AngⅡ)、降钙素基因相关肽(CGRP)、一氧化氮(NO)]、心肌能量代谢参数[乳酸(LA)、乳酸脱氢酶(LDH)、游离脂肪酸(FFA)、尿酸(UA)]、心室重构参数[左心室内径缩短率(LVFS)、左心室后壁厚度(LVPWT)、室间隔收缩末期厚度(IVSS)、左心室质量指数(LVMI)],比较2组临床疗效。结果:治疗后,临床疗效总有效率观察组95.00%,对照组77.50%,2组比较,差异有统计学意义(P<0.05)。2组血清ET-1、AngⅡ水平均较治疗前下降,CGRP、NO水平均较治疗前升高,差异均有统计学意义(P<0.05);观察组血清ET-1、AngⅡ水平均低于对照组,CGRP、NO水平均高于对照组,差异均有统计学意义(P<0.05)。2组血清LA、LDH、FFA、UA水平均较治疗前下降,差异均有统计学意义(P<0.05);观察组血清LA、LDH、FFA、UA水平均低于对照组,差异均有统计学意义(P<0.05)。2组LVFS值均大于治疗前,LVPWT、IVSS、LVMI值均小于治疗前,差异均有统计学意义(P<0.05);观察组LVFS值大于对照组,LVPWT、IVSS、LVMI值均小于对照组,差异均有统计学意义(P<0.05)。结论:在现代医学常规疗法基础上加用复方丹参注射液联合加味复元活血汤治疗,能有效改善冠心病合并急性充血性心力衰竭气虚血瘀证患者的心功能,作用机制可能与改善血管内皮功能、纠正心肌能量代谢和抑制心室重构有关。

Objective:To observe the curative effect of the therapy of Compound Danshen Injection combined with modified Fuyuan Huoxue Decoction on coronary heart disease complicated with acute congestive heart failure based on routine therapy of modern medicine.Methods:A total of 80 patients with coronary heart disease complicated with acute congestive heart failure with qi deficiency and blood stasis syndrome were included as the study objects and randomly divided into the control group and the observation group,with 40 cases in each group.The two groups were given routine symptomatic treatment of modern medicine,and the observation group was additionally treated with Compound Danshen Injection combined with modified Fuyuan Huoxue Decoction.The two groups were treated for one month.Before and after treatment,the indexes of vascular endothelial function,including endothelin-1(ET-1),plasma angiotensinⅡ(AngⅡ),calcitonin gene related peptide(CGRP)and nitric oxide(NO),parameters of myocardial energy metabolism,including lactic acid(LA),lactate dehydrogenase(LDH),free fatty acid(FFA)and uric acid(UA),and parameters of ventricular remodeling,including left ventricular fractional shortening(LVFS),left ventricular posterior wall thickness(LVPWT),interventricular septal end-systolic thickness(IVSS)and left ventricular mass index(LVMI)were detected,and the clinical effects were compared between the two groups.Results:After treatment,the total clinical effective rate was 95.00%in the observation group,higher than that of 77.50%in the control group,the difference being significant(P<0.05).The levels of serum ET-1 and AngⅡin both groups were decreased when compared with those before treatment,and the levels of CGRP and NO were increased when compared with those before treatment,differences being significant(P<0.05);the levels of serum ET-1 and AngⅡin the observation group were lower than those in the control group,and the levels of CGRP and NO were higher than those in the control group,differences being significant(P<0.05).The levels of serum LA,LDH,FFA and UA in the two groups were lower than those before treatment,differences being significant(P<0.05);the above four levels in the observation group were lower than those in the control group,differences being significant(P<0.05).The values of LVFS in both groups were higher than those before treatment,and the values of LVPWT,IVSS and LVMI were lower than those before treatment,differences being significant(P<0.05);the value of LVFS in the observation group was higher than that in the control group,and the values of LVPWT,IVSS and LVMI were lower than those in the control group,differences being significant(P<0.05).Conclusion:Based on the routine therapy of modern medicine,the additional application of Compound Danshen Injection combined with modified Fuyuan Huoxue Decoction can effectively improve the heart function of patients with coronary heart disease complicated with acute congestive heart failure syndrome with qi deficiency and blood stasis,and its mechanism may be related to the improvement of vascular endothelial function,adjustment of myocardial energy metabolism and inhibition of ventricular remodeling.