应用程志清症证结合辨治心衰喘证学术经验治疗心衰喘证的临床观察

Clinical Application Observation of Cheng Zhiqing's Academic Experience in Combining Symptoms and Syndrome Differentiation and Treatment for Heart Failure and Asthma Syndrome

目的将程志清教授治疗心力衰竭症证结合经验应用于临床,以心衰喘证进行临床验证。方法将66例患者按随机数字表法分为治疗组与对照组各33例。对照组行常规心衰西医治疗,治疗组在对照组基础上增加症证结合法中医药治疗,疗程2周。比较治疗前后两组患者心率、血压、尿量和肾小球滤过率(eGFR)等临床指标,两组患者的纽约心功能分级(NYHA)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、N末端前体脑钠肽(NT-proBNP)、生活质量量表和6分钟步行试验(6MWT)等心功能指标,以及中医证候积分、证候有效缓解天数,并随访统计12周内心衰恶化再住院率和死亡发生率,描绘生存曲线。结果治疗后,治疗组e GFR、6MWD结果高于对照组,NT-proBNP、生活质量量表评分、中医证候积分、证候有效缓解天数、心衰再住院率和死亡率均低于对照组(P<0.05);治疗后两组心率、血压、尿量、NYHA心功能分级、LVEF和LVEDD差异无统计学意义(P>0.05)。结论程志清治疗心衰症证结合经验,方法简单,安全有效,临床应用能快速缓解心衰症状、改善心功能、提高生活质量、改善近期心血管预后。

Objective:To study Professor Cheng Zhiqing's experience in combining symptoms and syndromes in the treatment of heart failure,and to conduct clinical verification with heart failure asthma syndrome.Methods:A total of 66 hospitalized patients with heart failure and asthma syndrome were selected and randomly divided into a treatment group and a control group,with 33 cases in each group.The control group received routine western medicine treatment for heart failure,while the treatment group received traditional Chinese medicine treatment on the basis of the control group with a differentiation method of combining symptoms and syndromes.Both groups were treated for a course of 2 weeks.The clinical indicators such as heart rate,blood pressure,urine volume,and estimated glomerular filtration rate(eGFR)between the two groups of patients before and after treatment,the cardiac function indicators such as New York heart function rating(NYHA),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),N-terminal precursor brain natriuretic peptide(NT-proBNP),quality of life scale,and 6-minute walking test(6MWT),as well as traditional Chinese medicine syndrome scores and effective remission days of the two groups of patients were compared.Follow up statistics were conducted on the rate of rehospitalization and mortality after 12 weeks of worsening heart failure,and survival curves were plotted.Results:After treatment,the eGFR and 6MWT results of the treatment group were higher than those of the control group,while the NT-proBNP,quality of life scale score,traditional Chinese medicine syndrome score,effective symptom relief days,heart failure readmission rate,and mortality rate were lower than those of the control group(P<0.05);after treatment,there was no statistically significant difference in heart rate,blood pressure,urine volume,NYHA cardiac function grading,LVEF,and LVEDD between the two groups(P>0.05).Conclusion:Cheng Zhiqing's experience in combining symptoms and syndromes in the treatment of heart failure is simple,safe,and effective.Its clinical application can quickly alleviate heart failure symptoms,improve heart function,improve quality of life,and improve recent cardiovascular prognosis.