真武汤加减治疗老年窦性心动过缓心肾阳虚证临床观察

Clinical Observation of Zhenwu Decoction(真武汤)in Treatment of Senile Sinus Bradycardia with Yang Deficiency of Heart and Kidney

目的探讨真武汤加减对心肾阳虚型老年窦性心动过缓(SB)的疗效。方法选取2020年2月—2022年2月于医院门诊就诊的老年窦性心动过缓患者80例,其辨证分型属心肾阳虚证。随机分为对照组与治疗组各40例。两组均予西药常规治疗,治疗组在对照组基础上予真武汤加减方治疗,4周为1个疗程,观察比较两组患者治疗前后24 h动态心电图疗效、中医证候疗效、心率变异性(HRV)指标(SDNN、SDANN、SDNN Index、rMSSD、PNN50)和心功能指标(CI、SV、LVEF、CO)。结果治疗后,治疗组动态心电图总有效率为90.0%高于对照组的70.0%(P<0.05);两组中医证候积分均比治疗前降低,且治疗组较对照组降低更显著(P<0.05);两组心率均有改善,且治疗组改善效果更显著(P<0.05);两组CI、SV、LVEF、CO均提高,且治疗组更显著(P<0.05);两组HRV分析各指标均有所提高,且治疗组更显著(P<0.05)。结论真武汤加减方治疗心肾阳虚型老年窦性心动过缓有较好临床疗效,对患者心率、心率变异性指标、心功能均有改善。

Objective To investigate the effect of Zhenwu Decoction(真武汤)on sinus bradycardia(SB)in the elderly with Yang deficiency of heart and kidney.Methods Eighty cases of senile sinus bradycardia were selected from February 2020 to February 2022 in the outpatient department.Their syndrome differentiation belonged to heart-kidney Yang deficiency syndrome.They were randomly divided into control group and treatment group.Both groups were treated with conventional western medicine,and the treatment group was treated with Zhenwu Decoction plus reduced formula on the basis of the control group,with 4 weeks as a course of treatment.The 24-hour ambulatory electrocardiogram efficacy,TCM syndrome efficacy,heart rate variability(HRV)indexes[standard diviation of NN intervals(SDNN),standard deviation of average normal RR interval(SDANN),SDNN index,root mean square of the difference between adjacent normal cardiac cycles(RMSSD),percent of NN50 in the total number of RR intervals(PNN50)]and cardiac function indexes[cardiac index(CI),stroke volume(SV),ventricular ejection fraction(LVEF),cardiac output(CO)]were observed and compared between the two groups before and after treatment.Results After treatment,the total effective rate of ambulatory electrocardiogram in the treatment group was 90.0%,which was higher than 70.0%in the control group(P<0.05).The TCM syndrome scores of the two groups were lower than those before treatment,and the decrease in the treatment group was more significant than that in the control group(P<0.05).The heart rate was improved in both groups,and the improvement effect was more significant in the treatment group(P<0.05).The levels of CI,SV,LVEF and CO increased in both groups,and those were more significantly in the treatment group(P<0.05).After treatment,all indexes of HRV analysis in the two groups were improved,and those of the treatment group were more significant(P<0.05).Conclusion Zhenwu Decoction has a good clinical effect in the treatment of senile sinus bradycardia with Yang deficiency of heart and kidney,and improves the heart rate,heart rate variability and cardiac function.