加味真武汤治疗慢性心力衰竭合并缓慢性心律失常患者的疗效及对其血流动力学的影响

Effect of Jiawei Zhenwu Decoction on Chronic Heart Failure Patients with Slow Arrhythmia and Its Effect on Hemodynamics

目的研究加味真武汤治疗慢性心力衰竭合并缓慢性心律失常患者的疗效及对其血流动力学的影响。方法选取2019年1月—2022年1月期间开封市中医院心内科收治的慢性心力衰竭合并缓慢性心律失常患者80例,按随机数字表法分为对照组和研究组,每组各40例。对照组采用西医常规治疗,研究组在对照组基础上给予加味真武汤口服治疗。治疗6周后,观察比较两组患者临床疗效、不良反应,治疗前后两组患者心功能指标[左心室舒张末期内径(Left ventricular end-diastolic diameter,LVEDD)、左心室射血分数(Left ventricular ejection fraction,LVEF)、心率]、血流动力学指标[心排血量(Cardiac output,CO)、心排血指数(Cardiac output index,CI)]、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、基质金属蛋白酶-9(Matrix metalloproteinases-9,MMP-9)及内皮素-1(Endothelin-1,ET-1)水平。结果治疗后研究组临床总有效率90.00%(36/40)明显高于对照组70.00%(28/40),差异有统计学意义(P<0.05)。治疗后两组患者心功能指标LVEDD均较治疗前降低、LVEF及心率均较治疗前升高,差异有统计学意义(P<0.05);且研究组LVEDD明显低于对照组、LVEF及心率明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者CO、CI均较治疗前升高,差异有统计学意义(P<0.05);且研究组CO、CI均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者NT-proBNP、MMP-9、ET-1水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组NT-proBNP、MMP-9、ET-1水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,对照组总不良反应发生率17.50%(7/40)与研究组15.00%(6/40)比较,差异无统计学意义(χ^(2)=0.092,P=0.762)。结论慢性心力衰竭合并缓慢性心律失常患者应用加味真武汤治疗效果较佳,可有效改善心功能,调节血流动力学,值得临床推广使用。

Objective To study the effect of Jiawei Zhenwu Decoction on chronic heart failure patients with slow arrhythmia and its effect on hemodynamics.Methods From January 2019 to January 2022,80 chronic heart failure patients with slow arrhythmia were selected and divided into a control group and study group according to the random number table,with 40 cases in each group.The control group was treated with conventional western medicine,and the study group was treated with Jiawei Zhenwu Decoction on the basis of the control group.Patients in both groups were treated continuously for six weeks.After treatment,the clinical efficacy and adverse reactions of the two groups were compared,and the cardiac function indexes[left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),and heart rate],hemodynamic indexes[cardiac output(CO)and cardiac output index(CI)],N-terminal pro-B-type natriuretic peptide(NT-proBNP),matrix metalloproteinase-9(MMP-9),and endothelin-1(ET-1)levels were compared between the two groups before and after treatment.Results After treatment,the total clinical effective rate of 90.00%(36/40)in the study group was higher than that of 70.00%(28/40)in the control group,with statistical significance(P<0.05).After treatment,LVEDD decreased,and LVEF and heart rate increased(P<0.05).LVEDD in the study group was lower than that in the control group,and LVEF and heart rate in the study group were higher than those in the control group(P<0.05).After treatment,the CO and CI of the two groups were higher than those before treatment(P<0.05),and the CO and CI in the study group were higher than those in the control group(P<0.05).After treatment,the levels of NT-proBNP,MMP-9,and ET-1 in both groups were lower than those before treatment(P<0.05),and the levels of NT-proBNP,MMP-9,and ET-1 in the study group were lower than those in the control group(P<0.05).During the treatment,the total incidence of adverse reactions in the control group was 17.50%(7/40).Compared with 15.00%(6/40)in the study group,there was no significant difference(χ^(2)=0.092,P=0.762).Conclusion Jiawei Zhenwu Decoction is effective in treating chronic heart failure patients with slow arrhythmia,which can effectively improve cardiac function and regulate hemodynamics.It is worthy of clinical application.