针刺联合补肺强心方治疗肺源性心脏病心肺气虚证临床研究

Clinical Study on Acupuncture Combined with Bufei Qiangxin Prescription for Pulmonary Heart Disease with Heart-Lung Qi Deficiency Syndrome

目的:观察针刺联合补肺强心方治疗肺源性心脏病心肺气虚证的临床疗效。方法:采用随机数字表法将129例肺源性心脏病心肺气虚证患者分为针刺组、中药组、联合组各43例。3组均给予常规西药治疗,在此基础上,针刺组联用针刺治疗,中药组联用补肺强心方治疗,联合组联用针刺合补肺强心方治疗,3组疗程均为4周。比较3组治疗前后中医证候积分、6 min步行试验(6MWT)、英国医学研究委员会呼吸问卷(mMRC)评分、明尼苏达心力衰竭生存质量量表(MLHFQ)评分;比较3组治疗前后肺功能指标[最大呼气峰流速(PEF)、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、第1秒用力呼气容积占用力肺活量比值(FEV_(1)/FVC)]、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、每搏输出量(SV)]及血气指标[动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、二氧化碳分压(PaCO_(2))、氢离子浓度指数(pH值)];评估3组临床疗效及不良反应发生情况。结果:联合组总有效率97.67%,高于针刺组81.40%、中药组76.74%(P<0.05)。治疗后,3组mMRC、MLHFQ评分、中医证候积分、LVEDD、LVESD、PaCO_(2)均较治疗前降低(P<0.05),且联合组治疗后上述指标均低于针刺组、中药组(P<0.05)。治疗后,3组6MWT、PEF、FEV_(1)、FVC、LVEF、PaO_(2)、SaO_(2)、SV、FEV_(1)/FVC及联合组pH值均较治疗前升高(P<0.05),且联合组治疗后上述指标均高于针刺组、中药组(P<0.05)。3组均未发生不良反应。结论:针刺联合补肺强心方治疗肺源性心脏病心肺气虚证临床疗效确切,能够改善患者心肺功能和血气指标,提高生活质量,安全性较高。

Objective:To observe the clinical effect of acupuncture combined with Bufei Qiangxin Prescription on pulmonary heart disease with heart-lung qi deficiency syndrome.Methods:A total of129 cases of patients with pulmonary heart disease with heart-lung qi deficiency syndrome were divided into the acupuncture group,the Chinese medicine group and the combination group,with 43 cases in each group.All the three groups were treated with routine western medicine;the acupuncture group was additionally treated with acupuncture,the Chinese medicine group was additionally treated with Bufe Qiangxin Prescription,and the combination group was additionally treated with acupuncture combined with Bufei Qiangxin Prescription.All the three groups were treated for 4 weeks.Traditional Chinese medicine(TCM) syndrome scores,six-minute walking test (6MWT),modified Medical Research Council (mMRC)scores,and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores were compared before and after treatment among the three groups;lung function indexes[peak expiratory flow rate (PEF),forced expiratory volume in the first second (FEV_(1)),forced vital capacity (FVC),ratio of forced expiratory volume in the first second to forced vital capacity (FEV_(1)/FVC),heart function indexes left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic dimension (LVESD),cardiac artery acceleration time (AT)],and blood gas indexes[arterial oxygen partial pressure (PaO_(2)),oxygen saturation (SaO_(2)),carbon dioxide partial pressure (PaCO_(2)),hydrogen ion concentration index (pH)]before and after treatment were compared among the three groups;the clinical effects and the incidence of adverse reactions in the three groups were evaluated.Results:The total effective rate was 97.67%in the combination group,higher than that of 81.40%in the acupuncture group and 76.74%in the Chinese medicine group (P<0.05).After treatment,mMRC,MLHFQ scores,TCM syndrome scores,LVEDD,LVESD,and PaCO_(2)in the three groups were decreased when compared with those before treatment (P<0.05),and the above indexes in the combination group were lower than those in the acupuncture group and the Chinese medicine group (P<0.05).After treatment,6MWT,PEF,FEV_(1),FVC,LVEF,PaO_(2),SV、SaO_(2),and FEV_(1)/FVC in the three groups and the values of p H in the combination group were increased when compared with those before treatment (P<0.05),and the above indexes in the combination group were higher than those in the acupuncture group and the Chinese medicine group (P<0.05).No adverse reaction occurred in the two groups.Conclusion:Acupuncture combined with Bufei Qiangxin Prescription for pulmonary heart disease with heart-lung qi deficiency syndrome can improve cardiopulmonary function and blood gas indexes and enhance the quality of life,with high safety.