基于“心与小肠相表里”评价温阳通络安肠方治疗慢性心力衰竭合并肠功能障碍的临床疗效

Clinical efficacy evaluation of Wenyang Tongluo Anchang Formula in the treatment of chronic heart failure combined with intestinal dysfunction based on'interior and exterior of heartandintestine'

目的:评价温阳通络安肠方联合西医治疗慢性心力衰竭(CHF)合并肠功能障碍(ID)的疗效及安全性。方法:将2022年10月至2023年9月就诊于山东中医药大学附属医院的72例CHF合并ID心脾阳虚、痰瘀阻络证患者随机分为2组:对照组(36例)予西医常规治疗,试验组(36例)在西医常规治疗基础上加用温阳通络安肠方浓煎口服,疗程均为8周。治疗前后观察患者中医证候积分、堪萨斯城心肌病患者生活质量量表(KCCQ)、急性胃肠损伤(AGI)分级和六分钟步行试验(6MWT)变化情况。检测超声心动图、N末端脑钠肽前体(NT-Pro BNP)、二胺氧化酶(DAO)、脂多糖(LPS)以及安全性指标;统计3个月内再入院率。结果:试验组总有效率[87.88%(29/33)显著优于对照组][65.63%(21/32)](P<0.05)。与对照组比较,治疗后试验组患者左心室舒张末期内径(LVEDD)、NT-ProBNP、DAO及LPS显著降低(P<0.05,P<0.01),6MWT距离显著提高(P<0.05)。试验组3个月内再入院率显著低于对照组(P<0.05)。两组患者在治疗期间均未出现明显的不良反应。结论:温阳通络安肠方治疗CHF合并ID疗效显著,能够改善心功能和肠功能,提高患者生活质量,降低再入院率,具有较好的安全性。

Objective:To assess the therapeutic efficacy and safety of Wenyang Tongluo Anchang Formula(WTAF)in combination with Western medicine for the management of chronic heart failure(CHF)combined with intestinal dysfunction(ID).Methods:A total of 72 patients with CHF combined with ID who presented with heart-spleen-yang deficiency and phlegm-stasisobstruction syndrome received treatment in at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2022 to September 2023 were randomly divided into two groups:control group(36 patients)receiving conventional Western medicine treatment,and experimental group(36 patients)receiving oral administration of WTAF for 8 weeks.Traditional Chinese medicine syndrome score scale,KCCQ scores,AGI grade,and 6MWT results were assessed before and after treatment.Echocardiography measurements along with concentrations of serum NT-Pro BNP,DAO,LPS as well as safety indexes were determined.The readmission rate within a 3-month period was recorded.Results:The overall effective rate in the experimental group[87.88%(29/33)]was significantly higher than that in the control group[65.63%(21/32)](P<0.05).Following treatment,compared to the control group,the experimental group exhibited significantly lower LVEDD,NT-Pro BNP levels along with DAO and LPS concentrations(P<0.05,P<0.01)while showing increased distance covered during the 6MWT(P<0.05).Moreover,the experimental group had a significantly lower readmission rate within three months compared to the control group(P<0.05).No significant adverse reactions occurred in either groups during the treatment period.Conclusion:WTAF demonstrates remarkable efficacy in treating CHF combined with ID by improving cardiac function as well as intestinal function,resulting in enhanced quality of life,reduced readmission rates,and excellent safety profile.