自拟益气活血方联合针灸治疗冠心病慢性心力衰竭临床观察

Clinical Observation on the Treatment of Heart Function and Inflammatory Factors in Chr onic Heart Failure of Coronary Heart Disease with Self made Yiqi Wenyang Recipe and Acupuncture and Moxibustion

目的:研究自拟益气活血方联合针灸治疗冠心病慢性心力衰竭(Congestive Hearts Failure,CHF),对心功能及炎性因子的影响。方法:于太和县中医院心血管科内,选择2022年10月—2023年10月入院的CHF患者,采用随机数字表法将研究对象分成观察组和治疗组,每组30人。两组患者均接受CHF的西药常规治疗。治疗组在对照组基础上进行了干预,服用自拟益气活血方剂,并进行针灸治疗,比较两组患者治疗前后超声心动图左室射血分数(LVEF)、每搏输出量(SV)、左室舒张末期内径(LVDD)、血清超敏C反应蛋白(hs-CRP)、血清TNF-α、血清白细胞介素6(IL-6)、脑钠肽含量(BNP)、心功能疗效评价标准、中医证候疗效评价标准、6min步行实验(6MWT)、生活质量评价。结果:在治疗前,两组患者在各项评价指标上的差异均不显著(P>0.05)。但在治疗后,观察到两组患者进行6min步行实验时存在显著差异(P<0.05)。对照组患者在心脏彩超指标(左室射血分数、左室舒张末期内径、脑钠肽含量、6min步行实验)上表现出显著改善(P<0.05),而观察组在心脏彩超指标方面也有显著进展(P<0.05),但在每搏输出量上的变化没有显著差异(P>0.05)。治疗后,两组患者的血清炎性因子水平(血清超敏C反应蛋白、TNF-α、IL-6)和生活质量评分在比较时呈现显著差异(P<0.05)。对照组患者的IL-6水平比较显示显著差异(P<0.05),但血清超敏C反应蛋白和TNF-α比较显示并不具备统计学意义(P>0.05)。观察组患者在血清超敏C反应蛋白、TNF-α、IL-6的指标变化均显示具有显著差异(P<0.05),治疗后两组心功能、中医证候疗效比较具有显著差异(P<0.05)。结论:自拟益气温阳方联合针灸疗法在治疗CHF时,疗效是明显优于单纯使用西药治疗。这种综合治疗方案能够有效改善患者的心功能,降低炎性因子水平,延缓疾病进展,且安全性良好。

Objective:To study the clinical observation of self-prescribed Yiqi Huoxue prescription combined with acupuncture in the treatment of cardiac function and inflammatory factors in chronic heart failure(CHF)due to coronary heart disease.Methods:CHF patients admitted from October 2022 to October 2023 were selected in the Department of Cardiology of Taihe County Hospital of Traditional Chinese Medicine.They were grouped according to the syndrome differentiation of yang qi deficiency.The subjects were divided into an observation group and a treatment group by random number table method,with 30 people in each group.Both groups of patients received conventional western medicine treatment for CHF.The treatment group was intervened on the basis of the control group,taking selfmade prescriptions for invigorating qi and activating blood circulation,and receiving acupuncture treatment.The left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular end-diastolic diameter(LVDD),serum highsensitivity C-reactive protein(hs-CRP),serum TNF-α,serum interleukin-6(IL-6),brain natriuretic peptide(BNP),cardiac function efficacy evaluation criteria,TCM syndrome efficacy evaluation criteria,6-min walking test(6MWT),and quality of life evaluation were compared between the two groups before and after treatment.Results:Before treatment,there were no significant differences in the two groups in various evaluation indicators(P>0.05).However,after treatment,significant differences were observed between the two groups in the 6-min walking test(P<0.05).The control group showed significant improvement in cardiac ultrasound indices(left ventricular ejection fraction,left ventricular end-diastolic diameter,brain natriuretic peptide content,and 6-min walking test)(P<0.05),while the observation group also showed significant progress in cardiac ultrasound indices(P<0.05),but there was no significant difference in stroke volume(P>0.05).After treatment,the serum inflammatory factor levels(serum high-sensitivity C-reactive protein,TNF-α,IL-6)and quality of life scores of the two groups of patients showed significant differences when compared(P<0.05).The IL-6 level of the control group showed a significant difference(P<0.05),but the comparison of serum high-sensitivity C-reactive protein and TNF-αshowed no statistical significance(P>0.05).The changes in serum high-sensitivity C-reactive protein,TNF-α,and IL-6 in the observation group showed significant differences(P<0.05).After treatment,the two groups showed significant differences in cardiac function and TCM syndrome efficacy(P<0.05).Conclusion:The efficacy of self-prescribed Qi-invigorating and Yang-warming prescription combined with acupuncture therapy in the treatment of CHF is significantly better than that of Western medicine alone.This comprehensive treatment program can effectively improve the patient’s cardiac function,reduce the level of inflammatory factors,delay the progression of the disease,and has good safety.