益气通络化痰方联合达格列净治疗急性心肌梗死后心力衰竭疗效及对血清BNP、cTnl水平的影响

Effect of Yiqi Tongluo Huatan Recipe combined with dapagliflozin in the treatment of heart failure after acute myocardial infarction and the impact on serum BNP and cTnl levels

目的:观察益气通络化痰方联合达格列净治疗急性心肌梗死后心力衰竭的疗效及对心功能、血清脑钠肽(BNP)、心肌肌钙蛋白l(cTnl)水平的影响,以期为临床治疗提供可靠参考。方法:按照纳入和排除标准选用因急性心肌梗死入院时或住院期间出现心力衰竭的104例患者为研究对象,采集时间为2022年9月~2023年9月,按照随机数字表法将上述患者随机分为两组,即实验组与对照组,每组52例,其中对照组患者标准心力衰竭治疗(达格列净),实验组在标准治疗上加用益气通络化痰方。比较2组疗效,对其中医证候积分、心功能指标[心排出量(CO)、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)]、血清指标[心房钠尿肽(ANP)、BNP、cTnl]的变化,并记录两组用药安全性及预后情况。结果:实验组总有效率为96.15%,而对照组总有效率为82.69%,两组相比差异有统计学意义( P <0.05);治疗后两组中医证候各项积分均较治疗前有不同程度的升高或降低( P <0.05),且治疗后相比,实验组LVESD、ANP、BNP、cTnl低于对照组( P <0.05),CO、LVEF、LVEDD高于对照组( P <0.05);实验组不良反应总发生率及因心衰再住院率分别为11.54%、5.77%,对照组分别为19.23%、19.23%,两组不良反应总发生率比较差异无统计学意义( P >0.05),但因心衰再住院率相比,差异有统计学意义( P <0.05)。结论:中医益气通络化痰方药联合达格列净用于急性心肌梗死后心力衰竭患者中疗效确切,不仅能有效恢复患者心功能作用,改善心室重构,还能调节ANP、BNP、cTnl等水平,抑制疾病进展,且预后良好,具有较大的临床应用价值。

Objective: To observe the effect of Yiqi Tongluo Huatan Recipe combined with dapagliflozin in the treatment of heart failure after acute myocardial infarction, and the impact on cardiac function, serum brain natriuretic peptide(BNP) and cardiac troponin I(cTnI) levels, so as to provide reliable reference for clinical treatment. Methods: According to the inclusion and exclusion criteria, 104patients with heart failure due to acute myocardial infarction who were admitted to the hospital from September 2022 to September 2023 were selected as the study subjects. They were divided into the treatment group and the control group using a random number table, with 52 patients in each group. The control group was treated with dapagliflozin, and treatment group was treated with Yiqi Tongluo Huatan Recipe combined with dapagliflozin. Therapeutic effects, and the changes in traditional Chinese medicine syndrome scores, cardiac function indicators [cardiac output(CO), left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD)] and serum indicators [atrial natriuretic peptide(ANP), BNP and cTnI] were compared between the two groups. Medication safety and prognosis of the two groups were evaluated. Results: The total effective rates in the treatment group and the control group were 96.15% and 82.69%, with a statistically significant difference between the groups( P <0.05). After treatment, traditional Chinese medicine syndrome scores of both groups were improved( P <0.05). Compared with the control group, LVESD, ANP, BNP and cTnI in the treatment group were lower. CO, LVEF and LVEDD in the treatment group were higher( P <0.05). The total incidence of adverse reactions and readmission rate due to heart failure in the treatment group were 11.54% and 5.77.%. Compared with those in the control group(19.23% and 19.23%), there was no statistically significant difference in the total incidence of adverse reactions, but the difference in readmission rate due to heart failure was statistically significant( P <0.05). Conclusion: Yiqi Tongluo Huatan Recipe combined with dapagliflozin is effective in the treatment of patients with heart failure after acute myocardial infarction. It can not only effectively restore the patients’ cardiac function and improve ventricular remodeling, but also regulate the levels of ANP, BNP and cTnI, and inhibit disease progression, with a good prognosis.