真武汤加减辅助治疗冠心病合并心力衰竭的疗效及对心功能、运动耐力的影响

Effect of Modified Zhenwu Decoction on Coronary Heart Disease Complicated with Heart Failure and Its Influence on Cardiac Function and Exercise Endurance

目的:探讨真武汤加减辅助治疗冠心病合并心力衰竭(CHF)的临床疗效及对病人心功能、运动耐力的影响。方法:选取2021年1月-2023年1月德阳市第二人民医院收治的112例冠心病合并CHF病人,采用随机数字表法分为观察组和对照组,各56例。对照组予以常规西药治疗,观察组在对照组基础上予以真武汤加减辅助治疗。比较两组临床疗效及治疗前后中医证候积分、超声心动图参数、心力衰竭指标[N末端B型利钠肽前体(NT-proBNP)、B型钠尿肽(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)]、运动耐力[6 min步行距离(6MWT)、病人的峰值摄氧量(VO_(2)peak)及无氧阈值(AT)]变化;比较两组不良反应发生率。结果:观察组治疗后总有效率为94.64%,高于对照组的80.36%(P<0.05);两组治疗后中医证候积分、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、BNP、NT-proBNP、cTnⅠ水平均低于治疗前(P<0.001),且观察组低于对照组(P<0.001);两组治疗后左室射血分数和(LVEF)、6MWT、VO_(2)peak、AT水平均高于治疗前(P<0.001),且观察组高于对照组(P<0.001);治疗期间两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:真武汤加减辅助治疗冠心病合并CHF病人,可明显提高临床疗效,改善临床症状与心功能,提升运动耐力且具有较高安全性。

Objective:To explore effect of modified Zhenwu decoction on cardiac function and exercise tolerance in patients with coronary heart disease and heart failure(CHF).Methods:A total of 112 CHF patients were selected and divided into observation group and control group by random number table method,with 56 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with modified Zhenwu decoction on the basis of control group.The clinical effect of the two groups was compared.Traditional Chinese medicine(TCM)syndrome scores,echocardiographic parameters,heart failure indexes[N-terminal B-type natriuretic peptide precursor(NT-proBNP),B-type natriuretic peptide(BNP),cardiac troponinⅠ(cTnⅠ)],and exercise endurance[6 min walking distance test(6MWT),patient's peak oxygen uptake(VO_(2)peak)and anaerobic threshold(AT)]of the two groups were compared before and after treatment.The incidence of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group was 94.64%,higher than that of the control group(80.36%)(P<0.05).The levels of TCM syndrome score,LVESV,LVEDV,BNP,NT-proBNP,and cTnⅠafter treatment were all lower than that of before treatment(P<0.001),and the observation group were lower than that in the control group(P<0.001).After treatment,LVEF,6MWT,VO_(2)peak and AT levels in both groups were higher than that of before treatment(P<0.001),and observation group were higher than that in control group(P<0.001).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion:The modified Zhenwu decoction can significantly improve clinical efficacy,improve clinical symptoms and cardiac function,enhance exercise endurance with high safety for the treatment of CHF in patients with coronary heart disease.