血府逐瘀汤合五苓散加减对老年舒张性心力衰竭(气虚水停夹瘀证)的临床疗效

Observation of the clinical efficacy of Xuefuzhuyu Decoction and Wuling Powder in the treatment of diastolic heart failure in the elderly patients(Qi deficiency and water stasis pattern)

目的探讨血府逐瘀汤合五苓散加减对老年舒张性心力衰竭(DHF)(气虚水停夹瘀证)的临床疗效。方法筛选浙江省温州市中医院收治的DHF患者114例,对照组57例和联合组57例。对照组给予常规西药,联合组在对照组的基础上给药血府逐瘀汤合五苓散,2组均连续治疗4周。评估治疗后临床疗效,并比较治疗前后中医证候积分(TCMSS)、超声心动图指标和生化指标及步行试验,统计治疗期间不良反应发生情况。结果治疗2周后,联合组主症、次症及总分较对照组降低(t主症=2.782,P=0.006;t次症=2.909,P=0.004;t总分=3.129,P=0.002),且治疗4周后各项分值均低于治疗2周后,差异有统计学意义(t主症=4.977,P<0.001;t次症=12.304,P<0.001;t总分=8.040,P<0.001)。联合组临床总有效率较对照组高(89.5%与73.7%,χ^(2)=4.728,P<0.05)。治疗后,联合组左心房容积指数(LAVI)、左心室质量指数(LVMI)和二尖瓣血流频谱波峰值速度与二尖瓣环舒张早期波峰值速度之比(E/E′)比值较对照组下降(t=5.163,P<0.001;t=3.408、P=0.001;t=6.163,P<0.001),舒张早期和晚期二尖瓣血流峰值的比值(E/A)则较对照组上升(t=6.023,P<0.001)。治疗后,联合组血浆氨基末端脑钠肽前体(NT-proBNP)水平较对照组降低(t=16.411,P<0.001),联合组6 min步行试验(6MWT)距离较对照组增加(t=6.975,P<0.001)。联合组和对照组不良反应发生率比较,差异无统计学意义(12.3%与8.8%,χ2=0.373,P>0.05)。结论血府逐瘀汤合五苓散治疗老年气虚水停夹瘀证DHF可提高疗效,改善临床症状和心功能,有效逆转心脏重构,且安全性良好。

Objective To investigate the clinical efficacy of Xuefuzhuyu Decoction and Wuling Powder in the treatment of diastolic heart failure(DHF)in the elderly patients.Methods A total of 114 DHF patients admitted to Wenzhou Traditional Chinese Medicine Hospital were screened,including the control group(n=57)and the combination group(n=57).The control group was given conventional western medicine,and the combined group was given Xuefuzhuyu Decoction and Wuling Powder on the basis of the control group,and the both groups were treated continuously for 4 weeks.The clinical effect after treatment was evaluated.And the TCM syndrome score,echocardiogram index,biochemical index and walking test before and after treatment were compared to calculate the occurrence of adverse reactions during treatment.Results After 2 weeks of treatment,the main disease,secondary disease and total score of the combined group were lower than those of the control group(t major disease=2.782,P=0.006;t secondary disease=2.909,P=0.004;t total score=3.129,P=0.002);and all scores after 4 weeks of treatment were lower than after treatment 2,the difference was statistically significant(t major disease=4.977,P<0.001;t secondary disease=12.304,P<0.001;t total score=8.040,P<0.001).The total effective rate of the combined group was higher than that of the control group(89.5%vs 73.7%,χ^(2)=4.728,P<0.05).After treatment,the ratio of left atrial volume index(LAVI),left ventricular mass index(LVMI)and mitral flow spectrum peak velocity to mitral ring peak velocity at early di-astolic stage(E/E')in combination group was lower than that in control group(t=5.163,P<0.001;t=3.408,P=0.001;t=6.163,P<0.001).The ratio of mitral peak blood flow(E/A)in early and late diastolic periods was higher than that in control group(t=6.023,P<0.001).After treatment,the level of plasma NT-proBNP in combination group was lower than that in control group(t=16.411,P<0.001),and the distance of 6 min walking test(6MWT)in combination group was higher than that in control group(t=6.975,P<0.001).There was no significant difference in the incidence of adverse reactions between the combined group and the control group(12.3%vs 8.8%,χ^(2)=0.373,P>0.05).Conclusion Xuefuzhuyu Decoction combined with Wuling Powder can significantly improve the curative effect,improve clinical symptoms and cardiac function,and effectively reverse cardiac remodeling in the treatment of Syndrome of Qi deficiency and water stopping blocking blood stasis DHF with good safety.