中医综合干预快速性心律失常伴广泛性焦虑障碍临床疗效的研究

Study on the Clinical Effect of TCM Comprehensive Intervention on Tachyarrhythmia Accompanied by Generalized Anxiety Disorder

目的:观察中医综合干预疗法对快速性心律失常伴广泛性焦虑障碍患者的临床疗效,结合该法对自主神经功能的影响探索相关作用机制。方法:选取快速性心律失常伴有GAD的患者120例,将符合纳入标准的患者根据随机双盲的方法分为对照组、中药治疗组和中医综合干预组,每组40例。对照组予常规抗心律失常西药治疗,中药治疗组予对照组治疗之上加用灵景方治疗,中医综合干预组予中药治疗组治疗之上加用心理辅导法、放松功疗法。三组疗程均为8周,观察比较治疗前后患者的中医证候疗效、Holter评估快速性心律失常事件的数量、HAMA评分量表分值、自主神经功能指标(心率变异性分析)以及血清神经递质的变化情况。结果:① 在中医症候疗效上,对照组、中药治疗组、中医综合干预组有效率分别为:75%、90%、97.5%,说明采用中医综合干预及中药治疗疗效优于对照组的西药治疗,且加用放松功的中医综合干预较中药治疗有更好的改善趋势。② 在快速性心律失常事件数量上,对照组、中药治疗组、中医综合干预组有效率分别为:50%、85%、87.5%,说明采用中医综合干预及中药治疗疗效优于对照组的西药治疗,且加用放松功的中医综合干预较中药治疗有更好的改善趋势。③ 在HAMA评分量表分值上,中医综合干预组、中药治疗组患者HAMA评分下降较对照组更显著,且中医综合干预组优于中药治疗组。④ 在自主神经功能方面,三组患者无论是SDNN、RMSSD还是SDANN、PNN50都有升高,表明交感神经张力有所降低,迷走神经张力则是有所升高,中医综合干预组、中药治疗组患者SDNN、RMSSD和PNN50升高较对照组更显著。⑤ 在血清神经递质方面,三组患者多巴胺指标下降,乙酰胆碱指标升高,说明自主神经功能稳定性及平衡性增强,中医综合干预组、中药治疗组患者升高较对照组更显著。结论:中医综合干预组能更好地改善快速性心律失常伴广泛性焦虑障碍患者的临床症状,缓解焦虑状态,稳定、平衡自主神经功能。

Objective: To observe the clinical effect of TCM Comprehensive Intervention Therapy on patients with tachyarrhythmia and generalized anxiety disorder, and explore the related mechanism combined with the effect on autonomic nervous function. Methods: 120 patients with tachyarrhythmia and GAD were selected and randomly divided into control group, TCM treatment group and TCM Comprehensive intervention group, 40 cases in each group. The control group was treated with conventional antiarrhythmic western medicine, the traditional Chinese medicine treatment group was treated with Lingjing Fang on top of the control group, and the traditional Chinese medicine comprehensive intervention group was treated with traditional Chinese medicine treatment group with psychological counseling and relaxation therapy. The treatment course of the three groups was 8 weeks. The curative effect of TCM syndrome, the number of tachyarrhythmia events assessed by Holter, HAMA score, autonomic nerve function index (heart rate variability analysis) and the changes of serum neurotransmitters were observed and compared before and after treatment. Results: ① In terms of TCM syndrome efficacy, the effective rates of the control group, TCM treatment group and TCM Comprehensive intervention group were 75%, 90% and 97.5% respectively, with statistical difference among the three groups, indicating that TCM Comprehensive Intervention and TCM treatment were better than western medicine treatment of the control group, and TCM Comprehensive Intervention with relaxation function had better improvement trend than TCM treatment. ② In terms of the number of tachyarrhythmia events, the effective rates of the control group, the traditional Chinese medicine treatment group and the traditional Chinese medicine comprehensive intervention group were 50%, 85% and 87.5%, indicating that the curative effect of the traditional Chinese medicine comprehensive intervention and traditional Chinese medicine treatment was better than that of the western medicine treatment of the control group, and the traditional Chinese medicine comprehensive intervention with relaxation function was better than that of traditional Chinese medicine treatment. ③ In terms of HAMA score, HAMA score of patients in TCM Comprehensive intervention group and TCM treatment group decreased more significantly than that in control group, and TCM Comprehensive intervention group was better than TCM treatment group. ④ In terms of autonomic nervous function, the three groups of patients, whether SDNN, RMSSD or SDANN, pNN50 were increased, indicating that the sympathetic nerve tension was decreased, while the vagus nerve tension was increased. The increase of SDNN, RMSSD and pNN50 in TCM Comprehensive intervention group and TCM treatment group was more significant than that in the control group. ⑤ In terms of serum neurotransmitters, dopamine index decreased and acetylcholine index increased in the three groups, indicating that the stability and balance of autonomic nerve function were enhanced. The increase in the comprehensive intervention group and the treatment group was more significant than that in the control group. Conclusion: TCM Comprehensive intervention group can better improve the clinical symptoms of patients with tachyarrhythmia and generalized anxiety disorder, relieve anxiety, stabilize and balance autonomic nervous function.