自拟复脉定悸汤治疗心肌炎-室性早搏临床验案

由病毒性心肌炎所致的心律失常中最常见的为室性早搏,多为偶发室早,对患者无致命性伤害。但是频发室性早搏,近年有上升趋势,若得不到有效治疗,极易发生室性心动过速,危及生命。临床治疗无特效药物,多给予西药抗心律失常治疗,此类药物具有致心律失常、肝肾损害、肺纤维化等毒副作用,且停药后心律失常极易复发。为此,笔者通过临床观察中药,自拟复脉定悸汤治疗心肌炎室性早搏取得了良好的临床效果,且无明显不良反应。

复脉定悸汤治疗心悸证64例临床观察

心悸一证临床颇为常见,尤以老年人更易罹患,若不有效加以治疗,会直接影响患者的生存质量,甚至危及生命。近年来,笔者应用自拟复脉定悸汤治疗心悸证64例,取得较好的治疗效果,现简述如下。

定悸复脉汤及其拆方对快速型心律失常大鼠心电图及Ca^(2+)-Mg^(2+)-ATP酶的影响

目的 观察定悸复脉汤对快速型心律失常大鼠心电图及Ca^(2+)-Mg^(2+)-ATP酶的影响,并探讨其组方的合理性。方法 将健康雄性SD大鼠用定悸复脉汤及其拆方大鼠适应性喂养2周,2周后将大鼠随机分为空白、对照、维拉帕米、定悸复脉汤全方、拆方1号(去龙骨)、拆方2号(去合欢皮)6个组,每组8只。每日予以相应药物灌胃,共14 d,末次给药后,各组(除空白组)外大鼠予以氯化钙溶液尾静脉注射诱导快速型心律失常。氯化钙注射10 s后开始观察心电图变化,并记录室性心动过速(VT)、心室颤动(VF)、心脏骤停(CA)的开始时间等。大鼠心脏骤停后,取心脏组织用于Ca^(2+)-Mg^(2+)-ATP酶的检测。结果 心电图提示,各药物组造模成功率均为100%;定悸复脉汤全方及拆方组使大鼠心电图QT离散度、T波起点至T波终点的距离(To-Tp)、T波起点至波峰的距离(Tp-Te)明显缩短(P<0.05);定悸复脉汤全方及拆方组使大鼠心脏组织中Ca^(2+)-Mg^(2+)-ATP酶活性明显升高(P<0.05)。结论 定悸复脉汤及拆方1号、拆方2号均有抗快速型心律失常的作用,其机制可能与稳定心肌细胞电活动、增加心脏组织中Ca^(2+)-Mg^(2+)-ATP酶活性有关,其中龙骨、合欢皮两味药物在抗快速型心律失常机制中作用不明显。

定悸复脉汤治疗冠心病心功能不全并心律失常44例

目的:观察定悸复脉汤治疗冠心病心功能不全并心律失常的临床疗效。方法:83例患者随机分为治疗组44例,对照组39例,两组均给予扩冠、改善心肌供血、强心、利尿等治疗。治疗组在对照组治疗基础上加用定悸复脉汤,每日1剂,水煎服。两组均1月为1个疗程。结果:治疗组总有效率为86.4%,对照组为64.1%,明显优于对照组(P<0.05);治疗组症状控制有效率、早搏、房颤治疗有效率均优于对照组(P<0.05)。结论:定悸复脉汤治疗冠心病心功能不全并心律失常有较好的疗效。

定悸复脉汤抗室性心律失常的疗效观察

目的观察定悸复脉汤对室性心律失常患者的临床疗效。方法将120例室性心律失常患者随机分为治疗组和对照组各60例,两组均常规治疗,对照组给予美托洛尔治疗,治疗组加用定悸复脉汤治疗,观察患者中医症状评分及有效率。结果两组患者中医症状积分治疗后均较治疗前显著降低(P<0.05);治疗组降低程度优于对照组(P<0.05)。治疗组总有效率为90.00%,明显高于对照组的76.67%(P<0.05)。在室性早搏的疗效方面,治疗组明显优于对照组(P<0.05),室性心动过速两组疗效相当(P>0.05),治疗后,两组正常R-R间期标准差(SDNN)、每5分钟R-R间期均值的标准差(SDANN)、24h内每分钟一段正常R-R间期标准差的平均值(RMSSD)、Pnn50水平均显著升高(P<0.05),且治疗组治疗后心率变异性(HRV)各参数改善程度更明显,组间比较差异显著(P<0.05)。结论在常规治疗基础上,定悸复脉汤联合美托洛尔对室性心律失常患者疗效较佳。

定悸复脉汤治疗病态窦房结综合征48例

目的 :观察益气温阳、化痰活血类中药配伍治疗病态窦房结综合征的效果。方法 :采用定悸复脉汤 (人参、熟附子、细辛、炙麻黄、茯神、远志等 )治疗本病 48例。结果 :总有效率 83 %。提示 :本汤剂具有补益心脾 ,兼化痰降浊 。

定悸复脉汤治疗室性心律失常对患者左室重构及心率变异性的影响

目的:探讨定悸复脉汤治疗室性心律失常对患者左室重构及心率变异性的影响。方法:选择2018年6月~2020年6月收治的120例室性心律失常患者,采用随机数字表法将其分为对照组和观察组,每组60例。对照组行常规治疗,观察组在对照组基础上加用定悸复脉汤治疗,疗程为4周。对比治疗前及治疗4周后两组左室重构情况(左心室射血分数、左心室舒张末期内径、左心室收缩末期内径)及心率变异性(全程每5分钟R-R间期均值标准差、全部正常R-R间期标准差、相邻RR间期差值的均方根)。结果:治疗后,两组左心室射血分数、全程每5分钟R-R间期均值标准差、全部正常R-R间期标准差、相邻RR间期差值的均方根水平较治疗前升高,左心室舒张末期内径、左心室收缩末期内径水平较治疗前降低,且观察组左心室射血分数、全程每5分钟R-R间期均值标准差、全部正常R-R间期标准差、相邻RR间期差值的均方根水平高于对照组,左心室舒张末期内径、左心室收缩末期内径水平较对照组低,差异有统计学意义(P<0.05)。结论:定悸复脉汤治疗室性心律失常效果较好,可抑制左室重构,改善心率变异性。

Effects of Dingjifumai Decoction on Electrocardiogram and sodium potassium pump of rats with ventricular arrhythmia

Objective:To investigate the effect of Dingjifumai Decoction(DJFM)on Electrocardiogram(ECG)and sodium potassium pump in rats with ventricular arrhythmia.Methods:Forty healthy male SD rats(200±20g)were randomly divided into blank group,model group,Metoprolol group and DJFM group.Ten rats in each group were fed with normal diet and free drinking water.Each group was given gavage,and the amount of gavage in each group was calculated according to body weight.In the model group,0.001%Aconitine was injected into the tail vein at 30ug/kg.In the Metoprolol group,Metoprolol suspension was given according to the standard of 5.2mg/kg per day.In the DJFM group,DJFM was given at 17.6g/kg per day.After 2 weeks of administration,the biologic experiment system BL-420F was used to monitor the II lead ECG curve,and the ECG changes were observed and recorded.Then,the left ventricle of the rat was taken,and part of the heart tissue sodium potassium pump was detected.Results:(1)The effect of DJFM on ECG of rats with ventricular arrhythmia:After intravenous injection of aconitine,the incidence of Ventricular Premature beat(VP),Ventricular Tachycardia(VT),Ventricular Fibrillation(VF)in the model group was 100%,suggesting that the model building of rats with ventricular arrhythmia was successful.(2)VP,VT,and VF time:Compared with model group,DJFM group and Metoprolol group can significantly delay the VP,VT and VF,the difference was statistically significant(P<0.05).The effect of DJFM group and Metoprolol group on delaying the appearance of VP,VT and VF was the same,there was no significant difference(P>0.05).(3)The effect of DJFM on sodium potassium pump in rat ventricular arrhythmia heart tissues:Compared with the blank group,the sodium potassium pump value in the model group was significantly decreased,and the difference was statistically significant(P<0.05).Compared with the model group,the sodium potassium pump value of the tissues in the Metoprolol group and the DJFM group increased,and the difference was statistically significant(P<0.05).There was no significant difference in sodium potassium pump between the Metoprolol group and the DJFM group(P>0.05).Conclusion:1.The rat model of ventricular arrhythmia can be successfully prepared by intravenous injection of Aconitine.2.DJFM can prolong the occurrence time of cardiac arrhythmias caused by aconitine in rats,such as VP,VT,VF,et al.The mechanism may be related to fast Na^+channel,and it may prevent and control arrhythmias by inhibiting Na^+influx and reducing the fast response cellular self-discipline.3.DJFM can protect the myocardial tissue sodium potassium pump,which can protect the myocardial cells and improve the myocardial metabolism.