Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

High Density Lipoprotein Phospholipids as a Marker of Coronary Heart Disease of Shen-Yang Deficiency Syndrome

Objective: To seek a new biochemical index for diagnosis of coronary heart disease (CHD) of shen-Yang deficiency syndrom (CHD-SYD). Methods: Sixty-one patients with CHD were divided into 3 groups according to their TCM Syndrome type, 10 patients in the group without Xin-Qi deficiency (Group A), 25 in the group with Xin-Qi deficiency but without Shen-Yang deficiency (Group B) and 26 in the group both with Xin-Qi deficiency and Shen-Yang deficiency (Group C). Levels of 17-hydroxy-corticoste-roid in urine (urinary 17-OHCS) per 24 hrs, and serum level of high density lipoprotein cholesterol (HDL-C) and high density lipoprotein phospholipid (HDL-PL) in them were determined in synchrostep and compared with those in the control group of 23 healthy aged persons, urinary 17-OHCS per 24 hrs was taken as the diagnostic standard to screen a new index for diagnosis of Shen-Yang deficiency Syndrome, and preliminary appraisal to the index was made. Results: Serum HDL-PL in the CHD-SYD patients( Group C) was 616+157 mg/L, which was obviously lower than that in the patients of Group A and B. With low HDL-PL(<650 mg/L) used as the index to diagnose CHD-SYD, the sensitivity was 73%, the specificity 86% and the accuracy 80%. Conclusion: HDL-PL <650 mg/L could be adopted as an index for CHD-SYD diagnosis, which is simple and practical.

Treatment of insomnia by differentiation of yang deficiency syndrome

Insomnia has become one of the common clinical diseases.In recent years,it has been found that patients with insomnia of Yang deficiency type are more and more common,and the trend of rejuvenation gradually appears,which seriously affects the normal progress of people's life,work and study.Clinical treatment through syndrome differentiation,mainly from the heart,spleen,kidney three viscera yang deficiency,on the basis of the warm yang method to add Qianzhen tranquilizing products,and pay attention to multiple organs as diseases,add moisture,blood The qi thing,while not forgetting the psychological counseling,adjusting the body and mind,and achieving a certain clinical effect,can provide ideas for the treatment of this disease.

Preventive and therapeutic effect of long snake moxibustion on psoriasis with yang deficiency and external cold syndrome based on the theory of "treatment of winter disease in summer"

Psoriasis is a chronic inflammatory skin disease with multiple layers of silvery white scales on the surface of erythema papule as the main clinical characteristics,of which yang-deficiency external cold psoriasis is refractory,recurrent and severe in winter and mild in summer,which has a great impact on patients'physical and mental health and quality of life.Traditional Chinese medicine has unique insights in the treatment of psoriasis,both curative effect and safety,have obvious advantages.Based on the concept of"winter disease and summer treatment",long-snake moxibustion gives full play to its functions of warming the kidney,invigorating the marrow,warming the meridians,activating blood circulation and removing blood stasis,so as to restore the deficiency of Yang in patients with psoriasis with external cold syndrome,enhance disease resistance,and prevent psoriasis recurrence or aggravation in winter.Therefore,based on the theory of"winter disease and summer treatment",this paper preliminarily discusses the mechanism of long-snake moxibustion in the prevention and treatment of psoriasis with external cold syndrome of Yang deficiency,and provides new ideas and directions for the prevention and treatment of psoriasis with traditional Chinese medicine.

Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

Clinical Research of Zhenwu Decoction Combined with Tingli Dazao Xiefei Decoction in the Treatment of Chronic Heart Failure with Edema Syndrome due to Yang Deficiency

[Objectives]The paper was to investigate the clinical effects of Zhenwu Decoction combined with Tingli Dazao Xiefei Decoction in the treatment of chronic heart failure with edema syndrome due to yang deficiency.[Methods]Eighty patients with chronic heart failure were randomly divided into 2 groups(control group and treatment group),with 40 cases in each group.The patients in the control group were treated with conventional western medicine for 14 d,and the patients in the treatment group were treated with Zhenwu Decoction and Tingli Dazhao Xiefeng Decoction on the basis of the control group for 14 d.The curative effect of traditional Chinese medicine(TCM)syndrome score,left ventricular ejection fraction(LVEF),plasma N-terminal brain natruretic peptide precursor(NT-proBNP)and New York Heart Association(NYHA)functional class were compared between the two groups before and after treatment.Minnesota living with heart failure questionnaire in the principle of Chinese civilization and traditional medicine characteristics(C-MLHF)at admission and 1 month after discharge were compared between the two groups.[Results]After treatment,the total effective rate of TCM syndrome score in the treatment group was 82.50%,and that in the control group was 67.50%.The curative effect of TCM syndrome score in the treatment group was better than that in the control group(P<0.05).After treatment the LVEF in both groups was increased compared with that before treatment,and the NT-proBNP level was decreased compared with that before treatment(P<0.05),and those in the treatment group were better than those in the control group.The total effective rate of cardiac function in the treatment group was 87.50%,and that in the control group was 65.00%.The improvement of cardiac function in the treatment group was better than that in the control group(P<0.05).One month after discharge,C-MLHF scores in both groups were decreased compared with those before treatment,and that in the treatment group was lower than in the control group(P<0.05).[Conclusions]Zhenwu Decoction combined with Tingli Dazao Xiefei Decoction based on traditional western medicine treatment could improve the clinical efficacy,symptoms and quality of life of patients in the treatment of chronic heart failure with edema syndrome due to yang deficiency.

Moxibustion plus acupuncture improves the efficacy and quality of life of patients with polycystic ovary syndrome: A randomized controlled trial

Objective:To observe the effect of moxibustion combined with acupuncture on the efficacy and quality of life of spleen-kidney-yang-deficiency patients with polycystic ovary syndrome(PCOS).Materials and Methods:A total of 90 patients with PCOS of spleen-kidney yang deficiency type from January 2020 to March 2021 were selected and randomly divided into three groups,30 patients each in the moxibustion group,acupuncture group,and moxibustion combined with acupuncture group(combined group).The changes of body mass index(BMI),waist-to-hip ratio(WHR),fasting insulin(FINS),fasting plasma glucose(FPG),homeostasis model assessment-insulin resistance index(HOMA-IR),follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),triglycerides(TG),total cholesterol(TC),traditional Chinese medicine(TCM)clinical symptom score,efficacy,and quality of life score in the three groups were observed before and 3 months after treatment.Results:After treatment,(1)compared with the moxibustion and acupuncture groups,the combined group was more effective in reducing BMI(F=5.274,P<0.05)and WHR(F=8.246,P<0.05)in PCOS patients;(2)FINS,FPG,and HOMA-IR were reduced in all three groups,and the reduction in these three indicators was more pronounced in combined group(FINS:F=5.637,P<0.05,FPG:F=4.915,P<0.05,HOMA-IR:F=3.817,P<0.05);(3)The FSH,LH,and T levels of patients in the combined group were better than those in the remaining two groups(FSH:F=4,163,P<0.05,LH:F=5.098,P<0.05,T:F=7.038,P<0.05);(4)The TG and TC of patients in the combined group were lower than those in the remaining two groups(TG:F=4.806,P<0.05,TC:F=3.828,P<0.05);(5)The TCM clinical symptom score of the combined group was significantly lower than those of the moxibustion and acupuncture groups(F=4.547,P<0.05);(6)The quality of life of patients in the combined group improved more significantly than the moxibustion and acupuncture groups(F=6.239,P<0.05);(7)The total effective rate of the combined group was higher than that of the moxibustion and acupuncture groups(χ2=6.947,P=0.031).Conclusion:The combination of moxibustion and acupuncture can effectively reduce the BMI and WHR of PCOS patients,improve the endocrine function,sex hormone level,TCM symptoms and quality of life of patients,and has significant efficacy and high safety,which is worthy of wide clinical application.

加味苓桂术甘汤对阳虚水停证慢性心力衰竭患者TGF-β1、TNF-α、NT-proBNP及心室重构的影响

目的探究加味苓桂术甘汤对阳虚水停证慢性心力衰竭患者TGF-β1、TNF-α、NT-proBNP及心室重构的影响。方法将2017年12月至2020年11月六安市中医院收治的98例阳虚水停证慢性心力衰竭患者纳入本研究,随机分为两组,各49例。对照组行西医常规治疗,观察组在此基础上行加味苓桂术甘汤口服治疗,治疗6个月后检测心功能,血清肿瘤坏死因子(tumor necrosis factor,TNF)-α、转化生长因子(transforming growth factor,TGF)-β1、同型半胱氨酸(homocysteine,Hcy)、氨基末端脑钠素原(amminoterminal brain sodium minogen,NT-proBNP)水平并比较临床疗效。结果两组患者治疗后各项指标均较治疗前明显改善(P<0.05)。其中观察组患者治疗后血清TNF-α、TGF-β1、Hcy、NT-proBNP、左室舒张末期内径、左室收缩末期内径和中医证候总积分低于对照组,左室射血分数、6 min步行距离和临床疗效高于对照组(P<0.05)。结论加味苓桂术甘汤治疗阳虚水停证慢性心力衰竭可减轻患者炎症反应,预防心室重构,提高临床疗效。

畅尔舒方联合针刺治疗脾肾阳虚型便秘临床研究

目的:观察畅尔舒方联合针刺治疗脾肾阳虚型便秘的疗效。方法:选取70例脾肾阳虚型便秘患者,按随机数字表法分为治疗组及对照组各35例。治疗组给予畅尔舒方联合针刺治疗,对照组给予乳果糖口服溶液治疗。比较2组临床疗效,比较2组治疗前后便秘症状积分、中医证候积分、生活质量评分标准(PAC-QOL)、血清胃泌素(GAS)、胃动素(MTL)、P物质(SP)、血管活性肽(VIP)、一氧化氮(NO)水平的变化。结果:治疗后,2组便秘状积分及中医证候积分均较治疗前下降(P<0.05),治疗组上述2项积分均低于对照组(P<0.05)。治疗后,2组血清SP、GAS、MTL水平均较治疗前升高(P<0.05),NO、VIP水平均较治疗前下降(P<0.05);治疗组血清SP、GAS、MTL水平均高于对照组(P<0.05),NO、VIP水平均低于对照组(P<0.05)。治疗后,2组PAC-QOL评分均较治疗前下降,治疗组PAC-QOL评分低于对照组(P<0.05)。治疗组临床疗效总有效率为91.43%,对照组为68.57%,2组比较,差异有统计学意义(P<0.05)。结论:畅尔舒方联合针刺治疗脾肾阳虚型便秘能较好地改善患者临床症状,提高生活质量。

300 CASES OF MENOPAUSAL SYNDROME TREATED BY ACUPUNCTURE

Caused by hypo-ovarianism, menopausal syndrome usually occurs in women aged from 45-55 years. With high incidence and various symptoms, the disease often severely jeopardize the health of the women. The authors had treated 300 cases of menopausal syndrome by acupuncture and obtained a good result.

慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究

目的探索慢性心力衰竭(CHF)气虚血瘀证潜在亚组人群,为心力衰竭的中医精准辨治提供客观依据。方法收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标,利用R和Python软件进行K-mediods聚类算法分析,以轮廓系数确定最佳的聚类数目。组间比较,连续变量采用Kruskal-Wallis检验,分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。结果CHF气虚血瘀证患者被聚类为3组,组间比较发现,气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体(NT-proBNP)、红细胞比容、尿素氮4个临床指标差异具有统计学意义(P<0.05)。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低;第2组人群以颈脉怒张发生频率较其他组高为特征,且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势,血小板有偏低的趋势;第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征,伴随尿素氮增高、红细胞比容降低。结论CHF气虚血瘀证潜在3种亚型,分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。

参杞强精颗粒对慢性疲劳综合征脾肾阳虚证大鼠免疫调节作用研究

目的:探讨参杞强精颗粒对慢性疲劳综合征(CFS)脾肾阳虚证模型大鼠的影响以及免疫调节作用。方法:将50只无特定病原体(SPF)级健康雄性斯泼累格·多雷(SD)大鼠随机分为正常对照组,模型对照组,参杞强精颗粒高剂量组、中剂量组、低剂量组,采用游泳力竭实验造成大鼠体力疲劳,慢性束缚应激造成大鼠心理疲劳,同时给予番泻叶煎煮液灌胃造成脾肾阳虚证候,构建CFS脾肾阳虚证大鼠模型,造模成功后分别按照各组剂量灌胃,连续给药21 d后,测定各组大鼠的胸腺和脾脏指数,酶联免疫吸附试验(ELISA)检测血清免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)浓度以及细胞因子白细胞介素2(IL-2)、白细胞介素6(IL-6)和γ干扰素(IFN-γ)含量,MTT法检测脾脏T、B淋巴细胞增殖能力,流式细胞法检测各组大鼠外周血T淋巴细胞亚群分布情况。结果:行为学结果显示,模型大鼠的体质量增长缓慢,精神萎靡,摄食水量减少,活动减少,便质稀软,力竭游泳时间减少,悬尾静止时间增加。药物干预后,与模型组比较,各给药组大鼠精神状态、体质量、摄食水量均显著改善,力竭游泳时间增加、悬尾静止时间减少(P<0.01或P<0.05);参杞强精颗粒各剂量组能显著提升大鼠胸腺和脾脏指数,提高IgG、Ig M、IgA浓度和IL-2、IL-6、IFN-γ的含量,显著提高脾脏T、B淋巴细胞增殖能力,也能提高CD3+、CD4+T淋巴细胞百分率和CD4+/CD8+T比值,降低CD8+T淋巴细胞百分率,差异有统计学意义(P<0.01或P<0.05)。结论:参杞强精颗粒能显著改善慢性疲劳综合征脾肾阳虚证大鼠免疫功能,缓解疲劳症状,且具有很好的免疫调节作用。

参附注射液治疗心肾阳虚型慢性心力衰竭急性加重的临床研究

目的:观察参附注射液治疗心肾阳虚型慢性心力衰竭急性加重的临床疗效。方法:选取2023年10月—2024年1月在安徽中医药大学第一附属医院住院的慢性心力衰竭急性加重病人60例,按照随机数字表法分为观察组与对照组,各30例。观察组给予参附注射液加西医常规治疗,对照组仅给予西医常规治疗,比较两组治疗前后血浆氨基末端B型钠尿肽前体(NT-proBNP)、超敏肌钙蛋白I(hs-cTnI)、6 min步行试验(6MWT)、明尼苏达州心力衰竭生活质量问卷评分(MLHFQ)、中医证候积分及纽约心脏病协会(NYHA)心功能分级。结果:与治疗前比较,两组治疗后NT-proBNP、hs-cTnI水平降低(P<0.05),两组治疗后NT-proBNP、hs-cTnI水平比较差异均无统计学意义(P>0.05);与治疗前比较,两组治疗后6MWT、MLHFQ评分均明显改善(P<0.05),观察组改善程度优于对照组(P<0.05);两组治疗后各单项中医证候积分低于治疗前(P<0.05),观察组治疗后喘促气短、倦怠乏力、畏寒肢冷及言语声低评分低于对照组(P<0.05)。观察组总有效率为96.7%,对照组为80.0%,两组比较差异有统计学意义(P<0.05)。结论:参附注射液联合西药常规治疗可改善心肾阳虚型慢性心力衰竭急性加重病人心功能,提高病人运动耐量和生活质量。

袁兴石验方济川延寿膏治疗老年功能性便秘脾肾阳虚证的临床效果研究

目的探究袁兴石验方济川延寿膏治疗老年功能性便秘脾肾阳虚证的临床效果。方法选择70例老年功能性便秘脾肾阳虚证患者作为研究对象,根据随机数字表法分为对照组与观察组,各35例。观察组给予袁兴石验方济川延寿膏治疗,对照组给予乳果糖口服溶液治疗。比较两组治疗效果、中医证候积分、生活质量及不良反应发生情况。结果观察组患者治疗总有效率97.14%明显高于对照组的80.00%(P<0.05)。治疗后观察组患者大便干、排便困难、脉沉主症中医证候积分及小便清长、舌淡苔白、腹中痛冷次症中医证候积分均明显低于对照组(P<0.05)。治疗后,两组患者的生活质量评分均高于治疗前,且观察组患者的生活质量评分(88.14±5.62)分显著高于对照组的(74.05±4.37)分(P<0.05)。观察组与对照组不良反应比较(2.86%VS 5.71%)无差异(P>0.05)。结论在老年功能性便秘脾肾阳虚证治疗中,袁兴石验方济川延寿膏可以有效提高治疗效果,且患者中医证候积分改善显著,生活质量明显提高,用药安全可靠,有显著应用价值,值得推广应用。

浅谈颜红教授温阳法治疗抑郁症低动力症状

“低动力”为抑郁症的常见特征,表现为精力减退、疲劳感、反应迟缓、性欲减退等,严重影响患者的生活、工作、社交能力。作者随第七批全国老中医药专家学术经验继承老师、天津市名中医颜红教授学习,发现临床上此类症状可归为阳虚证,由于患者长期七情内伤、思虑过度,使情志失遂,进而导致阳气不振、心神失养。治以温阳之法,振奋阳气,可有效改善抑郁症患者低动力症状,值得临床推广使用。

破格救心汤加减对心力衰竭合并室性心律失常患者生物标志物和近期不良心血管事件的影响

目的评价破格救心汤加减对心力衰竭合并室性心律失常患者生物标志物和近期不良心血管事件的影响。方法将88例心力衰竭合并室性心律失常患者随机分为对照组与观察组各44例。对照组进行抗心衰治疗,并口服美托洛尔缓释片和盐酸胺碘酮胶囊。观察组在对照组治疗的基础上口服破格救心汤加减治疗。比较治疗前后左室射血分数(LVEF)、每搏心输出量(SV)、左心室收缩末期内径(LVESD)、正常窦性心搏间期标准差(SDNN)、校正TP-Te间期(TP-Tec)每5分钟窦性心搏间期平均值的标准差(SDANN)、校正QT间期(QTc)和正常相邻R-R间期差值>50ms的百分比(Pnn50%);检测N末端B型利钠肽原(NT-proBNP)、生长分化因子15(GDF-15)可溶性肿瘤生成抑制因子-2(sST-2)和半乳糖凝集素-3(GAL-3)水平;记录近期不良心血管事件;进行治疗前后阳气亏虚血瘀证评分;比较心功能疗效和室性心律失常疗效。结果治疗后,观察组心功能疗效和室性心律失常疗效的总有效率均高于对照组(P<0.05);两组患者LVEF、SV升高,LVESD降低(P<0.05),均以观察组更明显(P<0.05);两组患者NT-proBNP、GAL-3、GDF-15和sST2水平下降(P<0.05),且观察组低于对照组(P<0.05);两组患者主要症状评分及阳气亏虚血瘀证总积分降低(P<0.05),且观察组低于对照组(P<0.05);两组患者QTc、TP-Tec减少,SDNN、SDANN和Pnn50%增加(P<0.05),且观察组改善明显(P<0.05)。观察组近期不良心血管事件累积发生率低于对照组(P<0.05)。结论破格救心汤加减方联合西医常规疗法治疗心力衰竭合并室性心律失常,能够抑制心室重构,提高心功能,减少不良心血管事件发生,临床疗效优于单纯的西医治疗。

中药滋阴补阳方剂治疗肾气亏虚型多囊卵巢综合征不孕症对患者超声动态多参数的影响评价

目的评价中药滋阴补阳方剂治疗肾气亏虚型多囊卵巢综合征不孕症对患者超声动态多参数的影响。方法选取2022年1月至2023年1月江西省妇幼保健院收治的80例肾气亏虚型多囊卵巢综合征患者作为研究对象,按照随机数字法将其分为观察组(40例)与对照组(40例)。对照组采用枸橼酸氯米芬片治疗,观察组在对照组方法的基础上联合中药滋阴补阳方剂治疗。比较两组患者的治疗效果、卵泡发育情况、激素水平、子宫动脉血流灌注情况及子宫内膜厚度。结果观察组的有效率高于对照组,差异有统计学意义(P<0.05);观察组治疗后的卵泡及优势卵泡数目多于对照组,差异有统计学意义(P<0.05);观察组治疗后的黄体生成素(LH)、促卵泡激素(FSH)、睾酮(T)均低于对照组,雌二醇(E2)高于对照组,差异有统计学意义(P<0.05);观察组治疗后的搏动指数(PI)、阻力指数(RI)均低于对照组,差异有统计学意义(P<0.05);观察组治疗后的子宫内膜厚度高于对照组,差异有统计学意义(P<0.05)。结论将中药滋阴补阳方剂应用于肾气亏虚型多囊卵巢综合征不孕症患者治疗中,可积极改善患者的激素水平及子宫动脉血流灌注情况,同时能够促进卵泡发育,增加子宫内膜厚度,改善症状,值得推广。

复心合剂治疗阳虚水泛型心肌梗死后心力衰竭的前瞻性临床研究

目的探讨复心合剂治疗阳虚水泛型心肌梗死后心衰患者临床疗效及对血清心肌损伤、心室重构相关指标的影响。方法将92例阳虚水泛型心肌梗死后心衰患者随机分为观察组与对照组各46例。对照组给予西医基础治疗,观察组在对照组治疗基础上加服复心合剂,治疗前后评估2组患者的中医证候积分,超声心动图指标[左心室射血分数(LVEF)、左心室Tei指数、每搏输出量(SV)],血清心肌损伤指标[血清N末端B型利钠肽原(NT-ProBNP)水平、血清高敏心肌肌钙蛋白I(hs-cTnI)水平、肌酸激酶同工酶(CK-MB)水平],血清心室重构指标[缺氧诱导因子1α(HIF-1α)、可溶性生长刺激表达基因2蛋白(sST2)、血管紧张素Ⅱ(AngⅡ)],明尼苏达州心功能不全生命质量量表(MLHFQ)变化情况,治疗后随访1年观察2组患者主要不良心血管事件发生情况。结果治疗后,2组中医证候积分均显著降低(P<0.01),观察组优于对照组(P<0.05,P<0.01)观察组中医临床总有效率优于对照组(P<0.05);2组患者血清超声心动图指标,心肌损伤、心室重构指标及MLHFQ评分均显著降低(P<0.01),观察组优于对照组(P<0.01)。随访期间,观察组治疗后全因死亡率、恶性心律失常率、急性心力衰竭率均显著低于对照组(P<0.05,P<0.01)。结论复心合剂治疗阳虚水泛型心肌梗死后心衰患者临床疗效显著,疗效机制可能与其减轻心肌损伤、抑制心室重构有关。

参芪真武汤加味治疗原发性肾病综合征疗效及对患者肾功能、微炎状态、凝血纤溶功能的影响

目的:探讨参芪真武汤加味治疗原发性肾病综合征效果及对患者肾功能、微炎状态、凝血纤溶功能的影响。方法:选取脾肾阳虚证原发性肾病综合征患者110例,根据治疗方案分为两组,观察组和对照组各55例。对照组给予常规对症治疗,观察组在对照组基础上给予参芪真武汤加味治疗,两组均连续治疗8周。比较两组治疗总有效率及不良反应发生情况,同时观察治疗前后中医证候积分、肾功能[24 h尿蛋白定量(24 hTP)、血白蛋白(ALB)、尿素氮(BUN)、血清肌酐(Cr)]、微炎状态[高敏-C反应蛋白(hs-CRP)、白细胞介素-21(IL-21)、白细胞介素-13(IL-13)]、凝血纤溶功能[纤维蛋白原(FIB)、D-二聚体(D-D)]变化情况。结果:观察组临床总有效率为90.91%,高于对照组的76.36%(P<0.05)。经治疗,观察组浮肿、面色白、畏寒肢冷、腰膝酸软、恶寒喜暖各项中医证候积分较对照组低(均P<0.05);观察组ALB水平较对照组高,24 hTP、BUN、Cr较对照组低(均P<0.05);观察组IL-13水平较对照组高,hs-CRP、IL-21水平较对照组低(均P<0.05)。两组FIB、D-D水平低于治疗前,且观察组低于对照组(均P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:参芪真武汤加味治疗原发性肾病综合征脾肾阳虚证可提高临床效果,降低中医证候积分,促进肾功能和凝血纤溶功能改善,减轻机体微炎症状态,且安全性佳。

刘小斌运用麻附细辛汤合甘草干姜汤加减治疗先天性肌无力综合征经验

先天性肌无力综合征(congenital myasthenia syndrome,CMS)为临床罕见的遗传性肌病。CMS患者虽与重症肌无力患者的症状相似,均有肌无力、易疲劳等症,但CMS为先天禀赋不足疾病,以肾元亏损为本,而重症肌无力为后天失养疾病,故在辨治侧重上有所区别。刘小斌教授认为,CMS的中医病机特点为“先天不足,肾元亏损”“脾胃虚损,五脏相关”,属于中医“痿病”范畴;根据患者不易出汗、舌淡红苔白、脉细的病症表现,可辨为脾肾阳虚兼寒邪束表证(少阴太阴兼太阳证);治疗可采用温阳补肾、健脾益损法,常以麻附细辛汤合甘草干姜汤加减,可酌加桑螵蛸、紫河车等益精养血之品,可获显效。