慢性充血性心力衰竭患者“心气虚”证研究*

[目的]进行充血性心力衰竭(CHF)人群中医证候调查,了解"心气虚"证候在CHF人群中的分布情况及特点,以及CHF患者中"心气虚"证和非"心气虚"证的区别.[方法]依据入选标准纳入124例心力衰竭患者,对其症状、心功能、症状积分进行量化评价,并采用超声心动对全部患者心功能进行检测.[结果]1)临床研究结果显示,全部CHF患者中,符合"心气虚"诊断标准的有103例,占全部病例的83.1%,其余患者多以阳虚、血瘀和水停等证候表现为主,但所占比例相对较少.对心气虚组与非心气虚组患者证候差别的研究显示,心气虚组患者平均病程短于非心气虚组(P＜0.05),其中病程超过5 a的病例,心气虚组占12.6%,而非心气虚组高达47.6%.心气虚组患者平均心功能级别优于非心气虚组(P＜0.01).2)对CHF患者的超声心动检查结果显示,心气虚组与非心气虚组患者心脏收缩功能均下降.但左室舒张末期内径(LNDd)、左室收缩末期内径(LVDs)、每搏输出量(SV)、每分输出量(CO)、射血分数(EF)、短轴缩短率(FS%)等指标组间比较均无显著性差异(P＞0.05),但非心气虚组E/A值高于心气虚组(P＜0.05),心气虚组患者存在更为严重的左室舒张功能不全.[结论]CHF具有比较突出的中医"心气虚"的表现,心脏左室功能尤其是舒张功能严重下降和"心气虚"证的出现有一定的内在联系.因此,CHF时左室舒张功能严重下降可以作为CHF"心气虚"的证候诊断因素之一,对丰富和规范传统的辨证标准有一定的参考价值.

Research on syndrome of heart-energy deficiency in patients with chronic congestive heart failure

[Objective] To carry out a investigation on syndrome in patients with chronic heart failure (CHF) for understanding the syndrome distribution and characteristic and the difference of heart-energy deficiency and non-heart-energy deficiency syndrome in these patients.[Methods] The symptoms,heart function and symptoms scores in one hundred and twenty-four CHF patients were evaluated and determined the heart function with ultrasoundcardiogram.[Results] One hundred and three patients were diagnosed as heart-energy deficiency syndrome and the ratio of heart-energy deficiency syndrome was 83.1%.The course of disease in patients with heart-energy deficiency syndrome was obviously shorter than those of patients with non-heart-energy deficiency syndrome (P<0.05).The course of disease exceeding five years in heart-energy deficiency group was 12.6% and non-heart-energy deficiency group was 47.6%.The heart function of heart-energy deficiency group was obviously better than that of another group (P<0.01). There weren't obvious differentiations on the LVDd,LVDs,SV,CO,EF,FS% level (P>0.05).The E/A value of non-heart-energy deficiency group was obviously higher than that in heart-energy deficiency group (P<0.05).[Conclusion] The syndrome of heart-energy deficiency is a representative symptom in CHF patients.The decline of dilative function of left ventricle is connected with the heart-energy deficiency syndrome.