定悸方联合西医治疗阵发性房颤气阴两虚证的疗效观察

目的:探讨定悸方联合西药治疗气阴两虚证阵发性房颤的临床疗效.方法:将2016年10月～2018年3月接受胺碘酮治疗的49例阵发性房颤患者纳入对照组,同期接受胺碘酮联合定悸方治疗的49例患者纳入观察组.两组均连续治疗8周,比较两组临床疗效、中医证候积分及血清炎症介质水平.结果:观察组临床总有效率高于对照组,差异有统计学意...     

玉液汤加减对气阴两虚型糖尿病肾病的影响

目的:观察玉液汤加减治疗气阴两虚型糖尿病肾病的临床疗效。方法:60例患者随机分为两组,治疗组予玉液汤加减,对照组予二甲双胍、依那普利,进行治疗前后空腹血糖、24h尿蛋白水平比较及中医证候疗效评价。结果:治疗组有效率90.00%,对照组有效率66.67%,两组中医证候疗效比较差异具有显著性(P<0.05)。两组治疗后空腹血糖、24h尿蛋白均较治疗前下调,差异具有统计学意义(P<0.05),其中24h尿蛋白治疗组下调更为明显,与对照组比较差异具有统计学意义(P<0.05)。结果:玉液汤加减可以降低气阴两虚型糖尿病肾病空腹血糖及24h尿蛋白,从而缓解中医症状、体征。     

陆峰运用益气养阴方治疗气阴两虚型心绞痛临证经验

<正>冠心病是冠状动脉粥样硬化性心脏病的简称,是指由冠状动脉粥样硬化造成血管管腔狭窄或阻塞,导致心肌缺血、缺氧的心脏病,而心绞痛则是冠状动脉供血不足,心肌急剧的暂时缺血与缺氧所引起的以发作性胸痛或胸部不适为主要表现的一组临床综合征,95%是由冠状动脉粥样硬化性心脏病所致[1]。汉代张仲景的《金匮要略》正式提出胸痹一名,并进行了相关的阐述师曰:夫脉当取太过不及,阳微阴弦,即胸痹而痛,所以然者,责其极虚也。今阳虚知在上     

炙甘草汤加减治疗气阴两虚型心律失常临床观察

目的：观察炙甘草汤加减治疗气阴两虚型心律失常的临床价值。方法：选取2019年1月至2020年6月北京市昌平区沙河医院收治的120例气阴两虚型心律失常患者为研究对象,按简单随机化法分为对照组与研究组,各60例。对照组接受常规西药治疗,研究组接受常规西药联合炙甘草汤加减治疗。观察治疗4周后两组临床疗效,对比两组治疗前后心功能相关指标水平、血脂相关指标水平及中医证候评分,统计两组不良反应发生率。结果：研究组治疗总有效率为93.33%,高于对照组的80.00%（P＜0.05）;治疗后,两组中医证候评分均低于治疗前,且研究组低于对照组（P＜0.05）;治疗后,两组左心室射血分数（LVEF）、心脏指数（CI）及心排血量（CO）水平均高于治疗前,且研究组高于对照组（P＜0.05）;治疗后,两组总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）水平均低于治疗前,高密度脂蛋白胆固醇（HDL-C）水平均高于治疗前,且研究组TC、TG、LDL-C水平低于对照组,HDL-C水平高于对照组（P＜0.05）;研究组不良反应发生率（6.67%）与对照组（8.33%）相比差异不显著（P＞0.05）。结论：气阴两虚型心律失常患者接受炙甘草汤加减治疗的效果明显,可提高心功能,降低血脂与临床症状程度,且安全性良好。     

益气养阴方联合西药治疗对气阴两虚型2型糖尿病患者血糖及胰岛素水平的影响分析

目的 探讨益气养阴方联合西药治疗气阴两虚型2型糖尿病的临床疗效及对血糖及胰岛素水平的影响。方法 采用随机数字表法将就诊的70例T2DM患者分为对照组和观察组各35例。对照组采用常规西药治疗,观察组在对照组基础上予以益气养阴方治疗。对比两组临床疗效、血糖水平、胰岛素水平、中医证候积分及不良反应。结果 治疗后,观察组总有效率高于对照组,空腹血糖（FBG）、餐后2 h血糖（2hPBG）水平及中医证候积分低于对照组,空腹胰岛素（FINS）、餐后2 h胰岛素（2 hFINS）水平高于对照组（P<0.05）;两组均未见明显不良反应。结论 常规西药基础上加用益气养阴方治疗气阴两虚型T2DM患者可提升治疗效果,改善血糖及胰岛素水平,缓解临床症状,且安全性好,值得推广。     

中医食疗对气阴两虚型糖尿病患者生活质量的影响

目的观察中医食疗对气阴两虚型糖尿病患者生活质量的影响。方法按随机数字表将72例糖尿病患者分为观察组和对照组各36例,观察组脱落3例、对照组脱落1例。对照组给予社区常规饮食指导,观察组在常规饮食指导上辅以气阴两虚型食疗指导。两组患者在干预前后分别进行生活质量的评价。结果干预3个月后,观察组患者生活质量高于对照组患者,差异有统计学意义(P0.05),尤其是疾病维度和满意度维度方面。结论气阴两虚型糖尿病患者在现代营养学饮食指导的基础上加入中医食疗思路,更能有效提高患者生活质量。     

参冬消渴汤治疗2型糖尿病气阴两虚证的临床疗效

目的:研究参冬消渴汤治疗2型糖尿病气阴两虚证的临床疗效。方法:选取2010年2月~2014年2月我院100例2型糖尿病气阴两虚证患者,随机分为观察组与对照组各50例。对照组给予二甲双胍片治疗,观察组给予参冬消渴汤治疗,观察两组治疗效果。结果:观察组治疗总有效率为88.0%,明显高于对照组的68.0%,差异具有统计学意义(P0.05)。观察组患者临床症状及血糖指标改善更优(P0.05)。结论:2型糖尿病气阴两虚证患者服用参冬消渴汤可获得满意的临床疗效,患者临床症状得到显著改善,值得临床推广应用。     

郭洪波治疗气阴两虚型冠心病合并心律失常经验浅析

近年来,临床上冠心病合并心律失常是心内科常见的疾病.随着医学水平的巨大进步,虽然西医对冠心病合并心律失常的治疗发挥重要作用,但是仍存在副作用大、容易诱发心律失常、引起并发症等诸多情况.在中医理论指导下,导师郭洪波根据多年的临床诊疗经验,发现该病临床上以气阴两虚证最为常见,结合现代治疗冠心病合并心律失常的研究进展,治疗采用以益气养阴、活血通脉为主要治法,自拟养心平脉汤,临床效果显著,为治疗冠心病合并心律失常提供一种新的、有效的治则治法及方药,可供学习.     

比索洛尔对老年慢性心力衰竭患者心率变异性的影响

目的　观察比索洛尔对老年慢性心力衰竭 (CHF)患者心率变异性的影响。方法　将 5 70例患者随机分为常规基础治疗的对照组 2 0 3例和基础治疗加比索洛尔长期治疗的试验组 3 67例 ,入院后 48h内和治疗 2 4周后进行 2 4h动态心电图心率变异性 (HRV )的分析。结果　两组HRV经治疗后均有降低 ,试验组更为明显 ,两组差异有非常显著意义 (P <0 .0 1)。结论　比索洛尔对老年慢性CHF有良好的干预作用 ,并能有效改善CHF患者的心功能。     

曲美他嗪对老年慢性心力衰竭患者心率变异性的影响

[目的]研究在抗心衰常规药物治疗的基础上加用曲美他嗪对老年慢性心力衰竭患者心率变异性(HRV)的影响.[方法]选取本院2009年4月至2012年2月老年慢性心力衰竭患者96例,分为观察组和对照组.对照组(n=46)采用常规抗心衰药物治疗;观察组(n=50)在对照组治疗的基础上加用曲美他嗪20 mg,每日3次;两组用药12周后,分别检查两组患者的心脏功能与HRV指标.[结果]两组治疗前心率(HR)、6 min步行试验(6-MWT)和左室射血分数(LVEF)相比较,差异均无显著性(P>0.05).治疗后观察组HR、6-MWT和LVEF较对照组明显改善,且差异有显著性(P<0.05).两组患者治疗后心率变异性指标SDNN、SDANN、RMSSD和PNN50(50%)均较治疗前改善,且差异有显著性(P<0.05),且观察组SDNN和SDANN明显高于对照组(P<0.05).[结论]在抗心衰常规药物治疗的基础上加用曲美他嗪治疗老年心力衰竭疗效显著,能提高患者HRV,改善自主神经功能,有较高的临床价值.     

Effect of Transdermal Scopolamine on Heart Rate Variability in Patients with Severe Coronary Heart Disease

A decrease in cardiac parasympathetic tone is a recognized finding in patients with ischemia heart disease, correlating closely with disease severity and overall survival. The aim of this study was to assess whether transdermal Scopolamine (Tds), which increases parasympathetic tone in healthy volunteers, increases vagal tone in patients with severe CAD and whether it might have an antiischemic effect. Fifteen patients (10 men, aged 55 ± 8 years) with three-vessel CAD, but with no prior MI and preserved ventricular function, underwent 24-hour Holter monitoring and exercise testing before and after wearing a Scopolamine patch for 24 hours. Time-domain measures of heart rate variability (HRV) and the total number and duration of ischemic episodes were obtained from the Holter recordings for each patient. Tds significantly (P < 0.05) increased the values of all HRV measures. Tds also reduced the total number of ischemic episodes (from 273 to 159, P < 0.05) and their total duration (from 136 to 46 min per patient, P < 0.05). Tds also increased treadmill exercise duration from 293 ± 101 to 345 ± 95 seconds (P <0.05) and the time to 1-mm ST depression from 177 ± 105 to 244 ± 128 seconds (P < 0.02), while maximum ST depression was reduced from 2.86 ± 0.6 to 2.3 ± 0.3 (P < 0.05). No significant side effects were observed. Tds modifies the autonomic balance in patients with severe CAD toward a condition associated with a better prognosis. It may also be useful as an adjunctive treatment for ischemic heart disease.     

Heart Rate Variability in Patients with Vasovagal Syndrome

The aim of this study was to assess the heart rate variability in patients with vasovagal syndrome (WS). Heart rate variability was expressed as: (1) the standard deviation (SD) of the mean RR interval; and (2) the SD as a percentage of the mean RR interval (%SD). Heart rate variability was measured in VVS patients and compared with control individuals. Eighteen patients (mean age 50 ± 14 years) with a history of recurrent syncope and positive tilt testing were included in the study. Fifteen asymptomatic individuals (mean age 53 ± 13 years) with no history of syncope and negative tilt testing were used as a control group. The SD and %SD (39 ± 38 and 5 ± 4 msec) in the WS group were statistically higher at the tenth minute of tilt testing than in the control group (20 ± 14 and 2.5 ±1.8 msec, P = 0.03 and P < 0.05, respectively). The mean RR interval (mean heart rate) was shorter after the 15th minute of tilt testing in the WS group than in the control group (RR-WS 687 ± 136 msec, RR-control 801 ± 131 msec, P < 0.05). It is concluded that heart rate variability, as expressed by the SD of the mean RR interval, and the SD as a percentage of the mean RR interval (%SD) are significantly higher in VVS patients than in control asymptomatic individuals.     

高血压患者左心室的构造及功能对心率变异的相关分析

目的 :探讨高血压患者左心室构造和功能对心率变异性 (HRV)的影响。方法 :观察 12 2例高血压患者的 2 4h动态心电图的心率变异性和多普勒超声心动图资料 ,采用直线相关分析对两种检测指标进行单因素相关分析。结果 :超声心动图检测的A、E/A、EF、LVIDd、LVIDs、LVM等指标与HRV多项指标存在显著的相关性。结论 :高血压患者左心室舒张、收缩功能 ,左心室质量及容量的变化均能显著影响HRV。     

针灸并用对卒中后抑郁患者心率变异性的影响

目的观察针灸并用对卒中后抑郁患者心率变异性(HRV)的影响。方法将120例患者分为对照组(n=60)和治疗组(n=60)。两组均给予口服百忧解及针刺治疗,治疗组配合艾灸疗法,比较两组治疗前后汉密尔顿抑郁量表(HAMD)17项评分及HRV改变。结果治疗后,治疗组HAMD评分低于对照组,减分率高于对照组(P0.05);两组24 h正常R-R间期标准差(SDNN)、24 h每5分钟平均正常R-R间期标准差(SDANN)均较治疗前增加(P0.05),治疗组大于对照组(P0.05);24 h相邻R-R间期差值的均方根(RMSSD)、24 h相邻R-R间期差值50 ms的百分数(PNN50)较治疗前降低(P0.05),治疗组小于对照组(P0.05);两组低频功率(LF)、高频功率(HF)及LF/HF均大于治疗前(P0.05),治疗组大于对照组(P0.05)。结论针灸结合较单纯针刺能更好地调整卒中后抑郁患者自主神经功能,改善其抑郁状态。     

慢性肺心病患者的心率变异性

目的：观察慢性肺心病患者心率变异性，了解其自主神经功能的变化。方法：对25例慢性肺心病，25例健康对照者（对照组）作前瞻性对照研究，记录24h动态心电图，作时域和频域分析，结果：与对照组比较，肺心病组相邻心搏的R－R间期之差＞50ms的心搏数占R－R间期数的百分(pNN50)，每5min正常R－R间期标准差的平均值（SDANN），频域指标的高频（HF）明显降低，低频与高频的比值（LF／HF），明显升高，差异均有非常显著意义（P均＜0．01），而频域指标的低频（LF）无明显变化（P＞0．05），经过治疗后，肺心病组处于缓解期，与治疗前比较，HF，PNN50，SDANN等指标明显增加，而LF／HF明显降低，差异均有非常显著意义（P均＜0．01），肺心病组病人治疗后HF，pNN50,SDANN等指标均低于对照组，而LF／HF明显高于对照组，差异均有非常显著意义（P均＜0．01），肺心病组治疗后LF与治疗前及对照组比较，差异不具显著意义（P＞0．05）。结论：肺心中层得不仅交感神经活动占优势，同时并存迷走神经功能受损，自主神经功能可能存在连续性障碍。     

Heart Rate Variability in Patients with Familial Amyloid Polyneuropathy

The purpose of this study was to evaluate heart rate variability (HRV) in patients with familial amyloid polyneuropathy (FAP) using the time- and frequency-domain analysis. The study population consisted of 19 patients with FAP, and 19 age and sex matched normal volunteers. The 24-hour Holter recordings of all subjects in sinus rhythm and off medication were analyzed. Five time-domain indices of HRV were computed. The frequency component of HRV was calculated by fast Fourier transform analysis of the RR intervals. The power spectrum of the low frequency (LF) between 0.04–0.15 Hz and high frequency (HF) between 0.15–0.40 Hz and the LF/HF ratio was calculated. Global measures of HRV including the standard deviation of the mean of RR intervals (SDNN) and the standard deviation of 5-minute mean RR intervals (SDANN) were decreased in patients with FAP. Specific vagal influences on HRV including the proportion of RR intervals more than 50 milliseconds different (pNN50) and the HF power on spectral analysis were less in patients with FAP. LF power and LF/HF ratio were more decreased in patients with FAP at the advanced stage than at the early stage. In conclusion, HRV was significantly decreased in patients with FAP at the early stage, and sympathetic activity was more decreased in patients at the advanced stage. These findings suggest that the decrease of the HRV is an indicator of this disease and the power spectral analysis of the HRV is beneficial in assessing the severity of the autonomic dysfunction.     

Heart Rate Variability in Emergency Department Patients with Sepsis

OBJECTIVE: To test the hypothesis that heart rate variability (HRV) can provide an early indication of illness severity among patients presenting to the emergency department (ED) with sepsis. METHODS: The authors enrolled a convenience sample of 15 ED patients meeting the American College of Chest Physicians/Society of Critical Care Medicine criteria for sepsis. Each patient had continuous Holter monitoring performed in the ED. Acute Physiology and Chronic Health II (APACHE II) and Sequential Organ Failure (SOFA) scores were calculated for the day of presentation. Holter tapes obtained in the ED were analyzed off-line to calculate HRV variables for the 5-minute segment with the least artifact and non-sinus beats. These variables were correlated with APACHE II and SOFA scores. RESULTS: LFnu (normalized low-frequency power), an assessment of the relative sympathetic contribution to overall HRV, was correlated with increased illness severity as calculated using APACHE II (r = -0.67, r(2) = 0.43) and SOFA (r = -0.80, r(2) = 0.64) scores. LF/HF ratio (low-frequency/high-frequency ratio), a measure of sympathovagal balance, was correlated with the SOFA score [r = -0.54 (95% CI = -0.83 to -0.01), r(2) = 0.29]. All five patients who required critical care monitoring or ventilatory support or who died during the first 5 days of their hospitalization had LFnu values below 0.5 and LF/HF ratios less than 1.0. None of the patients with measurements greater than these threshold values died or required these interventions during the five days following admission. CONCLUSIONS: A single variable, LFnu, which reflects sympathetic modulation of heart rate, accounted for 40-60% of the variance in illness severity scores among patients presenting to the ED with sepsis. HRV, as reflected in LFnu and the LF/HF ratio and measured with a single brief (5-minute) period of monitoring while in the ED, may provide the emergency physician with a readily available, noninvasive, early marker of illness severity. The threshold effect of LFnu and LF/HF in the prediction of early clinical deterioration was an unexpected finding and should be regarded as hypothesis-generating, pending further study.