加用中药坎离煎对慢性心力衰竭患者活动耐量、生活质量及心衰加重次数的影响

目的：观察加用中药坎离煎对慢性心力衰竭（CHF）患者活动耐量、生活质量和CHF加重次数等的影响.方法：选择CHF心肾阳虚证患者60例,按2：1随机分为坎离煎组39例和对照组21例.两组患者均以西药规范治疗,坎离煎组加用坎离煎,疗程24周.分别于治疗前、治疗后4、8、12、24周时观察6分钟步行试验（6MWT）、CHF生活质量评分（LHFQ评分）、NYHA分级、中医证候积分、利尿剂和地高辛停减率,并统计1年中因CHF急性加重住院的次数.结果：中医证候疗效、6MWT、LHFQ评分、中医证候积分及NYHA分级方面,坎离煎组均优于对照组;血流动力学指标短轴缩短率、E峰/A峰（E／A）变化两组间差异无显著性;治疗后坎离煎组左室射血分数显著提高,对照组变化不明显;加用坎离煎治疗后,减少了利尿剂和地高辛的用量.结论：在西药治疗基础上加用中药坎离煎能显著提高CHF患者的生活质量和运动耐量,改善心功能,减少利尿剂、地高辛的使用,减少CHF急性加重的住院次数.

Effects of Addition of Kanlijian on Exercise Tolerance,Quality of Life and Worsened Times in the Patient of Chronic Heart Failure

Objective:To observe effects of addition of Kanlijian on exercise tolerance,quality of life and worsened times in the patient of chronic heart failure(CHF).Methods:60 cases of CHF with yang-deficiency of both the heart and the kidney were divided into a Kanlijian group (n=39) and a control group(n=21).The groups were treated routinely with western medicine,with Kanlijian added in the Kanlijian group.The treatment course was 24 weeks.6-minute walking test(6MWT),quality of life(LHFQ) scale,NYHA grading,score for symptoms and signs of TCM,and ratio of withdrawal or reduction of diuretic and digoxin before and 4,8,12,24,48 weeks after treatment were investigated.Worsened times of heart failure in one year was calculated.Results:The Kanlijian group was superior to the control group in the therapeutic effect on TCM syndromes,6MWT,LHFQ scale,score for symptoms and signs of TCM and NYHA grading.For hemodynamic indexes,there was no significant difference in FS and E/A ratio between the two groups.After treatment,left ventricle ejection fraction(LVEF) significantly increased in Kanlijian group and no significant change was found in the control group;After treatment with addition of Kanlijian,dosages of diuretic and digoxin decreased significantly.Conclusion:Addition of Kanlijian to western medicine can significantly increase LHFQ,exercise tolerance and heart function,and reduce dosage of diuretic and digoxin,as well as the times of readmission to hospital due to acute aggravation of heart failure in the patient of CHF.