中西医结合治疗慢性心力衰竭的回顾性分析

目的 回顾性分析中西医结合治疗慢性心力衰竭（CHF）134例患者的临床资料，探讨CHF的诊治特点。方法 利用冠心病中医临床研究数据平台，采集2003年1月—2004年12月西苑医院心血管科CHF住院患者的信息，对其证候特征、中西药物治疗情况及病死率进行调查分析。结果 134例CHF患者常见基础病以冠心病、糖尿病和高血压为主，中医证型主要为气虚血瘀、痰瘀互结、气阴两虚、水湿内停及阳虚型，NYHA心功能分级与证型分布有一定规律性。CHF总病死率为687%，年龄增长、陈旧性心肌梗死的存在及心功能的降低与CHF病死率呈正相关。中药治疗以益气、活血、化痰、养阴为主要治法，静脉应用中药以生脉、丹参、三七总皂甙、刺五加注射液为主。结论 西苑医院CHF患者中医证候以气虚、血瘀、痰阻、阳虚证为主，多采用中西医结合治疗，但中西医结合治疗CHF的优势尚未得到循证医学支持。

Retrospective Analysis on Integrative Medicinal Treatment of Chronic Heart Failure

OBJECTIVE: To explore the characteristics of integrative medicinal diagnosis and treatment on chronic heart failure (CHF) by retrospectively analyzing the clinical data of 134 patients. METHODS: Data of CHF patients hospitalized in Department of Cardiology, Xiyuan Hospital from Jan. 2003 to Dec. 2004 were collected and their characteristics of TCM syndromes, condition of treatment (both Western and Chinese medicine), and fatality rate were investigated and analyzed using the data system of Chinese medicine clinical research for coronary heart disease. RESULTS: In the 134 CHF patients, the commonly encountered basic diseases were mainly the coronary heart disease, diabetes mellitus and hypertension; the main TCM syndrome types were qi deficiency and blood-stasis type, phlegm-stasis inter mingling type, both qi-yin deficiency type, inner water-dampness stagnancy type and yang deficiency type; showing a certain regularity between syndrome type distribution and cardiac functional NYHA grading. The total fatality rate was 6.87%, which was positively correlated with the age of patients, existence of old myocardial infarction and impairing of heart function. The Chinese medicinal treatment applied was mainly the methods of supplementing qi, activating blood circulation, dissolving phlegm and nourishing yin, and the preparations used for intravenous perfusion were mainly injections of Shengmai, Salvia mitrorrhiza, Sanchi total saponin, and acanthopanax. CONCLUSION: The syndromes in CHF patients of Xiyuan Hospital mainly covered qi deficiency, blood stasis, phlegm blocking, and yang deficiency, who were mostly treated with integrative medicinal treatment. However, its superiority needs the support from evidence-based medicine.