益气活血利水汤联合西医常规治疗慢性心力衰竭临床观察

目的观察益气活血利水汤联合西医常规治疗慢性心力衰竭的临床疗效。方法将60例慢性心力衰竭患者随机分为2组,对照组30例予强心、利尿、扩血管等常规西医对症治疗,治疗组30例在对照组治疗基础上加用益气活血利水汤治疗。2组均1个月为1个疗程,1个疗程后统计临床疗效,并观察2组治疗前后6 min步行试验(6MWT)、血浆氮-末端脑钠肽前体(NT-pro BNP)、左室射血分数(LVEF)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)、Lee心衰计分、血浆醛固醇(ALD)及血管紧张素Ⅱ(AngⅡ)水平变化。结果治疗组总有效率86.67%,对照组总有效率63.33%,2组比较差异有统计学意义(P0.05),治疗组疗效优于对照组。2组治疗后血浆NT-pro BNP均降低,6MWT均升高,比较差异均有统计学意义(P0.05);治疗组治疗后降低血浆NT-pro BNP,升高6MWT水平均优于对照组(P0.05)。2组治疗后LVEF与本组治疗前比较均升高,LVESD、LVEDD均降低,比较差异均有统计学意义(P0.05),且治疗组治疗后升高LVEF水平优于对照组(P0.05),降低LVESD、LVEDD水平优于对照组(P0.05)。治疗组治疗后血浆ALD、AngⅡ及Lee心衰计分均降低,比较差异均有统计学意义(P0.05)。对照组治疗后ALD及Lee心衰计分均降低,比较差异均有统计学意义(P0.05),治疗前后AngⅡ比较差异无统计学意义(P0.05)。结论益气活血利水汤联合西医常规治疗慢性心力衰竭疗效确切,并能改善NT-pro BNP、6MWT、LVEF、LVESD、LVEDD及血脂指标。

ClinicalobservationofQi-tonifyingandblood-activatingandwater-alleviatingdecoctioncombinedwithconventionalwesternmedicineonchronicheartfailure

Objective To observe the clinical effects of Qi-tonifying and blood-activating and water-alleviating decoction combined with conventional western medicine on the treatment of chronic heart failure (CHF).Methods 60 patients with CHF were randomly divided into two groups.The control group (n=30) was treated by conventional western symptomatic treatment, involving strong heart, diuresis and vascular dilatation, etc.The treatment group (n=30) was treated by Qi-tonifying and blood-activating and water-alleviating decoction on the basis of the control group treatment.The treatment course was 1 month in two groups, and the curative effects were evaluated after 1 treatment course.The 6-minute walking test (6MWT), plasma nitrogen-terminal pro brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), Lee heart failure score, plasma aldosterone (ALD) and angiotensin Ⅱ (Ang Ⅱ) were observed before and after treatment in two groups.Results The total effective rate in treatment group (86.67%) was superior to that in control group (63.33%,P<0.05).The plasma NT-proBNP after treatment was decreased in two groups, and the 6MWT was increased, with statistical difference (P<0.05), and the improvements of plasma NT-proBNP and 6MWT in treatment group were superior to those in control group (P<0.05).The LVEF after treatment was increased in two groups, and the LVESD and LVEDD were decreased, with statistical difference (P<0.05), and the improvements of LVEF, LVESD and LVEDD after treatment in treatment group were superior to those in control group (P<0.05).The plasma ALD, Ang Ⅱ and Lee heart failure score after treatment were decreased in treatment group, with statistical difference (P<0.05).The plasma ALD and Lee heart failure score after treatment were decreased in control group, with statistical difference (P<0.05), and there was no statistical difference on Ang Ⅱ between before and after treatment in control group (P<0.05).Conclusion Qi-tonifying and blood-activating and water-alleviating decoction combined with conventional western medicine have exact effects on the treatment of CHF, can improve the NT-proBNP, 6MWT, LVEF, LVESD, LVEDD and blood lipid.