五参复脉汤加减对病毒性心肌炎后室性早搏患者QT间期离散度的影响

目的 观察五参复脉汤对病毒性心肌炎后室性早搏的疗效及QT间期离散度(QTd)的影响.方法 将100例病毒性心肌炎慢性期并频发室性早搏患者随机分为观察组和对照组各50例.对照组给予常规治疗+普罗帕酮片每次150mg,每日3次,有效后减为每次100mg；观察组给予常规治疗+五参复脉汤每日1剂,分早晚2次空腹温服.30天后评价临床疗效并检查治疗前后心电图、24小时动态心电图,观察室性早搏次数及QTd、校正后的QT离散度(QTcd)变化.结果 观察组总有效率84.0％,对照组总有效率90.0％,两组患者总有效率比较差异无统计学意义(P＞0.05).治疗后对照组患者的QTd、QTcd与治疗前比较差异无统计学意义(P＞0.05),观察组患者QTd、QTcd均显著小于治疗前和对照组(P＜0.05)；两组患者的室性早搏频率均显著低于治疗前(P＜0.01),对照组患者室性早搏改善程度优于观察组(P＜0.01).观察组不良反应发生率显著低于对照组(P＜0.05).结论 五参复脉汤治疗病毒性心肌炎后频发室性早搏有效,其能缩短QTd、QTcd,无明显的不良反应.

Influence of Modified Wushen Fumai Decoction on QT Interval Dispersion in 50 Cases of Premature Ventricular Contractions after Viral Myocarditis

Objective To observe the therapeutic effect of Wushen Fumai Decoction for premature ventricular contractions after viral myocarditis and its influence on QT interval dispersion.Methods One hundred cases of chronic viral myocarditis with frequent premature ventricular contractions were randomized into the observation group and the control group,with 50 in each.The control group was given conventional therapy and 150mg of propafenone tablets,or 100mg when it was into effect,three times daily.The observation group was given conventional therapy and Wushen Fumai Decoction one dosage daily.The treatment course lasted for 30 days.The number of premature ventricular contractions and the change of QTd and QTcd were observed with electrocardiogram(ECG) and 24-hour ambulatory ECG before and after treatment.Results There were 27 cases of excellence,15 cases of validity and 8 cases of invalidity in the observation group,with a total effective rate of 84.0%.There were 29 cases of excellence,16 cases of validity and 5 cases of invalidity in the control group,with a total effective rate of 90.0%.There was no significant difference in the total effective rate between groups(P>0.05).There was no significant difference in QTd,QTcd and the frequency of premature ventricular contractions between groups before treatment(P>0.05).After treatment,QTd and QTcd significantly decreased in the observation group,with statistical difference between groups and in group(P<0.05 or P<0.01).The frequency of premature ventricular contractions decreased significantly in both groups(P<0.01),especially in the control group(P<0.05).However,the incidence of adverse reactions in the observation group was significantly lower than that in the control group(P>0.05).Conclusion Wushen Fumai Decoction is effective for frequent premature ventricular contractions after viral myocarditis,with less therapeutic effect than propafenone.However,Wushen Fumai Decoction could shorten QTd and QTcd without obvious side effects as compared with propafenone.