【作者】 薛礼美；

【导师】 唐蜀华；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2004， 硕士

【摘要】 背景 舒张性心力衰竭(DHF)是指在心室收缩功能正常(射血分数正常EF＞45％)的情况下，心室松弛性和顺应性减低使心室充盈量减少和充盈压升高，从而导致肺循环和体循环淤血的综合征。二十世纪80年代住院患者的回顾性研究证明，DHF患者大约占全部心力衰竭患者的30％～40％。DHF的治疗大多是经验性的，现在还缺少大规模多中心的随机对照临床试验，DHF的诊治已成为心血管病领域中急需解决的重要课题。 目标 对益气舒心颗粒冲剂治疗新西兰白兔DHF药效的实验观察、分析，进一步探讨益气舒心颗粒治疗DHF的疗效及作用机制，冀其为中医研究DHF规范化和客观化提供依据。 研究方法 应用高脂饲料喂养新西兰白兔12周的方法建立兔DHF的模型，使用日本RW—6000光电八导生理仪检测左心室舒张、收缩功能，左心室内压(LVP)、左心室舒张末期压(LVEDP)、左心室等容舒张期压力最大上升速率(+dp／dtmax)、左心室等容舒张期压力下降速率(—dp／dtmax)、心率(HR)、心电图Ⅱ导(ECG)、动脉收缩压(SBP)、舒张压(DBP)计算左室松弛时间常数左室收缩指数、利用左心室重量与体重之比(LVW／BW)定量心肌肥厚程度。同时检测血ET、AngⅡ、ANP。治疗组用益气舒心颗粒(由具有益气宣肺活血利水的中草药制成)治疗，对照组用合心爽、开搏通，治疗8周后再用日本RW—6000光电八导生理仪检测左心室舒张、收缩功能，进行比较。评价益气舒心颗粒治疗DHF的疗效。 结论 应用高脂饲料喂养新西兰白兔12周的方法能够建立兔DHF的模型。益气舒心颗粒能够降低左心室等容舒张期压力下降速率(—dp／dtmax)、左心室舒张末期压(LVEDP)、左心室内压(LVP)、舒张压(DBP)、血ET、ATⅡ、ANP、CHO、LDL-C、TG。治疗效果与合心爽、开搏通相当，部分指标(CHO，LDL-C，TG，ET、LVSP)的改善优于合心爽、开搏通。证明益气舒心颗粒通过多靶点治疗DHF，最主要的机制可能为阻断钙离子通道，改善了心肌细胞内的钙超负荷，并能够降低血脂、调整紊乱的神经内分泌，特别是降低了血ET、ATⅡ、ANP，阻止了DHF的进一步的发展。更多还原

【Abstract】 Background: Diastolic heart failure (DHF) is a clinical syndrome characterized by the symptoms and signs of heart failure, a preserved ejection fraction (EF>45%), and abnormal diastolic function. From a conceptual perspective, diastolic heart failure occurs when the ventricular chamber is unable to accept an adequate volume of blood during diastole, at normal diastolic pressures and at volumes sufficient to maintain an appropriate stroke volume. These abnormalities are caused by a decrease in ventricular relaxation and/or an increase in ventricular stiffness and give rise to the left ventricular filling pressure elevating, the left ventricular filling capacity decreasing, systemic and pulmonary circulation congesting goring. It has been proofed that 35% to 40% of all the patients with heart failure are the DHF by reviewing the hospitalized patients in the 80’s 20th century .The treatment of DHF is most experiencing and still short of large scale multiplicity centers random control clinical trial now. Therefore the diagnosis and treatment of the DHF is a most important project which is urgent to resolved in the fields of cardiology.Objective: This test is to systematically study the effective of the YiQiShuXin granular medicine in treating DHF of the rabbit and to enucleate what is it’s probability functionary mechanism. Methods: The model of the rabbit DHF is established by feeding the New Zealand white rabbit 12 weeks with Cholesterol-Rich fodder. Treating groups are treated with the YiQiShuXin granular medicine(Chinese medicine with the effective of YiQiXuanfeiHuoxueLiShui), while control groups are treated with Cardizen and Captopril for 8 weeks. Such parameters as the left ventricle diastolic pressure (LVDP), contractility index and the left ventricle pressure (LVP) etc, are tested by the eight leads electricity physiology instrument (Japan, RW-6000) to evaluate the curative effect of the YiQiShuXin granular medicine on the DHF treatment. Results and Conclusions:1: The model of the rabbit DHF is successfully established by feeding the New Zealand white rabbit 12 weeks with Cholesterol-Rich fodder.2: The YiQiShuXin granular medicine can cut down the peak descending maximal rate in period of isovolumic contraction (-dp/dtmax), the left ventricle pressure (LVP), the left ventricle end diastole pressure (LVEDP), diastolic pressure (DBP), the level of the ET, XT, ANP, CHO, LDL-C and TG in blood.3: Such parameters as CHO, LDL-C, TG, ET and LVSP for the YiQiShuXin granular medicineare superior to Cardizen and Captopril, while its curative effect of is parallel with that of Cardizenand Captopril.4: The main mechanism is probably to obstruct the calcium ion passageway, decrease calcium overload inner the myocardium cell and cut down the blood grease and come back chaotic nerve endocritic level in some extent, particularly blood ET, AT and ANP, therefore stop further the development of DHF .更多还原