（冠心病、高血压病）慢性心力衰竭气阴两虚夹瘀证和阳虚水泛证中医诊疗方案的规范化研究

【作者】 尹金珠；

【导师】 张守琳；

【作者基本信息】 长春中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 目的通过采用中成药物配合西药常规治疗与单纯西药治疗组相对比,对入选的慢性心衰气阴两虚夹瘀证及阳虚水泛证病例进行研究,观察治疗前后病人临床疗效,旨在探讨出治疗气阴两虚夹瘀证及阳虚水泛证慢性心衰的安全有效、简便、实用、利于推广的康复治疗方案。方法将入选72例病人随机分为两组,其中对照组给予基础常规治疗;治疗组在基础常规治疗基础上,辨证加服中成药物;其中气阴两虚夹瘀证给予生脉饮加血府逐瘀胶囊,阳虚水泛证给予芪苈强心胶囊口服,疗程为1个月。观察两组病人治疗前后临床症状变化、通过心脏超声及心胸比率变化评估心功能变化;采用酶联免疫法检测治疗前后病人血清BNP含量的变化,采用明尼苏达量表估病人生活质量变化;随访3个月,观察病人再住院率及心血管终点事件的发生率(死亡及急性心梗心衰发生率)。结果1、临床观察结果表明,治疗1组(气阴两虚夹瘀组)总有效率为91.4%,治疗2组(阳虚水泛组)总有效率为91.07%,对照组总有效率为79.21%。两组总有效率及临床显效率经统计学处理均P<0.05,有显著性差异,说明治疗组疗效明显优于对照组。2、治疗前各组病人的血清BNP水平明显升高,并且BNP表达水平与心衰的严重程度正相关,经过治疗心衰症状好转后,病人血清BNP水平明显降低。其中治疗1组、治疗2组血清BNP变化程度较对照组明显。3、通过明尼苏达量表分析,治疗1组及治疗2组生活质量的改善程度明显优于对照组。4、治疗及随访期间治疗2组再住院率共1人次,对照组再住院率4人次,治疗组明显少于对照组。结论1、采用中药辩证治疗配合西药常规治疗可明显改善慢性心衰病人临床症状,改善病人的心功能,提高病人的生活质量,减少再住院率,优于单纯西药治疗;2、血清BNP作为心衰诊断的敏感性指标,对判定病情、判定疗效及预后的评价具有方向性的指导作用;3、中医药辩证治疗治疗配合西药常规疗法治疗慢性心力衰竭气阴两虚夹瘀证及阳虚水泛证方案行之有效,简便易行,值得进一步推广。更多还原

【Abstract】 Purpose through the use of Chinese patent medicines with conventional western medicine, western medicine treatment and simple treatment group compared to the selected folder with chronic heart failure Deficiency of Qi and Yin and Yang Stasis Syndrome water pan card case study to observe the clinical efficacy of patients before and after treatment to Discussion on the treatment of both Qi and Yin deficiency and Yang folder Stasis Syndrome water pan card chronic heart failure is safe and effective, simple, practical and conducive to the promotion of the rehabilitation treatment program.Methods 72 cases of selected patients were randomly divided into two groups, one of the control group given conventional treatment foundation; treatment group at the basis of conventional treatment based on differentiation of Chinese patent medicines to add service; one of Qi and Yin Deficiency Stasis Syndrome folder add ShengmaiYin give blood Zhuyu capsule, Yang Pan-permit water to give stilbazolium Lepidii Qiangxin capsules oral, treatment for a month. Patients were observed changes in clinical symptoms before and after treatment by echocardiography and assessment of heart rate changes in cardiac function changes; By enzyme-linked immunosorbent assay before and after treatment Patient serum BNP concentration changes, the use of the Minnesota Scale for assessing the quality of life of sick Change; 3 month follow-up to observe the patient re-hospitalization rates and the incidence of cardiovascular end point rate (death and acute myocardial infarction heart The incidence of failure).The results one clinical observation results show that treatment of one group (folder Yin Deficiency blood group) the total effective rate was 91.4%, treatment 2 group (Yang Pan-water group) the total effective rate was 91.07% in the control group the total effective rate was 79.21%. The two groups have a total efficiency and the efficiency of clinical significant statistical processing of P <0.05, there is significant difference on efficacy of the treatment group was superior to the control group. 2, pre-treatment of patients in each group serum BNP levels were significantly elevated, and the expression level of BNP with the severity of heart failure are related, after the treatment of heart failure symptoms improved, patients with BNP levels were significantly lower. One of the treatment of one group, treatment group 2 Change of serum BNP level higher than the control group significantly. 3, through the Minnesota scale analysis, the treatment of one group and treatment group 2 the quality of life improved significantly better than the control group. 4, 3 month follow-up results of the treatment group re-hospitalization rates were 0 views, the control group re-hospitalization rate of 4 million, the treatment group was significantly rare in the control group.Conclusion 1, the use of traditional Chinese medicine combined with western medicine dialectical conventional therapy can significantly improve the clinical symptoms of chronic heart failure patients, improving the patient’s cardiac function, improve the quality of life of patients and reduce re-hospitalization rate, better than western medicine treatment; 2, serum BNP for heart failure diagnosis of the sensitivity of indicators to determine the patient’s condition to determine the efficacy and prognostic evaluation of the role of directional guidance. 3, Chinese medicine treatment of the dialectical treatment of western medicine with conventional therapy in chronic heart failure folder Stasis Syndrome of Qi-Yin Deficiency and Yang Pan-water certification programs effective, user-friendly and worthy of further promotion.更多还原