【摘要】：目的觀察益氣養(yǎng)陰通絡法治療射血分數(shù)保存的心力衰竭(氣陰兩虛血瘀證)的臨床療效,為中醫(yī)藥治療本病提供一種新思路。方法本研究99例病例均選取自山西省中醫(yī)院心病科門診及住院部確診的氣陰兩虛血瘀型射血分數(shù)保存的心力衰竭患者。將99例符合納入標準的病例隨機分為A、B、C三組,三組均予常規(guī)西藥基礎治療,A組在此基礎上予八味通絡顆粒與通脈養(yǎng)心丸聯(lián)合治療,B組予通脈養(yǎng)心丸聯(lián)合常規(guī)西藥治療,C組僅進行常規(guī)西藥治療,療程均為8周。結(jié)果1.治療后A組較B、C組:中醫(yī)癥狀療效、中醫(yī)癥狀總積分比較均有顯著差異(P0.05),具體證候比較A組較C組均有顯著性差異(P0.01或P=0.01);2.A組、B組較治療前生存質(zhì)量量表計分有顯著差異(P0.01),C組較治療前比較,無統(tǒng)計學差異(P0.05),A組較B、C組改善明顯(P0.05);3.NYHA心功能療效分級評價,結(jié)果顯示三組治療后存在顯著性差異(P0.01),且A組總有效率及顯效率均優(yōu)于B、C組;4.A組治療后與B、C組比較:超聲心動圖指標“E、A、E/A、IVRT”均有顯著差異(P0.05),A組治療后較治療前指標“E、A、E/A、IVRT、DCTe”均有所改善(P0.05);5.經(jīng)治療,三組NT-pro BNP情況較治療前均有顯著性差異(P0.05),治療后三組間存在統(tǒng)計學差異(P=0.05),A組相較于C組有統(tǒng)計學差異(P0.05);6.治療后三組6min步行距離較治療前均有統(tǒng)計學差異(P0.05),且三組間相比差異非常顯著(P0.01),A組治療后步行距離與B、C組相比,明顯優(yōu)于其余兩組(P0.05),B組較C組改善程度較高(P0.05);7.治療后A組血流變指標“全血低、中、切粘度”較其治療前均有顯著差異(P0.05),較B、C組均有顯著差異(P0.05);8.全部病例治療前后體征及心電圖未見明顯異常,所測得血、尿、便常規(guī),肝功、腎功等結(jié)果較其治療前無明顯差異(P0.05)。結(jié)論益氣養(yǎng)陰通絡法能改善射血分數(shù)保存的心力衰竭(氣陰兩虛血瘀證)患者的癥狀、體征,可降低患者血液NT-pro BNP水平,顯著增加患者六分鐘步行試驗步行距離,較大程度改善患者生存質(zhì)量,對患者血流變指標也有一定程度改善作用。
[Abstract]:Objective to observe the clinical effect of nourishing qi and nourishing yin and dredging collaterals in treating heart failure (qi and yin deficiency and blood stasis syndrome) preserved by ejection fraction, and to provide a new way for traditional Chinese medicine to treat this disease. Methods Ninety-nine patients with heart failure were selected from Department of Heart Disease Department of traditional Chinese Medicine of Shanxi Province and inpatient department. Ninety-nine patients who met the inclusion criteria were randomly divided into three groups. The three groups were treated with routine western medicine. Group A was treated with Ba-Wei Tongluo granule and Tongmai Yangxin Pill on this basis. Group B was treated with Tongmai Yangxin pill combined with conventional western medicine, group C was treated with routine western medicine only for 8 weeks. Result 1. After treatment, there were significant differences in the curative effect of TCM symptoms and the total score of TCM symptoms between group A and group C (P0.05), and there were significant differences in specific syndromes between group A and group C (P0.01 or P0.01). 2. There was significant difference in quality of life scale score between group A and group B (P0.01), C group compared with pre-treatment group, there was no significant difference (P0.05), A group was significantly improved than BUC group (P0.05); The results showed that there was significant difference between the three groups after treatment (P0.01), and the total effective rate and effective rate of group A were better than those of group C. 4.Compared with group B C after treatment, there were significant differences in echocardiographic indexes (P 0.05) between group A and group B (P 0.05) after treatment compared with group B (P 0.05) after treatment, there was no significant difference between group A and group B (P > 0.05). DCTe was improved (P0.05). 5. After treatment, the NT-pro BNP in the three groups were significantly different from those before treatment (P0.05), and there were statistical differences between the three groups after treatment (P < 0.05) compared with group C (P0.05). After treatment, the walking distance of 6min in the three groups was significantly higher than that in the other two groups (P0.05), and the difference between the three groups was very significant (P0.01), A group compared with BPC group, significantly better than the other two groups (P0.05). The improvement of group B was higher than that of group C (P0.05). 7. After treatment, the hemorheological index of group A was lower than that of group A (P 0.05), while the viscosity of whole blood was lower than that of group B (P 0.05), and that of group C was significantly higher than that of group B (P 0.05). The signs and electrocardiograms of all cases were not abnormal before and after treatment, the results of blood, urine, stool routine, liver function, renal function and so on were not significantly different from those before treatment (P0.05). Conclusion the method of nourishing qi and nourishing yin and dredging collaterals can improve the symptoms and signs of patients with heart failure (qi and yin deficiency and blood stasis syndrome) preserved by ejection fraction, decrease the level of NT-pro BNP in patients' blood, and increase the walking distance of six minutes' walking test. The quality of life was improved to some extent, and the hemorheological index was improved to some extent.
【學位授予單位】：山西省中醫(yī)藥研究院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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