作者：徐燕,王颖辉,刘江波

单位：

100049 北京市，北京王府中西医结合医院心内科 通信作者：徐燕，E-mail：sunyong.100@163.com

Units：

Department of Cardiovascular Medicine, Beijing Royal Integrative Medicine Hospital, Beijing 100049, China Corresponding author: XU Yan, E-mail: sunyong.100@163.com

关键词：

冠心病; 前临床心力衰竭; 气虚血瘀型; 芪参益气滴丸; 治疗结果; 心功能;

Keywords：

Coronary disease; Pre-clinical heart failure; Qi deficiency with blood stasis; Qishen Yiqi dripping pills;Treatment outcome; Cardiac function

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.286

Funds：

昌平区卫生科技发展专项（中医药）课题计划（昌卫科 2017-5-13）

摘要：

背景前临床心力衰竭(心力衰竭B期)属于早期心力衰竭,目前临床主要采用西药治疗,但并不能达到预期疗效,故选择一种更加有效的治疗方案是目前临床研究的重点。目的 探讨芪参益气滴丸治疗气虚血瘀型冠心病并前临床心力衰竭的临床疗效及其对患者心功能的影响。方法 选取2018年1月至2020年1月北京王府中西医结合医院收治的110例气虚血瘀型冠心病并前临床心力衰竭患者作为研究对象,按照随机数字表法将其分为西医组和中西结合组,各55例。因各组均出现1例脱落病例,故每组54例。西医组患者基于指南采用西药治疗,中西结合组患者在西医组的基础上采用芪参益气滴丸治疗,两组患者均持续治疗4周。比较两组患者的临床疗效、治疗前及治疗后6个月心功能指标〔N末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕、6分钟步行距离(6MWD)、中医症候积分及健康调查简表(SF-36)评分,并比较两组患者随访6个月疾病恶化率及死亡率。结果 中西结合组患者临床疗效优于西医组(P <0.05)。治疗后6个月中西结合组患者血清NT-proBNP水平及中医症候积分低于西医组,LVEF高于西医组,LVEDD、LVESD小于西医组,6MWD长于西医组(P <0.05)。两组患者治疗后6个月血清NT-proBNP水平及中医症候积分分别低于本组治疗前,LVEF分别高于本组治疗前,LVEDD、LVESD分别小于本组治疗前,6MWD分别长于本组治疗前(P <0.05)。治疗后6个月中西结合组患者生理职能、生理机能、一般健康状况、精力、社会功能、情感职能、精神健康评分高于西医组,躯体疼痛评分低于西医组(P <0.05)。两组患者治疗后6个月生理职能、生理机能、一般健康状况、精力、社会功能、情感职能、精神健康评分分别高于本组治疗前,躯体疼痛评分分别低于本组治疗前(P <0.05)。中西结合组患者随访6个月疾病恶化率、死亡率低于西医组(P <0.05)。结论 芪参益气滴丸治疗气虚血瘀型冠心病并前临床心力衰竭的临床疗效确切,可有效改善患者心功能,提高患者生活质量,降低疾病恶化率及死亡率。

Abstract：

【Abstract】 Background Pre-clinical heart failure (heart failure stage B) belongs to early heart failure, westernmedicine is mainly used in clinical treatment as so far, but the expected curative effect cannot be achieved. Therefore, choosinga more effective treatment scheme is the focus of clinical research at present. Objective To investigate clinical effect of QishenYiqi dripping pills in the treatment of coronary heart disease complicated with pre-clinical heart failure due to Qi deficiency withblood stasis and its impact on cardiac function of patients. Methods A total of 110 coronary heart disease patients complicatedwith pre-clinical heart failure due to Qi deficiency with blood stasis admitted to Beijing Royal Integrative Medicine Hospital fromJanuary 2018 to January 2020 were selected as subjects of this study, and they were divided into western medicine group andChinese and western medicine group according to random number table method, 54 cases in each group because of one case felloff in each group. Patients in western medicine group were given western medicine treatment based on guideline, and patientsin Chinese and western medicine group were given Qishen Yiqi dripping pills based on western medicine group, both groupswere treated for 4 weeks. Clinical efficacy, cardiac function indexes [N-terminal pro-brain natriuretic peptide (NT-proBNP) ,left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter (LVEDD) , left ventricular end systolic diameter(LVESD) , 6 minutes walking distance (6MWD) ] , TCM symptom score and score of 36-Item Short Form Health Survey (SF-36) before treatment and at 6 months after treatment were compared between the two groups, and deterioration rate and mortalityafter 6 months' follow-up of the two groups were compared. Results Clinical effect of Chinese and western medicine group wasbetter than that of western medicine group (P < 0.05) . At 6 months after treatment, serum NT-proBNP level and TCM symptomscore of Chinese and western medicine group were lower than those of western medicine group, LVEF was higher than that ofwestern medicine group, LVEDD and LVESD were less than those of western medicine group, 6MWD was longer than that ofwestern medicine group (P < 0.05) . At 6 months after treatment, serum NT-proBNP level and TCM symptom score of the twogroups were lower than those before treatment, LVEF was higher than that before treatment, LVEDD and LVESD were less thanthose before treatment, 6MWD was longer than that before treatment, respectively (P < 0.05) . At 6 months after treatment, scoresof physical limitations, physiological function, general health, energy, social function, emotional function, and mental health ofChinese and western medicine group were higher than those of western medicine group, physical pain score was lower than thatof western medicine group (P < 0.05) . At 6 months after treatment, scores of physical limitations, physiological function, generalhealth, energy, social function, emotional function, and mental health of the two groups were higher than those before treatment,physical pain score of the two groups was lower than that before treatment, respectively (P < 0.05) . Deterioration rate and mortalityafter 6 months'follow-up of Chinese and western medicine group were lower than those of western medicine group (P < 0.05) .ConclusionQishen Yiqi dripping pills has a exactly clinical effect in the treatment of coronary heart disease complicated withpre-clinical heart failure due to Qi deficiency with blood stasis, and can improve cardiac function of patients, promote quality oflife, and reduce deterioration rate and mortality.

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