作者：李佳1，2 ，刘福明2 ，方罡1 ，何俊1

单位：

1.213000江苏省常州市德安医院康复科特需病房　2.210029江苏省南京市，南京中医药大学附属医院 江苏 省中医院心内科

Units：

1.Special Demand Ward of Rehabilitation, Changzhou Dean Hospital, Changzhou 213000, China 2.Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China

关键词：

心力衰竭；抗心衰颗粒；有氧运动；运动试验

Keywords：

Heart failure; Anti-heart failure granules; Aerobic exercise; Exercise test

CLC：

R 541.6

DOI：

10.12114/j.issn.1008-5971.2024.00.101

Funds：

江苏省中医药科技发展计划项目（ZD201906）

摘要：

目的　探讨抗心衰颗粒联合个体化有氧运动对慢性心力衰竭（CHF）患者心肺功能的影响。方法　选 取2023年5—12月常州市德安医院收治的CHF患者90例为研究对象，采用随机数字表法将患者分为有氧运动组、抗心 衰颗粒组、联合治疗组，每组30例。三组患者均进行CHF常规药物治疗，在此基础上，有氧运动组接受个体化有氧运 动治疗，抗心衰颗粒组接受抗心衰颗粒治疗，联合治疗组接受抗心衰颗粒联合个体化有氧运动治疗，共治疗12周。比 较三组治疗前后心肺运动试验（CPET）指标〔峰值摄氧量（VO2 peak）、最大代谢当量（METsmax）、氧脉搏、最大呼 吸交换率（RERmax）、二氧化碳通气当量斜率（VE/VCO2 slope）〕、中医证候积分、超声心动图检查指标〔左心室舒 张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）〕、改良Barthel指数（mBI）、 血清N末端脑钠肽前体（NT-proBNP）、6 min步行距离（6MWD）及不良事件发生率。结果　有氧运动组中途退出1 例，抗心衰颗粒组失访1例，最终有氧运动组纳入29例、抗心衰颗粒组纳入29例、联合治疗组纳入30例。治疗后，三 组VO2 peak、METsmax、氧脉搏、RERmax分别较本组治疗前升高，VE/VCO2 slope分别较本组治疗前降低（P＜0.05）。治 疗后，联合治疗组VO2 peak、METsmax、氧脉搏较有氧运动组、抗心衰颗粒组升高，VE/VCO2 slope较有氧运动组、抗心 衰颗粒组降低（P＜0.05）。治疗后，三组胸闷气喘、心悸、乏力自汗、咳嗽咳痰、口渴咽干、小便不利、失眠多梦、 面唇紫暗、手足心热积分分别较本组治疗前降低（P＜0.05）。治疗后，联合治疗组胸闷气喘、心悸、乏力自汗、咳嗽 咳痰、口渴咽干、小便不利、失眠多梦、面唇紫暗、手足心热积分较有氧运动组、抗心衰颗粒组降低（P＜0.05）。治 疗后，三组LVEDD、LVESD分别较本组治疗前缩小，LVEF分别较本组治疗前升高（P＜0.05）。治疗后，联合治疗组 LVEDD、LVESD较有氧运动组、抗心衰颗粒组缩小，LVEF较有氧运动组、抗心衰颗粒组升高（P＜0.05）。治疗后， 三组mBI分别较本组治疗前升高，NT-proBNP分别较本组治疗前降低，6MWD分别较本组治疗前延长（P＜0.05）。治 疗后，联合治疗组mBI较有氧运动组、抗心衰颗粒组升高，NT-proBNP较有氧运动组、抗心衰颗粒组降低，6MWD较 有氧运动组、抗心衰颗粒组延长（P＜0.05）。三组患者治疗过程中未发生明显不良事件。结论　抗心衰颗粒联合个体 化有氧运动能改善CHF患者心肺功能及运动耐量，减轻中医证候，抑制心肌重构，提高日常生活自理能力，且安全性 良好。

Abstract：

Objective To investigate the effect of anti-heart failure granules combined with individualized aerobic exercise on cardio-pulmonary function in patients with chronic heart failure (CHF) . Methods A total of 90 CHF patients admitted to Changzhou Dean Hospital from May to December 2023 were selected as the research objects. The patients were divided into aerobic exercise group, anti-heart failure granules group and combined treatment group using a random number table method, with 30 cases in each group. Patients in the three groups were treated with conventional medication for CHF, on this basis, the aerobic exercise group was given individualized aerobic exercise, the anti-heart failure granules group was given anti-heart failure granules, and the combined treatment group was given anti-heart failure granules combined with individualized aerobic exercise. All groups were treated for 12 weeks. CPET indicators [peak oxygen uptake (VO2 peak) , maximum metabolic equivalent (METsmax) , oxygen pulse, maximum respiratory exchange rate (RERmax) , and slope of ventilatory equivalent for carbon dioxide (VE/VCO2 slope) ] , TCM syndrome points, echocardiograpic indicators [left ventricular end-diastolic dimension (LVEDD) , left ventricular end-systolic diameter (LVESD) , left ventricle ejection fraction (LVEF) ] , modified Barthel Index (mBI) , serum N-terminal pro-brain natriuretic peptide (NT-proBNP) , and 6-minute walk distance (6MWD) before and after treatment, and the occurrence of adverse events were compared among the three groups. Results One case withdrew midway in the aerobic exercise group and 1 case was lost to follow-up in the anti-heart failure granules group, and ultimately 29 cases were included in the aerobic exercise group, 29 cases were included in the anti-heart failure granules group, and 30 cases were included in the combined treatment group. After treatment, VO2 peak, METsmax, oxygen pulse and RERmax in the three groups were higher than those before treatment respectively, and VE/VCO2 slope was lower than that before treatment respectively (P < 0.05) . After treatment, VO2 peak, METsmax, and oxygen pulse in combined treatment group were higher than those in aerobic exercise group and anti-heart failure granules group, and VE/VCO2 slope was lower than that in aerobic exercise group and anti-heart failure granules group (P < 0.05) . After treatment, the points of chest tightness and shortness of breath, palpitation, fatigue and spontaneous sweating, cough and phlegm, thirst and dry pharynx, unfavorable urination, insomnia and excessive dreaming, purple darkness of the face and lips, and heart heat of the hands and feet in the three groups were lower than those before treatment respectively (P < 0.05) . After treatment, the points of chest tightness and shortness of breath, palpitation, fatigue and spontaneous sweating, cough and phlegm, thirst and dry pharynx, unfavorable urination, insomnia and excessive dreaming, purple darkness of the face and lips, and heart heat of the hands and feet in combined treatment group were lower than those in aerobic exercise group and anti heart failure granules group (P < 0.05) . After treatment, LVEDD and LVESD in the three groups were smaller than those before treatment respectively, and LVEF was higher than that before treatment respectively (P < 0.05) . After treatment, LVEDD and LVESD in combined treatment group were smaller than those in aerobic exercise group and anti-heart failure granules group, and LVEF was higher than that in aerobic exercise group and anti-heart failure granules group (P < 0.05) . After treatment, mBI in the three groups was higher than that before treatment respectively, NT-proBNP was lower than that before treatment respectively, and 6MWD was longer than that before treatment respectively (P < 0.05) . After treatment, mBI in combined treatment group was higher than that in aerobic exercise group and anti-heart failure granules group, NT-proBNP was lower than that in aerobic exercise group and anti-heart failure granules group, and 6MWD was longer than that in aerobic exercise group and anti-heart failure granules group ( P < 0.05) . No significant adverse events occurred during the treatment of patients in the three groups. Conclusion Anti-heart failure granules combined with individualized aerobic exercise can improve the cardio-pulmonary function and exercise tolerance of CHF patients, alleviate TCM syndrome, inhibit myocardial remodeling, improve daily self-care ability, and have good safety.

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