参附强心汤治疗射血分数保留慢性心衰的临床研究

摘要

OBJECTIVE To study the effect of Shenfu Qiangxin Decoction on echocardiography indexes and clinical improvement for patients with chronic heart failure with preserved ejection fraction (HFPEF) (deficiency of both yin and yang,blood stasis and water retention),and to investigate its possible mechanism.METHODS 57 patients visited in our hospital and diagnosed as chronic HFPEF (deficiency of both yin and yang,blood stasis and water retention) from Aug.2014 to Aug.2015 were selected and randomly divided into the control group (28 cases) and the observation group (29 cases).The control group was given conventional therapy,and the treatment group was treated with Shenfu Qiangxin Decoction on the basis of conventional therapy,and two weeks as a course in both groups.Efficacy evaluation was performed after one course treatment.Indexes changes such as plasma brain natriuretic peptide (BNP),6-minute walk test (6MWT) and echocardiography in two groups were observed before and after treatment.RESULTS Plasma BNP and 6MWT in both groups improved after treatment (P<0.05~0.01),but the observation group decreased more significantly (P<0.05).Echocardiographic indexes showed that the size of left atrial (LAD) in both groups were not significantly improved (P>0.05),The ratio of early diastolic maximum flow velocity of mitral annulus (E peak)/early diastolic maximum velocity of tricuspid annular interventricular septum and left ventricular lateral wall tissue (Ea) and pulmonary arterial systolic pressure (PSA) of patients in two groups improved significantly(P<0.05~0.01),change extent of the observation group was more significant compared with the control group (P<0.05).CONCLUSION Shenfu Qiangxin Decoction can effectively improve plasma BNP level,6MWT,and echocardiography of patients with chronic HFPEF.%目的 观察参附强心汤对射血分数保留的慢性心衰(阴阳两虚,水瘀内停证)患者超声心动图指标的影响及临床疗效情况,并初步探讨其作用机制.方法 选取2014年8月-2015年8月来我院治疗并经检查确诊为射血分数保留的慢性心功能不全(阴阳两虚,水瘀内停证)的患者57例,随机分为对照组(28例)和观察组(29例).对照组给予常规治疗,观察组在常规治疗基础上加用参附强心汤,2组均2周为1个疗程,1个疗程后进行疗效评估.观察2组治疗前后血浆脑钠肽(BNP)、6min步行距离(6MWT)、超声心动图等指标变化.结果 2组治疗后血浆BNP、6MWT均有改善(P<0.05~0.01),但观察组下降显著(P<0.05);超声心动图指标中左房(LAD)大小2组均未明显改善(P>0.05),二尖瓣环舒张早期最大血流速度(E峰)/二尖瓣环室间隔及左室侧壁组织舒张早期最大速度(Ea)比值、肺动脉收缩压(PSA)2组患者均有明显改善(P<0.05~0.01),与对照组相比,观察组变化幅度更为显著(P<0.05).结论 参附强心汤能有效改善射血分数保留的慢性心功能不全患者血浆BNP水平、6min步行距离、超声心动图等指标.