升阳活血利水法联合西药治疗...中医症状积分及心功能的影响_孙善动.pdf

参考文献1 李想,何志义.病毒性脑炎继发自身免疫性脑炎的研究进展J.中国临床神经科学,2020,28(5):584-589,594.2 宋春兰,成怡冰,崔亚杰,等.重症 EB 病毒性脑炎一例 J.中华传染病杂志,2020,38(9):590-593.3 中华医学会.临床诊疗指南:神经病学分册 M.北京:人民卫生出版社,2009,134-136.4 国家中医药管理局.中医病证诊断疗效标准 S.南京:南京大学出版社,1994:159-161.5 程云,杨武.病毒性脑炎患儿发生神经系统后遗症的危险因素及其 Logistic 回归预测模型的构建 J.医学综述,2020,26(17):3522-3526.6冯刚.菖蒲郁金汤辅助治疗重症病毒性脑炎对神经功能、S100B、NSE 的影响 J.中华中医药学刊,2019,37(7):1744-1746.7 谢秋桂,周旭.脑电图联合血清 NSE、MBP 对病毒性脑炎的诊断及病情评估价值 J.标记免疫分析与临床,2018,25(9):1297-1300.8 白春峰,管敏仓,吕静,等.病毒性脑炎患儿神经功能指标和sICAM-1 分析 J.中华医院感染学杂志,2019,29(19):2943-2947.9 刘新生,李时光,王昆,等.NSE、S100 蛋白及 PCT 在寻常脑炎中的鉴别价值 J.中华全科医学,2020,18(1):37-40.10 方思思,罗兰,周海银,等.病毒性脑炎患儿神经元特异性烯醇化酶、髓鞘碱性蛋白、S-100 蛋白水平及临床意义 J.实用临床医药杂志,2020,24(17):89-91,95.11 李永春,张迎辉.肠道病毒性脑炎患儿外周血 T 淋巴细胞亚群与自然杀伤细胞及相关免疫细胞因子水平变化 J.中华实用诊断与治疗杂志,2020,34(1):52-55.12 梁丽,王利,李丹,等.中枢神经系统感染患儿血清和脑脊液CRP、PCT、TNF-及 MMP-9 水平及其临床意义 J.现代生物医学进展,2020,20(3):497-501.13 郭美彤,赵佳奇,韩诚,等.石菖蒲药效物质基础和作用机制研究进展 J.中药药理与临床,2019,35(2):179-184.14 葛翎,黄晓德,张峰伦,等.郁金香的化学成分及药理活性研究进展 J.中国野生植物资源,2019,38(5):79-83.15 高汉媛,史正刚,李小芹,等.菖蒲郁金汤对 TS 模型大鼠抗抽动效应及脑组织 IL-6、TNF-的影响 J.中药药理与临床,2017,33(01):135-138.16 李金萍,唐俊.菖蒲郁金汤联合丙种球蛋白治疗小儿病毒性脑炎疗效观察 J.中医学报,2018,33(8):1519-1523.(收稿日期 2021-03-22)基金项目:安徽省教育厅,安徽高校自然科学研究项目重点项目(KJ2020A0400)。作者简介:孙善动,硕士,副主任中医医师,研究方向:中医内科,E-mail:ssd416849346 。升阳活血利水法联合西药治疗慢性心衰疗效及对中医症状积分及心功能的影响孙善动1,周成胜1,甘小双1,叶挺2(1.宿州市中医医院全科医学科,安徽 宿州 234000;2.宿州市中医医院心病科,安徽 宿州 234000)摘要:目的:探讨升阳活血利水法联合西药治疗慢性心力衰竭(简称“慢性心衰”)患者的疗效及其对中医症状积分、心功能的影响。方法:选取 2019 年 5 月2021 年 6 月本院收治的 84 例慢性心力衰竭患者,随机数字表法将患者分为对照组(n=42)和观察组(n=42),对照组给予西药治疗,观察组在对照组基础上联合升阳活血利水法治疗,比较两组临床疗效、中医症状积分、心功能、心肌能量消耗值(MEE)、6 分钟步行距离(6-MWD)、N 端脑钠肽前体(NT-proBNP)以及不良反应发生情况。结果:观察组临床总有效率 92.86%高于对照组的 76.19%(P0.05);治疗后观察组气喘、乏力、心悸、气短、畏寒肢冷中医症状积分均低于对照组(P0.05);治疗后观察组心搏量、左室射血分数、左室收缩末期内径、左室舒张末期内径各心功能指标和 MEE、6-MWD、NT-proBNP 水平均优于对照组(P0.05);治疗后血小板聚集率(PAgT)降低,组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制因子 1(PAI-1)升高,观察组水平优于对照组(P0.05)。结论:升阳活血利水法联合西药治疗慢性心衰可有效改善患者临床症状,并可调节心功能及 NT-proBNP 水平,促进运动恢复,且安全性好。关键词:慢性心力衰竭;升阳活血利水法;中医症状积分;心功能 中图分类号:R 541.6 文献标志码:A 文章编号:1000-3649(2023)02-0094-04 Curative Effect of Applying Raising Yang,Activating Blood and Promoting Diuresis Method Combined with West-ern Medicine in the Treatment of Patients with Chronic Heart Failure and Its Influence on Traditional Chinese MedicineSymptom Scores and Cardiac Function/SUN Shandong,ZHOU Chengsheng,GAN Xiaoshuang,et al./1.Department ofGeneral Practice,Suzhou Municipal Hospital of Traditional Chinese Medicine(Suzhou Anhui 234000,China);2.Department of49四 川 中 医Journal of Sichuan of Traditional Chinese Medicine2023 年第 41 卷第 2 期Vol.41,No.2,2023Cardiology,Suzhou Municipal Hospital of Traditional Chinese Medicine(Suzhou Anhui 234000,China)Abstract:Objective:To investigate the curative effect of applying raising Yang,activating blood and promoting diuresismethod combined with western medicine in the treatment of patients with chronic heart failure(CHF),and its influence on TCMsymptom scores and cardiac function.Methods:84 patients with CHF admitted to the hospital between May 2019 and June 2021were selected.They were divided into a controlled group(n=42)and an observation group(n=42)by the random number tablemethod.All patients were treated with western medicine.On this basis,patients in the observation group were treated by raisingYang,activating blood and promoting diuresis method.The two groups were compared in terms of TCM symptom scores,cardiacfunction,myocardial energy expenditure(MEE),6-minute walking distance(6-MWD),N-terminal prohormone of brain natri-uretic peptide(NT-proBNP)and adverse reactions.Results:The total clinical response rate of the observation group(92.86%)was higher than that of the controlled group(76.19%)(P0.05).After treatment,the TCM symptom scores of asthma,fa-tigue,palpitations,shortness of breath,intolerance of cold and cold limbs in the observation group were lower than those in thecontrolled group(P0.05).After treatment,cardiac function indicators(stroke volume,left ventricular ejection fraction,leftventricular end-systolic diameter,left ventricular end-diastolic diameter),MEE,6-MWD and NT-proBNP level in the observa-tion group were better than those in the controlled group(P0.05).After treatment,platelet aggregation rate(PAgT)de-creased,tissue-type plasminogen activator(t-PA)and plasminogen activator inhibitor-1(PAI-1)increased,and these indica-tors in the observation group were better than those in the controlled group group(P0.05).Conclusion:Raising Yang,activating bloodand promoting diuresis method combined with western medicine for treating CHF can effectively improve clinical symptoms,regu-late cardiac function and NT-proBNP level,and promote exercise recovery of the patients,with good safety.Keywords:Chronic heart failure;Raising Yang,activating blood and promoting diuresis method;TCM symptom score;Cardiac function中医认为慢性心力衰竭(简称“慢性心衰”)主要与心失所养、气虚亏虚有关,而心主血脉,其发病一为心脏自病,二为他脏之病累及心,从而造成气血阴阳诸虚、六淫外邪犯心对心脏形成损伤发病。气血不足可导致血行不畅,不畅则瘀滞不通,不通则痛,可有气短、胸闷不畅表现1,2。现代医学在慢性心衰发病、治疗中虽有一定研究,但临床治疗靶点仍然较为单一,尚无特效治疗方式,患者远期预后不佳。随着中医药的发展,其在慢性心衰中疗效显著,当和西药联合治疗时可发挥协同作用,提升临床效果,临床意义重大。本研究旨