摘要
目的探讨强心汤联合伊伐布雷定对心气不足、阳虚水泛型慢性心力衰竭(CHF)患者血流动力学、N端脑钠肽前体、内皮素(ET)及心率变异性的影响。方法将134例心气不足、阳虚水泛型CHF患者随机分为2组,对照组在标准CHF治疗的基础上给予伊伐布雷定治疗,治疗组在对照组治疗基础上给予强心汤治疗,2组均治疗4周。观察2组治疗前后射血充盈血流速转间期(FRI)、射血充盈血流速转率(FRR)、左心室射血期峰值流率(FRPE)、左室射血分数(LVEF)、左室舒张末期内径(LVDD)及血浆N端脑钠肽前体(NT-proBNP)、内皮素(ET)水平和心率变异性指标[全部窦性R-R间期的均方差(SDNN)、每5min窦性R-R平均值的标准差(SDANN)、SDNN均值(SDNNI)、全部窦性R-R技巧的均方根(RMSSD)]变化,统计2组临床治疗效果。结果治疗4周后,2组FRI、LVEDD、ET、NT-proBNP均较治疗前明显降低(P均<0.05),且治疗组上述指标均明显低于对照组(P均<0.05);2组FRR、FRPE、LVEF、SDNN、SDANN、SDNNI、RMSSD均较治疗前明显升高(P均<0.05),且治疗组上述指标均明显高于对照组(P均<0.05)。治疗组有效率为92.5%(62/67),显著高于对照组的79.1%(53/67)(P<0.05)。结论强心汤联合伊伐布雷定治疗心气不足、阳虚水泛型CHF可明显改善患者心功能,提高治疗效果,治疗机制可能与改善左心室血流动力学、心率变异性及降低NT-proBNP、ET水平相关。
Objective It is to investigate the effects of Qiangxin Decoction combined with ivabradine on hemodynamics, N-terminal pro-brain natriuretic peptide(NT-proBNP), endothelin(ET) and heart rate variability in patients with chronic heart failure(CHF) with syndrome of heart Qi deficiency and Yang deficiency with water flooding. Methods A total of 134 patients with CHF with syndrome of heart Qi deficiency and Yang deficiency with water flooding were randomly divided into two groups. The control group was treated with ivabradine on the basis of standard CHF treatment. The treatment group was treated with Qiangxin Decoction on the basis of the control group. Both groups were treated for 4 weeks. The changes of ejection and filling flow reversal interval(FRI), ejection filling flow reversal rate(FRR),flow rate in peak ejection(FRPE) of left ventricle, left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVDD) and levels of plasma NNT-proBNP, endothelin(ET), and heart rate variability [standard deviation of normal R-R intervals(SDNN), standard deviation of 5 min average normal RR intervals(SDANN), the SDNN index(SDNNI), and square root of the mean of the squared differences between adjacent normal RR intervals(RMSSD) were observed before and after treatment in the two groups], and the clinical effects of the two groups were statistically analyzed. Results After 4 weeks of treatment, the FRI, LVEDD, ET and NT-proBNP of the two groups were significantly lower while FRR, FRPE, LVEF, SDNN, SDANN, SDNNI and RMSSD were significantly higher than those before treatment(P<0.05), and the increase or decrease of the above indexes of the treatment group were more significant than those of the control group(P<0.05). The effective rate of the treatment group was 92.5%(62/67), which was significantly higher than that of the control group(79.1%, 53/67)(P<0.05). Conclusion Qiangxin Decoction combined with ivabradine can significantly improve the heart function and improve the therapeutic effect in the treatment of CHF with syndrome of heart Qi deficiency and Yang deficiency with water flooding. The treatment mechanism may be related to improving left ventricular hemodynamics, heart rate variability and reducing the levels of NT-proBNP and ET.
作者
夏加辉
李思宁
XIA Jiahui;LI Sining(The First Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, Guangdong, China;The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, Guangdong, China)
出处
《现代中西医结合杂志》
CAS
2019年第31期3463-3467,共5页
Modern Journal of Integrated Traditional Chinese and Western Medicine
关键词
慢性心力衰竭
伊伐布雷定
强心汤
血流动力学
内皮素
心率变异性
chronic heart failure
ivabradine
Qiangxin Decoction
hemodynamics
endothelin
heart rate variability
