【摘要】：目的:原發(fā)性高血壓簡(jiǎn)稱高血壓病,主要臨床表現(xiàn)就是血壓升高。它的患病率和發(fā)病率因國(guó)度、地域和種族的差別而有不同,當(dāng)前在我國(guó)高血壓成人患病率為18.8%,中年人群中患病率為24%。高血壓發(fā)展到晚期可形成心、腦、腎等靶器官的損害,使病人的的發(fā)病率、死亡率很高,嚴(yán)重影響患者的壽命、生活質(zhì)量,已經(jīng)成為嚴(yán)重威脅人類健康、性命的疾病。在我國(guó)40歲以上人群的死亡原因中,第一位和第三位分別是心臟病和腦血管病,而高血壓是總死亡的第一危險(xiǎn)因素。如何安全、有效地防治高血壓病是廣大患者所關(guān)注的焦點(diǎn),也是臨床醫(yī)師研究的主要課題之一。研究表明中、西醫(yī)結(jié)合比單獨(dú)的中醫(yī)或西醫(yī)的應(yīng)用,可以增強(qiáng)身體對(duì)抗高血壓藥物的敏感性,減少靶器官損傷,取得較好的療效。本課題主要通過進(jìn)行對(duì)化痰通絡(luò)活血方的臨床觀察,探討高血壓病的中醫(yī)藥治療效果以及應(yīng)用前景。方法:將80例符合診斷標(biāo)準(zhǔn)的病人隨機(jī)分成中西藥組和西藥組進(jìn)行臨床觀察,兩組病人的一般情況無(wú)統(tǒng)計(jì)學(xué)差異。西藥組40例,給予苯磺酸氨氯地平(絡(luò)活喜、輝瑞制藥有限公司,國(guó)藥準(zhǔn)字H10950224),每次5mg,每日一次口服;中西藥組共40例,給予化痰通絡(luò)活血方(半夏10克,陳皮10克,天麻10克,炒白術(shù)10克,桃仁10克,紅花10克,當(dāng)歸10克,白芍15克,川芎10克,葛根30克,全蟲6克,蜈蚣2條),每日一劑,分早晚兩次口服;同時(shí)服用苯磺酸氨氯地平,每次5mg,每日一次口服;療程為4周。兩組病人經(jīng)西醫(yī)診斷均屬高血壓病,中醫(yī)辯證均屬痰瘀互結(jié)型。治療期間觀察病人的生命體征、血壓、臨床癥狀以及血糖,血脂,C反應(yīng)蛋白,血液流變學(xué),血漿腎素及血管緊張素Ⅱ等相關(guān)指標(biāo)的變化情況,觀察期間停服對(duì)血壓有影響的所有藥物。在治療前后各對(duì)病人做1次安全性檢查,結(jié)果:1兩組患者血壓變化情況比較治療前血壓水平比較無(wú)顯著性差異(P0.05),兩組在治療后收縮壓、舒張壓水平較治療前均有顯著性差異(P0.01),中西藥組較之西藥組治療后收縮壓、舒張壓降低更為明顯,有顯著性差異(P0.05)。表明中西藥組的血壓較西藥組下降持續(xù)、穩(wěn)定,說明加用化痰通絡(luò)活血方的中西藥組降壓效果比單用西藥組的降壓效果更明顯。2兩組患者治療前后動(dòng)態(tài)血壓平均值測(cè)定比較治療前兩組間收縮壓及舒張壓平均值比較無(wú)顯著性差異(P0.05);治療后同治療前比較,兩組均有顯著性差異(P0.05);治療后比較,中西藥組收縮壓及舒張壓平均值改善均優(yōu)于西藥組,有顯著性差異(P0.05)。表明加用化痰通絡(luò)活血方組高血壓病人的降壓效果優(yōu)于單用西藥組。3兩組患者降壓療效比較中西藥組顯效28例(70.00%),有效10例(25.00%),無(wú)效2例(5.00%),總有效率95.00%;西藥組顯效26例(65.00%),有效6例(15.00%),無(wú)效8例(20.00%),總有效率80.00%。兩組降壓療效的總有效率經(jīng)過比較,差異具有顯著性(P0.05)。表明加用化痰通絡(luò)活血方的降壓療效優(yōu)于單用西藥組。4兩組患者臨床癥狀療效比較中西藥組顯效30例(75.00%),有效6例(15.00%),無(wú)效4例(10.00%),總有效率90.00%;西藥組顯效10例(25.00%),有效16例(40.00%),無(wú)效14例(35.00%),總有效率65.00%。兩組相比有顯著性差異(P0.01)。說明加用化痰通絡(luò)活血方的中西藥組在改善臨床癥狀的治療效果明顯優(yōu)于單用西藥組。5兩組患者治療前后空腹血糖、血脂測(cè)定比較治療后中西藥組在血糖、膽固醇、甘油三酯、低密度脂蛋白較治療前均有明顯降低(P0.05),而且在治療后對(duì)兩組的各項(xiàng)指標(biāo)做同期比較,兩者間有顯著性差異(P0.05),但西藥組的各項(xiàng)指標(biāo)治療前后差異無(wú)統(tǒng)計(jì)學(xué)意義。說明加用化痰通絡(luò)活血方組在促進(jìn)血糖代謝和改善脂質(zhì)代謝紊亂的治療效果優(yōu)于單用西藥組。6兩組患者治療前后血液流變學(xué)比較治療后與治療前相比,中西藥組纖維蛋白原及全血粘度明顯降低(P0.05),纖維蛋白原與西藥組治療后比較有顯著性差異(P0.05);西藥組各項(xiàng)指標(biāo)變化無(wú)統(tǒng)計(jì)學(xué)意義。表明加用化痰通絡(luò)活血方的中西藥組降低血液粘度的效果優(yōu)于單用西藥組。7兩組患者治療前后C反應(yīng)蛋白測(cè)定比較治療前兩組間C反應(yīng)蛋白比較無(wú)顯著性差異(P0.05);治療后較治療前比較,兩組均有顯著性差異(P0.05);治療后比較,中西藥組C反應(yīng)蛋白降低明顯優(yōu)于西藥組,有顯著性差異(P0.05),表明加用化痰通絡(luò)活血方組降低C反應(yīng)蛋白的效果優(yōu)于單用西藥組。8兩組患者治療前后腎素、血管緊張素Ⅱ測(cè)定的比較治療前兩組腎素、血管緊張素Ⅱ測(cè)定比較無(wú)顯著性差異(P0.05);治療后同治療前比較,中西藥組下降明顯,有顯著性差異(P0.05);西藥組上升明顯,有顯著性差異(P0.05)。治療后兩組比較,有顯著性差異(P0.01)。說明加用化痰通絡(luò)活血方的中西藥組能明顯降低血漿腎素、血管緊張素Ⅱ水平,抑制了腎素活性和血管緊張素Ⅱ的生成。9不良反應(yīng)僅西藥組2例出現(xiàn)輕度踝部水腫,可耐受;兩組均未發(fā)現(xiàn)肝腎功能受損等其它不良反應(yīng)。結(jié)論:本課題臨床研究結(jié)果表明:加用化痰通絡(luò)活血方的中西醫(yī)治療較單獨(dú)西藥治療原發(fā)性高血壓具有明顯的優(yōu)勢(shì)。1加用化痰通絡(luò)活血方組對(duì)于痰瘀互結(jié)型高血壓病有顯著療效,降壓效果明顯優(yōu)于單用西藥組。2加用化痰通絡(luò)活血方與單用西藥苯磺酸氨氯地平的對(duì)比結(jié)果,證實(shí)了中西藥組在改善癥狀(如頭暈、頭痛等)、減少危險(xiǎn)因素(如血糖、血脂等)方面明顯優(yōu)于單用西藥組。3化痰通絡(luò)活血方可能是通過抑制了腎素活性和血管緊張素Ⅱ的生成、有效降低血液粘度、降低C反應(yīng)蛋白、促進(jìn)血糖代謝和改善脂質(zhì)代謝紊亂等因素來有效降低血壓和改善臨床癥狀,從而控制高血壓病的發(fā)生與發(fā)展以及延緩并發(fā)癥的發(fā)生。
[Abstract]:Objective:Essential hypertension is called hypertension for short.Its main clinical manifestation is elevated blood pressure.Its prevalence and incidence are different according to different countries,regions and races.At present,the prevalence rate of hypertension in China is 18.8% in adults and 24% in middle-aged people.Hypertension can cause damage to target organs such as heart,brain and kidney in advanced stage. As a result, the morbidity and mortality of the patients are very high, which seriously affects the life span and quality of life of the patients, and has become a serious threat to human health and life of the disease. Effective prevention and treatment of hypertension is the focus of attention of the majority of patients and one of the main topics of clinical physicians. Research shows that the combination of Chinese and Western medicine can enhance the body's sensitivity to antihypertensive drugs, reduce target organ damage, and achieve better results than the application of traditional Chinese medicine or western medicine alone. Methods: 80 cases of hypertension were randomly divided into Chinese and Western medicine group and Western medicine group for clinical observation. There was no significant difference in the general situation between the two groups. 40 cases in Western medicine group were given amlodipine besylate (Luohuoxi, Pfizer). Pharmaceutical Co., Ltd., the Chinese character H10950224, 5 mg each time, oral once a day; Chinese and Western medicine group, a total of 40 cases, given Huatan Tongluo Huoxue prescription (Banxia 10 grams, Chen Pei 10 grams, Gastrodia 10 grams, fried Atractylodes macrocephala 10 grams, peach kernel 10 grams, safflower 10 grams, Angelica 10 grams, white peony 15 grams, Chuanxiong 10 grams, Pueraria 30 grams, whole worm 6 grams, centipede 2), oral twice a day, morning and evening. The two groups of patients were diagnosed as hypertension by Western medicine, and they belonged to the syndrome of phlegm and blood stasis. The vital signs, blood pressure, clinical symptoms and blood glucose, blood lipids, C-reactive protein, hemorheology, plasma renin and vascular tension were observed during the treatment. The changes of blood pressure and other related indicators were observed. All the drugs that had effect on blood pressure were stopped during the observation period. The patients were checked for safety before and after treatment. Results: 1. There was no significant difference in blood pressure between the two groups before and after treatment (P 0.05). The systolic blood pressure and diastolic blood pressure in the Chinese and Western medicine group were significantly lower than those in the Western medicine group (P 0.05). The results showed that the blood pressure in the Chinese and Western medicine group decreased continuously and steadily compared with the Western medicine group, indicating that the hypotensive effect of the Chinese and Western medicine group with Huatan Tongluo Huoxue Fang was more obvious than that of the western medicine group alone. Before and after treatment, there was no significant difference between the two groups in systolic blood pressure and diastolic blood pressure (P The results showed that the effect of Huatan Tongluo Huoxue Decoction on hypertension was better than that of Western medicine alone. 3 Compared with western medicine group, 28 cases (70.00%), 10 cases (25.00%) were effective, 2 cases (5.00%) were ineffective, the total effective rate was 95.00%; 26 cases (65.00%), 6 cases (15.00%) were effective, 8 cases (20.00%) were ineffective, and the total effective rate was 80.00%. The total effective rate of antihypertensive therapy in the two groups was significantly different (P 0.05). The results showed that the antihypertensive effect of Huatan Tongluo Huoxue Fang was better than that of the western medicine alone. 16 cases (40.00%) were effective, 14 cases (35.00%) were ineffective, the total effective rate was 65.00%. There was a significant difference between the two groups (P 0.01). It showed that the treatment effect of Chinese and Western medicine plus Huatan Tongluo Huoxue Recipe on improving clinical symptoms was significantly better than that of Western medicine alone. The levels of sterol, triglyceride and low density lipoprotein were significantly lower than those before treatment (P 0.05), and there was significant difference between the two groups after treatment (P 0.05). However, there was no significant difference between the two groups before and after treatment. The therapeutic effect of lipid metabolism disorder was better than that of Western medicine alone. 6 Compared with before and after treatment, the fibrinogen and whole blood viscosity of the two groups decreased significantly (P 0.05), and there was significant difference between the fibrinogen and Western medicine groups (P 0.05). The results showed that the effect of Huatan Tongluo Huoxue Decoction on reducing blood viscosity was better than that of Western medicine alone.7 There was no significant difference in C-reactive protein between the two groups before and after treatment (P 0.05), and there was significant difference between the two groups after treatment (P 0.05). The decrease of CRP in western medicine group was significantly better than that in western medicine group (P After treatment, the levels of plasma renin, angiotensin II and renin were significantly decreased in the Chinese and Western medicine group (P 0.05), and significantly increased in the Western medicine group (P 0.05). The adverse reactions of activity and angiotensin II were mild ankle edema and tolerable in 2 cases of Western medicine group, and no other adverse reactions such as liver and kidney function impairment were found in both groups. Superiority.1 Additional Huatan Tongluo Huoxue Recipe group for phlegm and blood stasis type of hypertension has a significant effect, hypotensive effect is significantly better than the western medicine group.2 Additional Huatan Tongluo Huoxue Recipe and the western medicine Amlodipine Benzenesulfonate alone in the comparison of the results confirmed that the Chinese and Western medicine group in improving symptoms (such as dizziness, headache, etc.), reduce risk factors (such as blood sugar, blood sugar, blood circulation, etc.). 3. Huatan Tongluo Huoxue Decoction can effectively reduce blood pressure and improve clinical symptoms by inhibiting renin activity and angiotensin II production, effectively reducing blood viscosity, lowering C-reactive protein, promoting blood glucose metabolism and improving lipid metabolism disorders, and so on. Occurrence and development, and delay the occurrence of complications.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R544.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳啟鋒,熊尚全,溫茂詳,楊永東,蘭東輝;高血壓病中醫(yī)證型與鹽敏感性及胰島素抵抗關(guān)系臨床研究[J];福建中醫(yī)藥;2002年03期

2 杜林;中西醫(yī)結(jié)合治療頑固性原發(fā)性高血壓45例[J];國(guó)醫(yī)論壇;2004年03期

3 湯發(fā)琪;;中西醫(yī)結(jié)合治療原發(fā)性高血壓病58例總結(jié)[J];湖南中醫(yī)雜志;2006年04期

4 王培興;;中醫(yī)對(duì)高血壓病的辨證防治[J];遼寧中醫(yī)雜志;2006年01期

5 白春錦,周瀛,王麗,張德龍,楊瀅;不同中醫(yī)證型高血壓患者的心血管危險(xiǎn)因素分層、高血壓分期、分級(jí)及血脂等指標(biāo)變化特征[J];中國(guó)臨床康復(fù);2005年23期

6 齊連芬;胡元會(huì);方業(yè)明;石潔;;老年高血壓中醫(yī)辨證分型與24小時(shí)血壓變化水平相關(guān)性探討[J];中國(guó)中醫(yī)藥信息雜志;2009年01期

7 李玉芬,陳燕,戚其學(xué);高血壓患者血液流變學(xué)變化及臨床意義[J];中國(guó)醫(yī)科大學(xué)學(xué)報(bào);2002年04期

8 彭麗輝,馮玲媚,陳筑芳,蔡偉,楊春英,張軍,謝敏,楊丹;艾灸對(duì)高血壓病患者血壓及NO、ET、SOD、MDA的影響[J];中國(guó)針灸;2004年03期

9 陳淑芬;董強(qiáng);;動(dòng)脈粥樣硬化的早期生化標(biāo)志物[J];中國(guó)卒中雜志;2007年10期

10 陳國(guó)英;劉德桓;向成彬;;高血壓病中醫(yī)證型與腦卒中神經(jīng)功能缺損程度的相關(guān)性研究[J];中華中醫(yī)藥學(xué)刊;2008年02期

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