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  本文選題：冠心病　切入點：利尿劑抵抗　出處：《湖南中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:觀察心康飲治療冠心病慢性心力衰竭利尿劑抵抗(心腎陽虛、宗氣下陷證)的臨床療效。方法:采用配對設(shè)計及開放型單向質(zhì)反應(yīng)序貫設(shè)計,選取符合冠心病心力衰竭伴利尿劑抵抗診斷,且中醫(yī)辨證屬心腎陽虛、宗氣下陷證的患者18例,配對成2組,治療組9例,對照組9例。在西醫(yī)抗心衰治療基礎(chǔ)上,分別給予與心康飲(治療組)或芪藶強心膠囊(對照組)口服,療程兩周,以每24h尿量的變化情況判定試驗的有效性,并據(jù)此繪制序貫試驗圖;同時觀察比較兩組患者治療前后及兩組間,每24小時尿量、NT-pro BNP值、LVEF值、LVFS值、心功能分級、中醫(yī)證候積分的變化及安全性療效情況。結(jié)果:1.序貫試驗治療組病例中除第4例無效外,余均為有效,實驗至第7例時,實驗線觸及上邊界線(p0.01),故接受該藥;對照組病例中除第3例、第4例及第7例無效外,余均有效,但實驗至最大估計樣本量第9例時,仍未觸及上邊界線(p0.01),故拒絕該藥。2.治療后第一周平均每24h尿量值均不同程度的增加,與治療前相比,差異均有統(tǒng)計學(xué)意義(P0.05);治療后第1天至第2周末,兩組之間比較差異有統(tǒng)計學(xué)意義(P0.05);提示兩組均有利尿作用,但治療組優(yōu)于對照組。3.NT-pro BNP值與治療前相比均不同程度的減小,差異有統(tǒng)計學(xué)意義(P0.05);治療后兩組之間比較,差異有統(tǒng)計學(xué)意義(P0.05)。4.LVEF值、LVFS值與治療前相比較均不同程度升高,差異均有統(tǒng)計學(xué)意義(P0.05);治療后兩組間比較,差異均有統(tǒng)計學(xué)意義(P0.05)。5.治療后兩組間心功能分級比較,差異有統(tǒng)計學(xué)意義(p0.05)。6.中醫(yī)證候積分與治療前比較,差異具有統(tǒng)計學(xué)意義(p0.05);治療后兩組間比較,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:從序貫設(shè)計上(定性),心康飲對改善心腎陽虛、宗氣下陷證冠心病利尿劑抵抗療效顯著,從兩組自身前后對照及配對設(shè)計上(定量),心康飲、芪藶強心膠囊對利尿劑抵抗均有療效,且心康飲療效更顯著,可在短期內(nèi)明顯增加患者24h尿量;兩組均能降低NT-pro BNP水平,提高LVEF、LVFS值,改善心功能分級,能從整體上改善患者的臨床癥狀,如心悸、氣短、面肢浮腫、尿少、畏寒肢冷等表現(xiàn),且心康飲療效顯著;兩者安全有效,無嚴重不良反應(yīng)。
[Abstract]:Objective: to observe the clinical effect of Xinkang decoction in the treatment of diuretic resistance (deficiency of heart and kidney yang, syndrome of qi depression) in patients with coronary heart disease. Eighteen patients with heart failure and diuretic resistance diagnosed according to coronary heart disease and syndrome differentiation of heart and kidney yang and depression of qi were selected and matched into two groups: treatment group (n = 9) and control group (n = 9). On the basis of western medicine anti-heart failure treatment, the patients were divided into two groups: treatment group (n = 9) and control group (n = 9). They were given orally with Xinkang Yin (treatment group) or Qiliqiangxin capsule (control group) for two weeks. The efficacy of the test was determined by the change of urine volume per 24 hours, and the sequential test map was drawn accordingly. At the same time, before and after treatment and between the two groups, the NT-pro BNP value, LVEF value and cardiac function grade were observed and compared between the two groups. Results: 1. In the sequential trial group, except the fourth case was invalid, all the other cases were effective. In the 7th case, the experimental line reached the upper boundary line and p0.01, so it was accepted. In the control group, except the third case, the fourth case and the seventh case were ineffective, but the experiment was up to the 9th case of the maximum estimated sample size. The above boundary line was still not reached, so the drug was rejected. 2. The mean urine volume per 24 hours after treatment increased to different degrees, and the difference was statistically significant compared with that before treatment, from the first day to the second week after treatment, there was a significant difference in urine volume between the first day and the second week after treatment, and the difference was significant between the first day and the second week after treatment. The difference between the two groups was statistically significant (P 0.05), indicating that both groups had diuretic effect, but the value of NT-pro BNP in the treatment group was better than that in the control group, and the difference was statistically significant (P 0.05). The difference was statistically significant (P 0.05). 4. LVEF and LVFS were significantly higher than those before treatment (P 0.05), and there were significant differences between the two groups after treatment (P 0.05). After treatment, there were significant differences between the two groups in cardiac function grading, and there was no significant difference between the two groups after treatment, and there was no significant difference between the two groups (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05). The difference was statistically significant (P 0.05). The difference between TCM syndromes and pre-treatment was statistically significant (P 0.05), and the difference between the two groups was statistically significant (P 0.05). Conclusion: from the sequential design (qualitative analysis, Xinkang Yin can improve the deficiency of heart and kidney yang), The effect of diuretic resistance to coronary heart disease in Zongqi depression syndrome was significant, and the therapeutic effect of Xinkangyin and Qiliqiangxin capsule on diuretic resistance was more significant than that of control group before and after control and matched design (quantitative, Xinkang Yin, Qiliqiangxin capsule), and the effect of Xinkangyin was more significant. Both groups could decrease the level of NT-pro BNP, increase the value of LVEF BNP, improve the classification of cardiac function, and improve the clinical symptoms of the patients, such as palpitation, shortness of breath, edema of face limb, less urine, cold cold of cold limb, etc. Xinkangyin was effective and safe, and had no serious adverse reactions.
【學(xué)位授予單位】：湖南中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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