本文選題：歸脾湯合生脈飲 + 室性早搏　； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的觀察歸脾湯合生脈飲加減對(duì)心脾兩虛證室性早搏患者的臨床療效及安全性,初步探索和分析其作用機(jī)制,為其臨床應(yīng)用提供科學(xué)依據(jù),為室性早搏的中醫(yī)治療提供安全有效的方藥,從而更好地服務(wù)于臨床。方法選取自2015年9月至2017年2月湖北省中醫(yī)院光谷院區(qū)心血管內(nèi)科住院部及門診符合西醫(yī)室性早搏診斷標(biāo)準(zhǔn)同時(shí)中醫(yī)辨證為心脾兩虛證患者50例。按照隨機(jī)分組的方法分為治療組25例和對(duì)照組25例。治療組:口服中藥湯劑歸脾湯合生脈飲加減治療,2次/日,早中餐后各溫服。對(duì)照組:口服西藥琥珀酸美托洛爾緩釋片(倍他樂(lè)克)[阿斯利康制藥有限公司]規(guī)格:47.5mg*7片,起始量為23.75mg,每天一次,根據(jù)血壓、心率變化,逐步調(diào)整劑量,療程均為4周。觀察治療前后中醫(yī)證侯及舌脈、中醫(yī)證侯積分及24小時(shí)動(dòng)態(tài)心電圖早搏次數(shù)的變化,收集相關(guān)數(shù)據(jù)并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.室性早搏次數(shù)方面:兩組治療后室早總數(shù)均明顯減少,但治療后組間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);2.室早總療效方面:治療組治療后總有效率為76%,對(duì)照組總有效率為80%,組間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明治療后兩組無(wú)明顯差異;3.中醫(yī)證侯方面:治療組及對(duì)照組都能有效改善早搏中醫(yī)癥狀,但治療組明顯優(yōu)于對(duì)照組(P0.05),以心悸氣短、神疲乏力、納呆食少、面色無(wú)華改善更明顯,兩組在頭暈?zāi)垦�、少寐多�?mèng)、腹脹便溏改善方面無(wú)明顯差異(P0.05);4.中醫(yī)證侯積分總療效方面:治療后治療組顯效率60%,有效率28%,總有效率88%,對(duì)照組顯效率28%,有效率36%,總有效率為64%,兩組相比,治療組優(yōu)于對(duì)照組(P0.05);5.安全性方面:治療組在服用中藥過(guò)程中,患者未出現(xiàn)嚴(yán)重不良反應(yīng),全程定期監(jiān)測(cè)血尿糞三大常規(guī)、肝腎功能、凝血功能等安全性指標(biāo),無(wú)明顯變化。結(jié)論1.歸脾湯合生脈飲加減能明顯改善心脾兩虛證室性早搏患者的中醫(yī)證侯,其中以心悸氣短、神疲乏力、納呆食少、面色無(wú)華改善更明顯;2.歸脾湯合生脈飲加減能明顯減少室性早搏患者的早搏次數(shù);3.歸脾湯合生脈飲加減在治療室性早搏過(guò)程中未發(fā)現(xiàn)明顯不良反應(yīng)和毒副作用,說(shuō)明了其安全性和有效性。
[Abstract]:Objective To observe the clinical efficacy and safety of GUI PI decoction combined with Shengmai drink on ventricular premature beat of two deficiency syndrome of heart and spleen, preliminary exploration and analysis of its mechanism of action, provide scientific basis for its clinical application, provide a safe and effective prescription for the treatment of ventricular premature beat, so as to better serve the clinic. Methods from September 2015 to 2017 are selected. In February, the hospitalization department and outpatient department of the Department of cardiovascular medicine in Optics Valley Hospital of Hubei Provincial Traditional Chinese Medical Hospital were in accordance with the diagnostic criteria of Western medicine ventricular premature beat. At the same time, the TCM syndrome was divided into 50 patients with two deficiency syndrome of heart and spleen. The treatment group was divided into 25 cases and 25 cases in the control group. The treatment group was treated with Decoction of Chinese medicine and decoction of Chinese medicine, combined with Shengmai Decoction, 2 times / day, and early Chinese meal. The control group: the control group: oral western medicine Metoprolol Succinate Sustained-release Tablets (Betaloc) [AstraZeneca Pharmaceutical Co., Ltd.] specifications: 47.5mg*7 tablets, the initial amount of 23.75mg, once a day, according to the blood pressure, heart rate changes, gradually adjust the dose, the course is 4 weeks. Observe and treatment of TCM syndrome and tongue vein, TCM syndrome score and 24 hour movement The changes in the frequency of premature beat of the electrocardiogram were collected and analyzed statistically. Results the number of 1. ventricular premature beats decreased significantly in the two groups after treatment, but there was no significant difference between the groups after treatment (P0.05); the total effective rate in the 2. compartment was 76% after treatment and the total effective rate of the control group was 80%. The total effective rate of the control group was 80%. There was no statistical significance (P0.05), indicating that there was no significant difference between the two groups after the treatment. 3. the treatment group and the control group could effectively improve the symptoms of traditional Chinese medicine, but the treatment group was significantly better than the control group (P0.05), with palpitation shortness of breath, the weakness of God, the lack of food, the improvement of the color without China, and the two groups in dizziness, insomnia and many dreams, and abdomen. There was no significant difference in swelling and loose stool improvement (P0.05); 4. the total curative effect of TCM syndrome score: after treatment, the effective rate was 60%, the effective rate was 28%, the total effective rate was 88%, the control group was 28%, the effective rate was 36%, the total effective rate was 64%, the treatment group was superior to the control group (P0.05) compared with the control group (5.); 5. safety aspects: the treatment group was taking Chinese traditional medicine process, patients There was no serious adverse reaction. There was no obvious change in the safety indexes of three major routine hematuria excrement, liver and kidney function, blood coagulation function and so on. Conclusion 1. guanpi decoction combined with Shengmai drink can obviously improve the TCM syndrome of the patients with ventricular premature beat of two deficiency syndrome of heart and spleen. 2. PWM and Shengmai Decoction can significantly reduce the number of premature beat in the patients with premature ventricular contractions, and the addition and subtraction of Shengmai Decoction and Shengmai Decoction in the therapeutic room have not found obvious adverse reactions and side effects in the process of sexual premature beat in the therapeutic room, indicating its safety and effectiveness.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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