本文選題：肺動脈高壓 + 右心衰竭��； 參考：《山東中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:通過對益氣活血方治療肺動脈高壓(pulmonary hypertension,簡稱PH)導(dǎo)致的右心衰竭氣虛血瘀證的臨床研究,觀察其對PH導(dǎo)致的右心衰竭的肺動脈收縮壓,血Pro-BNP,右室射血分?jǐn)?shù),心功能分級,六分鐘步行試驗(yàn)的影響及用藥安全性。方法:采用隨機(jī)、開放、對照的方法,根據(jù)納入病例標(biāo)準(zhǔn),選取60例由肺動脈高壓導(dǎo)致右心衰竭的患者,隨機(jī)分成2組,西藥對照組和中藥治療組(治療組),不改變平素生活習(xí)慣,西藥對照組30例,給予西藥常規(guī)治療:地高辛0.125mg po qd,呋噻米片20mg po qd,螺內(nèi)酯片20mg po qd,西地那非25mg po tid。中藥治療組則在西藥常規(guī)治療的基礎(chǔ)上加用中藥益氣活血方,日一劑,早晚分服。兩組均給予2個療程(4周一個療程)治療后,觀察患者治療前后肺動脈收縮壓,血Pro-BNP,右室射血分?jǐn)?shù),心功能分級,六分鐘步行試驗(yàn)的變化,從而進(jìn)行療效評定。結(jié)果:1.心功能方面,兩組對比顯示右心功能,治療組和西藥對照組在治療后都有明顯改善,但治療組的改善優(yōu)于西藥對照組,治療組和西藥對照組差異有統(tǒng)計學(xué)意義,說明治療組可明顯提高右室射血分?jǐn)?shù);2.在肺動脈高壓方面:心臟彩超示兩組患者在治療后肺動脈高壓都有降低,但治療組降低幅度高于西藥對照組,兩組差異有統(tǒng)計學(xué)意義,但差距較小;3.Pro-BNP在治療后,兩組患者都有明顯降低,治療組優(yōu)于西藥對照組;4.六分鐘步行試驗(yàn)結(jié)果治療前后比較:治療后兩組患者步行距離都有增加,治療組優(yōu)于西藥對照組,兩組結(jié)果有統(tǒng)計學(xué)差異。5.中醫(yī)癥候療效比較中,治療組患者顯效12例,有效16例,無效2例,加重0例,總有效率93.99%,西藥對照組顯效4例,有效22例,無效4例,加重0例,總有效率83.33%,治療組有效率高于對照組;中醫(yī)癥候積分通過秩和檢驗(yàn)治療組優(yōu)于對照組,有統(tǒng)計學(xué)意義。6.心衰療效比較中:治療組顯效14例,有效14例,無效2例,加重0例,總有效率93.33%,對照組顯效6例,有效20例,無效4例,加重0例,總有效率86.67%,治療組有效率優(yōu)于對照組,心衰中醫(yī)積分通過秩和檢驗(yàn)治療組優(yōu)于對照組。7.在心功能分級方面,兩組患者治療后均有改善,治療組改善優(yōu)于對照組,但差距并不明顯。結(jié)論:益氣活血法在治療PH所致右心衰竭的治療中,能顯著的改善癥狀,明顯的降低肺動脈高壓、Pro-BNP水平,提高六分鐘步行試驗(yàn)值改善患者心功能,是治療PH所致右心衰竭的不容忽視的方法。
[Abstract]:Objective: To observe the clinical study of qi deficiency and blood stasis syndrome of right heart failure caused by pulmonary hypertension (PH) in the treatment of pulmonary artery systolic pressure, blood Pro-BNP, right ventricular ejection fraction, cardiac function classification, six minute walking test and the safety of drug use. According to the standard of random, open and controlled, 60 patients with right heart failure caused by pulmonary artery hypertension were randomly divided into 2 groups, the western medicine control group and the traditional Chinese medicine treatment group (treatment group), which did not change the plain living habits, and the western medicine control group were 30 cases, which were given the western medicine routine treatment: digoxin 0.125mg Po QD, furothim slice 20mg Po QD, Spironolactone Tablets 20mg Po QD, sildenafil 25mg Po tid. traditional Chinese medicine treatment group on the basis of traditional Chinese medicine treatment with traditional Chinese medicine Yiqi Huoxue recipe, day one dose, morning and evening. The two groups were given 2 courses of treatment (4 Monday courses) treatment, observe the systolic pressure of pulmonary artery, blood Pro-BNP, right ventricular ejection fraction, heart function classification, six points before and after treatment. The results of the change of the clock walking test were evaluated. Results: 1. in the heart function, the two groups showed the right heart function, the treatment group and the western medicine control group improved obviously after the treatment, but the improvement of the treatment group was better than the western medicine control group. The difference between the treatment group and the western medicine control group was statistically significant, indicating that the treatment group could obviously improve the right ventricular ejection. Blood fraction; 2. in pulmonary arterial hypertension: heart color ultrasound showed that two groups of patients had lower pulmonary arterial pressure after treatment, but the reduction in the treatment group was higher than that in the western medicine control group. The difference between the two groups was statistically significant, but the gap was small. After the treatment, the two groups were significantly reduced, the treatment group was better than the western medicine control group, and the 4. six minutes walk in the treatment group. Test results before and after treatment: after treatment, the two groups of patients' walking distance increased, the treatment group was better than the western medicine control group, the two groups had statistical difference in.5. syndrome, the treatment group showed 12 cases, effective 16 cases, invalid 2 cases, 0 cases aggravated, the total effective rate was 93.99%, the western medicine control group was 4 cases, 22 cases effective, 4 cases ineffective, The total effective rate was 0, the total effective rate was 83.33%, the effective rate of the treatment group was higher than the control group; the TCM syndrome score was better than the control group through the rank sum test. There was significant effect in.6. heart failure in the treatment group: 14 cases were significantly effective in the treatment group, 14 cases were effective, 2 cases were invalid, 0 cases were aggravated, the total effective rate was 93.33%, the control group was 6 cases, 4 cases were invalid, 4 cases null and 0, and total aggravation. The effective rate was 86.67%, the efficiency of the treatment group was better than the control group. The TCM score of the heart failure through the rank sum test was better than the control group.7. in the heart function classification, the two groups were improved after treatment, the treatment group was better than the control group, but the gap was not obvious. Conclusion: the beneficial Qi live blood method can be significant in the treatment of right heart failure in the treatment of PH. To improve the symptoms, obviously reduce the pulmonary hypertension, Pro-BNP level, and improve the six minute walk test value to improve the heart function of the patients, it is not a neglecting method for the treatment of right heart failure caused by PH.
【學(xué)位授予單位】：山東中醫(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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