本文選題：冠心病慢性心力衰竭 + RAAS系統(tǒng)　； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:1、在常規(guī)標(biāo)準(zhǔn)化治療的基礎(chǔ)上,聯(lián)合使用益氣通陽活血方對冠心病慢性心力衰竭(CHF)患者的臨床癥狀的改善效果。2、觀察益氣通陽活血方對冠心病慢性心力衰竭患者機(jī)體內(nèi)NT-proBNP、hs-CRP水平的影響。3、初步探討益氣通陽活血方對冠心病慢性心力衰竭患者干預(yù)作用的機(jī)制,探索中醫(yī)治療冠心病慢性心力衰竭的有效方法。方法:選取無錫市中醫(yī)醫(yī)院住院部2016.01--2016.12月收治的60例明確診斷為冠心病慢性心力衰竭的患者,且辨證為心肺氣虛、血瘀飲停,分成對照組和治療組。兩組患者都給予規(guī)范化的西醫(yī)標(biāo)準(zhǔn)治療,并恰當(dāng)合理的使用利尿劑、ACEI、ARB、β阻劑等西藥。而治療組患者在規(guī)范化西藥標(biāo)準(zhǔn)治療的同時配合使用益氣通陽活血方(本方包括黃芪30克、黨參10克、桂枝10克、干姜5克、當(dāng)歸10克、川芎10克、赤芍10克、茯苓15克、丹參20克、白術(shù)10克、甘草3克,由無錫市中醫(yī)院制劑室統(tǒng)一配置,每天早晚2次服用,入院當(dāng)天開始服用中藥,連續(xù)2周)。2周后對患者臨床癥狀的變化進(jìn)行比較與分析,同時,測量兩組患者入院24小時內(nèi)及入院2周時機(jī)體hs-CRP、NT-proBNP的水平,然后進(jìn)行統(tǒng)計分析比較。結(jié)果:1、兩組入院2周后中醫(yī)臨床癥狀均有所減輕,總有效率是70.0%,對照組和治療組治療的有效率分別是53.3%、86.7%,兩組差異存在明顯的統(tǒng)計學(xué)意義(P0.05)。2、治療組入院2周后NYHA心功能分級的有效率是86.6%,對照組的有效率是53.3%,治療組治療有效率大于對照組,存在明顯的統(tǒng)計學(xué)差異(P0.05)。3、治療組入院2周后Lee氏心衰積分的有效率是76.7%,對照組總有效率是50.0%,治療組總有效率大于對照組,對比兩組差異,存在明顯的統(tǒng)計學(xué)意義(P0.05)。4、2周后,治療組與對照組明尼蘇達(dá)生活質(zhì)量表下降幅度平均值分別為35.400±21.937、14.700±20.40,治療組積分下降要比對照組多,差異顯示統(tǒng)計學(xué)意義(P0.05)。5、2周后,治療組與對照組hs-CRP治療前后減少幅度平均值分別為13.967± 18.785,0.620±16.128,治療組下降幅度大于對照組(P0.05)。6、2周后、治療組與對照組NT-proBNP水平下降幅度平均值分別為4777.333±7489.795、1214.367±3652.951,治療組下降幅度大于對照,差異顯示統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、本次研究顯示,冠心病CHF時候,在單純西醫(yī)標(biāo)準(zhǔn)化治療的基礎(chǔ)上配合使用益氣通陽活血方治療,更能有效減輕臨床癥狀、改善心功能。2、本次研究表明,聯(lián)合益氣通陽活血方較單純運(yùn)用西藥治療更能有效降低冠心病CHF患者h(yuǎn)s-CRP水平,這可能是益氣通陽活血方能抑制機(jī)體的炎癥反應(yīng),從而有效改善患者預(yù)后。3、本次研究表明,在單純運(yùn)用西藥治療上加用益氣通陽活血方更能有效降低冠心病CHF患者NT-proBNP水平,這可能是益氣通陽活血方可以加強(qiáng)冠心病CHF患者心肌的收縮力,改善心肌的收縮與舒張功能,從而有效延長心肌代償-失代償?shù)臅r間,改善預(yù)后。
[Abstract]:Objective: 1, on the basis of conventional standardized treatment, Effect of combined use of Yiqi Tongyang Huoxue recipe on the improvement of clinical symptoms in patients with chronic heart failure of coronary heart disease. 2. To observe the effect of Yiqi Tongyang Huoxue recipe on NT-proBNPHs-CRP level in patients with chronic heart failure of coronary heart disease. Mechanism of the intervention effect of Yiqi Tongyang Huoxue recipe on patients with chronic Heart failure of Coronary Heart Disease, To explore the effective method of TCM in the treatment of chronic heart failure of coronary heart disease. Methods: sixty patients with chronic heart failure of coronary heart disease were selected and divided into control group and treatment group from June 2016.01-December 2016.The patients were divided into control group and treatment group with syndrome differentiation of deficiency of heart and lung qi and stopping of blood stasis drink. The patients in both groups were given standardized western medicine treatment, and appropriate and rational use of ACEIARB, 尾 -blocker and other western medicine. While the patients in the treatment group were treated with the standardized western medicine standard in combination with Yiqi Tongyang Huoxue recipe (this prescription included 30 grams of Astragalus, 10 grams of Codonopsis, 10 grams of Guizhi, 5 grams of dry ginger, 10 grams of Angelica sinensis, 10 grams of Chuanxiong, 10 grams of Radix Paeoniae Alba, 15 grams of Poria cocos, Salvia miltiorrhiza 20 grams, Atractylodes macrocephala 10 grams, Glycyrrhiza uralensis 3 grams, by Wuxi traditional Chinese medicine hospital preparation room unified configuration, every morning and evening take 2 times, start to take Chinese medicine on the day of admission. After 2 weeks and 2 weeks in succession, the changes of clinical symptoms of the patients were compared and analyzed. At the same time, the levels of NT-proBNP were measured within 24 hours of admission and 2 weeks after admission, and then compared statistically. Results two weeks after admission to the hospital, the clinical symptoms of traditional Chinese medicine in the two groups decreased somewhat. The total effective rate was 70.0. the effective rate of treatment in the control group and the treatment group was 53.3 and 86.7, respectively. The difference between the two groups was statistically significant (P 0.05). The effective rate of NYHA cardiac function grading was 86.6 in the treatment group and 53.3 in the control group two weeks after admission. The effective rate of treatment was higher than that of control group. The effective rate of Lee's heart failure score in the treatment group was 76.70.The total effective rate in the control group was 50.0.The total effective rate in the treatment group was higher than that in the control group. The mean value of the decrease of quality of life in the treatment group and the control group was 35.400 鹵21.937 鹵14.700 鹵20.40, respectively. The score of the treatment group decreased more than that of the control group, and the difference was statistically significant after 2 weeks. The mean decrease amplitude of hs-CRP in treatment group and control group was 13.967 鹵18.785n0.620 鹵16.128.After 2 weeks after treatment, the decreasing amplitude of hs-CRP in treatment group was greater than that in control group (P 0.05). The average value of NT-proBNP in treatment group and control group was 4777.333 鹵7489.795n 1214.367 鹵3652.951respectively. The decrease of NT-proBNP in treatment group was higher than that in control group. The difference was statistically significant (P 0.05). Conclusion: 1, this study shows that the treatment of coronary heart disease CHF combined with the use of Yiqi Tongyang Huoxue recipe on the basis of simple western medicine standardized treatment can effectively alleviate clinical symptoms and improve cardiac function .2.This study shows that The combination of Yiqi Tongyang Huoxue recipe can effectively reduce the level of hs-CRP in CHF patients with coronary heart disease, which may be that Yiqi Tongyang Huoxue recipe can inhibit the inflammatory reaction of the body and thus effectively improve the prognosis of the patients. The combination of Yiqi Tongyang Huoxue decoction and Yiqi Tongyang Huoxue recipe can effectively reduce the level of NT-proBNP in CHF patients with coronary heart disease. This may be that Yiqi Tongyang Huoxue recipe can enhance the contractility of myocardium and improve the systolic and diastolic function of myocardium in CHF patients with coronary heart disease. Thus effectively prolong the time of myocardial compensation-decompensation and improve the prognosis.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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