本文選題：養(yǎng)心息風(fēng)湯 + 慢性阻塞性肺疾病　； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：通過觀察養(yǎng)心息風(fēng)湯對慢性阻塞性肺疾病(COPD)合并慢性肺源性心臟病(簡稱肺心病)并發(fā)室上性早搏患者的臨床療效(包括癥狀、體征的改善及理化指標(biāo)的評(píng)估)。深化中醫(yī)藥對COPD合并肺心病室上性早搏的病因病機(jī)認(rèn)識(shí)。通過觀察養(yǎng)心息風(fēng)湯治療肺心病并發(fā)室上性早搏的作用,進(jìn)一步拓展了中醫(yī)藥治療室上性早搏的方法。方法：將符合納入標(biāo)準(zhǔn)的60例患者采用隨機(jī)化對照的臨床試驗(yàn)方案研究,隨機(jī)分為治療組(西醫(yī)常規(guī)治療+養(yǎng)心息風(fēng)湯)和對照組(西醫(yī)常規(guī)治療組+普羅帕酮)。每組30例,療程均為14天。治療期間記錄患者臨床癥狀及體征變化,進(jìn)行評(píng)分。并在治療前后進(jìn)行動(dòng)態(tài)心電圖檢查,血常規(guī)、肝腎功能、二便常規(guī)等理化檢查。比較兩組治療前后的臨床療效、室上性早搏減少率進(jìn)行有有效性判定,比較兩組肝腎功能變化以進(jìn)行安全性評(píng)定。臨床觀察結(jié)束后,采用SPSS13.0行統(tǒng)計(jì)學(xué)分析。結(jié)果：1、臨床療效：①治療組臨床癥狀改善指數(shù)平均0.7301±0.1879,對照組療效指數(shù)平均為0.5867±0.1756,兩組療效指數(shù)相比較有顯著異常,有統(tǒng)計(jì)學(xué)意義(P0.05)。②經(jīng)治療,在癥狀體征改善方面,對照組顯效11例,有效15例,無效4例,總有效率58.67%；治療組顯效12例,有效15例,無效3例,總有效率73.01%,兩組總有效率相比存在顯著性差異,有統(tǒng)計(jì)學(xué)意義(P0.05)。2、動(dòng)態(tài)心電圖變化：治療組及對照組治療前后早搏減少率相比較,其差異均存在統(tǒng)計(jì)學(xué)意義。對照組治療后室上性早搏數(shù)平均為2864.87±2740.83,治療組早搏數(shù)平均為1335.20±1895.87,兩組早搏減少數(shù)相比較有顯著性異常,有統(tǒng)計(jì)學(xué)意義(P0.05)。3、安全性比較：兩組患者治療期間未發(fā)現(xiàn)明顯不良反應(yīng),治療前后肝腎功能指標(biāo)對比無明顯差異。結(jié)論：1、近期療效比較：治療組與對照組在治療前后臨床療效存在差異,提示養(yǎng)心息風(fēng)湯與西醫(yī)常規(guī)治療在COPD合并肺心病并發(fā)室上性早搏近期療效方面,養(yǎng)心息風(fēng)湯對其臨床癥狀的改善優(yōu)于西藥普羅帕酮治療方案。2、動(dòng)態(tài)心電圖變化相比較：兩組治療室上性室上性早搏均有明顯療效。治療組與對照組在治療前后臨床療效存在差異,提示養(yǎng)心息風(fēng)湯對控制COPD合并肺心病室上性早搏作用優(yōu)于單純西醫(yī)治療方案。3、安全性評(píng)估：本研究未見藥物不良反應(yīng),可進(jìn)一步開發(fā)劑型,以供臨床藥物試驗(yàn)。
[Abstract]:Objective: to observe the clinical effect of Yangxinxufeng decoction (YXXR) on patients with chronic obstructive pulmonary disease (COPD) complicated with chronic pulmonary heart disease (Cor pulmonale) complicated with supraventricular premature beats (SVPB), including the improvement of symptoms, signs and the evaluation of physical and chemical indexes. To deepen the understanding of the etiology and pathogenesis of superventricular premature beats in COPD complicated with cor pulmonale. By observing the effect of Yangxinxinxinfeng decoction in the treatment of pulmonary heart disease complicated with supraventricular premature beat, the method of traditional Chinese medicine for treatment of supraventricular premature beat was further expanded. Methods: sixty patients who met the inclusion criteria were randomly divided into two groups: the treatment group (western medicine routine treatment) and the control group (western medicine routine treatment group, propafenone group). 30 cases in each group were treated for 14 days. The changes of clinical symptoms and signs were recorded and scored during treatment. Dynamic electrocardiogram (ECG), blood routine, liver and kidney function, routine examination and so on were performed before and after treatment. The clinical effect, supraventricular premature beat reduction rate and liver and kidney function were compared before and after treatment in the two groups to evaluate the safety. After clinical observation, SPSS 13.0 was used for statistical analysis. Results the clinical symptom improvement index of the treatment group was 0.7301 鹵0.1879, and that of the control group was 0.5867 鹵0.1756. There was significant difference between the two groups (P0.05) in the improvement of symptoms and signs. In the control group, there were 11 cases of remarkable effect, 15 cases of effective effect, 4 cases of ineffective, total effective rate of 58.67 cases, 12 cases of remarkable effect, 15 cases of effective and 3 cases of failure in treatment group, and the total effective rate was 73.01%. There was a significant difference between the two groups in total effective rate. There was statistical significance (P0.05) .2. dynamic electrocardiogram changes: treatment group and control group before and after treatment of premature beat reduction rate, the difference was statistically significant. The average number of supraventricular premature beats in the control group was 2864.87 鹵2740.83, and that in the treatment group was 1335.20 鹵1895.87.The decrease of premature beats in the two groups was significantly abnormal (P0.05) .3The safety comparison: no significant adverse reactions were found in the two groups during the treatment period. There was no significant difference in liver and kidney function before and after treatment. Conclusion: compared with control group, there is a difference in clinical effect between treatment group and control group before and after treatment, suggesting that Yangxinxinfeng decoction and routine western medicine are effective in the treatment of COPD complicated with cor pulmonale complicated with supraventricular premature beat. The improvement of clinical symptoms of Yangxinxinfeng decoction was better than that of propafenone. The changes of dynamic electrocardiogram were compared: the two groups had obvious curative effect on supraventricular premature beats. The difference of clinical effect between the treatment group and the control group before and after treatment indicated that Yangxinxinxufeng decoction was superior to western medicine in the control of superventricular premature beats in COPD complicated with cor pulmonale. The safety evaluation: there was no adverse drug reaction in this study. Dosage forms can be further developed for clinical drug trials.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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