陈颖　崔燕　李国文

【摘要】 目的 观察舒心通脉组方用于慢性心力衰竭（心衰）心肺气虚证中西医结合治疗的效果以及药学监护的作用。方法 82例慢性心衰心肺气虚证患者， 随机分为对照组与观察组， 各41例。对照组给予西医常规治疗， 观察组在西医常规治疗基础上加用舒心通脉组方治疗， 两组在治疗过程中均给予药学监护。根据中医症候评分情况评价疗效， 统计两组患者治疗前后纽约心脏协会（NYHA）心功能分级情况， 以及静脉血N末端B型利钠肽原（NT-proBNP）水平， 并进行比较。结果 观察组患者中医证候疗效明显优于对照组（P<0.05）， 两组治疗后的NYHA心功能分级Ⅱ级例数较治疗前均显著增加（P<0.05）， 且观察组显著多于对照组（P<0.05）， 两组治疗后的静脉血NT-proBNP水平均较治疗前显著下降（P<0.05）， 且观察组NT-proBNP水平[（1019.6±316.9）ng/L]较对照组更低[（1645.8±278.1）ng/L]（P<0.05）。结论 舒心通脉组方可提高慢性心衰心肺气虚证患者的疗效， 临床药师参与药物治疗， 提供药学监护， 有利于提高患者依从性， 促进安全合理用药， 利于治疗。

【关键词】 慢性心力衰竭；舒心通脉；临床观察；药学监护

DOI：10.14163/j.cnki.11-5547/r.2016.29.003

Clinical observation and pharmaceutical care of Shuxin Tongmai compound prescription in the treatment of chronic heart failure patients with syndrome of qi deficiency of heart and lung CHEN Ying， CUI Yan， LI Guo-wen. Shanghai City Hospital of Traditional Chinese and Western Medicine， Shanghai 200082， China

【Abstract】 Objective To observe effect by combined treatment of traditional Chinese and Western medicine through Shuxin Tongmai compound prescription for chronic heart failure patients with syndrome of qi deficiency of heart and lung. Methods A total of 82 chronic heart failure patients with syndrome of qi deficiency of heart and lung were randomly divided into control group and observation group， with 41 cases in each group. The control group received conventional Western therapy， and the observation group also received additional Shuxin Tongmai compound prescription for treatment. Both groups received pharmaceutical care during treatment. Summary was made on New York Heart Association （NYHA） cardiac functional classification and venous blood N-terminal pro brain natriuretic peptide （NT-proBNP） level for comparison， in accordance with traditional Chinese medicine syndrome score for curative effect evaluation. Results The observation group had obviously better traditional Chinese medicine syndrome curative effect than the control group （P<0.05）. After treatment， both groups had increased cases with grade Ⅱ NYHA cardiac functional classification （P<0.05）， and the observation group had more cases than the control group （P<0.05）. Both groups had much lower venous blood NT-proBNP levels after treatment than those before treatment （P<0.05）， and the observation group had lower NT-proBNP level [（1019.6±316.9）ng/L] than the control group [（1645.8±278.1）ng/L] （P<0.05）. Conclusion Shuxin Tongmai compound prescription can improve curative effect for chronic heart failure patients with syndrome of qi deficiency of heart and lung. Anticipation of clinical pharmacists in drug therapy with pharmaceutical care is beneficial for improving compliance in patients. This method promotes safe and rational drug use and is helpful for treatment.

【Key words】 Chronic heart failure； Shuxin Tongmai； Clinical observation； Pharmaceutical care

慢性心衰是各种心脏疾病的严重和终末阶段， 是临床发病率较高的心血管疾病之一[1]。各种心血管疾病由于心脏长时间负荷过重、心肌损伤及收缩力减弱， 都可以导致心功能不全。临床主要表现为心悸、喘促、水肿、瘀血等症状。病情较重， 预后较差。本病属于中医学的“心水”、“心悸”等范畴。根据不同情况可辩证分为心肺气虚、气阴两虚、气虚血瘀、阳虚水停、热痰壅肺、寒痰阻肺、阴竭阳脱等多种证型。心肺气虚证以气短喘促、心悸咳嗽为主症， 可兼见胸闷乏力、动则加剧、面色灰青等症， 舌淡， 苔薄白， 脉沉弱。随着中西医结合治疗在临床上的开展， 中西药联合应用的安全性、有效性问题日益突出， 药学监护是提供直接的、负责的与药物有关的监护， 其目的是发现潜在的或实际存在的用药问题， 防止潜在的用药问题发生， 以改善患者生活质量。……