冷建春 魏颖

[摘要] 目的 观察参附救心汤对不同类型心力衰竭患者的临床疗效。 方法 选取符合心力衰竭诊断的患者101例，按照入院顺序将患者分为西医治疗组（对照组）50例及中西结合治疗组（治疗组）51例。两组均予西医常规治疗，治疗组加用参附救心汤口服。治疗时间均为10 d。比较两组治疗前后中医证候积分、NYHA分级、血清NT-proBNP水平变化情况；亚组分析：依据入院时患者LVEF的水平，将治疗组分为收缩性心力衰竭组（S组）和舒张性心力衰竭组（D组），比较参附救心汤对S组和D组不同类型心力衰竭的疗效差异。 结果 治疗组在提高总疗效、改善中医证候积分和血清NT-proBNP方面均优于对照组（P<0.05）；在亚组分析中，参附救心汤对S组和D组患者的心功能、中医证候评分和血清NT-proBNP水平均有明显改善作用（P<0.05），但亚组间比较差异无统计学意义（P>0.05）。 结论 参附救心汤温阳益气、利水化瘀，能够在一定程度上改善心衰患者的临床疗效，且对收缩性心衰和舒张性心衰的疗效一致。

[关键词] 参附救心汤；收缩性心力衰竭；舒张性心力衰竭；中医证候；中医治法

[中图分类号] R259 [文献标识码] B [文章编号] 1673-9701（2018）02-0114-04

[Abstract] Objective To observe the therapeutic effect of Shenfu Jiuxin decoction on different types of heart failure. Methods A total of 101 patients who met the diagnosis of heart failure were enrolled in the study. All patients were divided into western medicine group（control group， n=50） and Chinese and western integrated treatment group（treatment group， n=51）， according to the order of admission. The two groups were treated with routine western medicine treatment， and the treatment group was also given Shenfu Jiuxin decoction oral. The treatment time was 10 days in both groups. The changes of TCM syndrome score， NYHA classification and serum NT-proBNP level before and after treatment were compared between two groups. According to the level of LVEF on admission， the patients in the treatment group were divided into systolic heart failure group（group S） and diastolic heart failure group（group D）. The changes of therapeutic effect of Shenfu Jiuxin decoction on different types of heart failure were compared. Results The treatment group was better than the control group in improving the total curative effect， improving the TCM syndrome score and serum NT-proBNP（P<0.05）. In the subgroup analysis， Shenfu Juxin decoction significantly improved the cardiac function， TCM syndrome score and serum NT-proBNP level in patients in group S and group D（P<0.05）. But there was no significant difference between subgroups（P>0.05）. Conclusion Shenfu Jiuxin decoction for warming Yang and benefiting Qi and promoting blood circulation and inducing diuresis can improve the clinical curative effect of heart failure patients to a certain extent， and has the same curative effect on systolic heart failure and diastolic heart failure.

[Key words] Shenfu Jiuxin decoction； Systolic heart failure； Diastolic heart failure； TCM syndrome； TCM treatment

心力衰竭（chronic heart failure，CHF）是心血管疾病最重要的死亡原因，也是絕大多数心脏疾病的最终归宿，因此心力衰竭的防治是心血管领域的重要课题[1]。中医学虽无心力衰竭的病名，但对心力衰竭相关的病状、病机及治疗认识由来已久。如《医宗金鉴》记载：“水停心下，甚者病悸，已明其治矣。微饮短气，是水停阻碍呼吸而短也。用苓桂术甘汤以通其阳，阳气通则膀胱之窍利矣”。当今的多数学者将其病机也归结为“心阳不足、水饮内停”。相关临床研究表明，“阳虚水泛证型”是心力衰竭发病过程中的常见证型，临床多采取温阳利水方药治疗[2]。……