舒挥文 纪亚明 李玉环

[摘要] 目的 觀察归脾汤加减治疗心律失常的临床效果。 方法 收集2014年10月～2017年6月北京小汤山医院中医门诊的心律失常患者60例，将60例患者按照治疗方法的不同分为治疗组和对照组，各30例。治疗组用西药基础治疗+归脾汤，对照组用西药基础治疗，疗程均为4周。比较两组临床疗效、24 h动态心电图疗效、治疗前后中医证候积分变化及中医证候积分疗效，观察两组药物安全性。 结果 临床疗效中，治疗组总有效率为93.3%，对照组为73.3%，两组总有效率比较差异有统计学意义（P < 0.05）；24 h动态心电图疗效中，治疗组总有效率为90.0%，对照组为66.7%，两组总有效率比较差异有统计学意义（P < 0.05）；中医证候积分方面，治疗组治疗后中医证候积分较治疗前显著降低（P < 0.05），且明显低于对照组，差异有统计学意义（P < 0.05）；中医证候积分疗效中，治疗组总有效率为96.7%，对照组为76.7%，两组总有效率比较差异有统计学意义（P < 0.05）。两组患者肝、肾功能及血、尿、便常规化验检查在治疗前后均无明显异常变化。 结论 归脾汤能有效缓解心律失常患者心肌缺血情况，改善临床症状。

[关键词] 归脾汤；心律失常；动态心电图；中医证候

[中图分类号] R541.7 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0119-04

[Abstract] Objective To observe the clinical effect of modified Guipi Decoction in the treatment of arrhythmia. Methods Sixty patients with arrhythmia in Outpatient Department of TCM， Beijing Xiaotangshan Hospital from October 2014 to June 2017 were collected， and 60 patients were divided into treatment group and control group according to different treatment methods， with 30 cases in each group. The treatment group was treated with basic western medicine + Guipi Decoction， the control group was treated with basic western medicine， the course was 4 weeks. The clinical efficacy， the 24-hour dynamic electrocardiogram efficacy， the changes of TCM symptom scores before and after treatment and the TCM symptom score efficacy between the two groups were compared， and the drug safety of the two groups was observed. Results In the clinical effect， the total effective rate was 93.3% in the treatment group and 73.3% in the control group， the difference of the total effective rate between the two groups was statistically significant （P < 0.05）. In the 24-hour dynamic electrocardiogram efficacy， the total effective rate was 90.0% in the treatment group and 66.7% in the control group， the difference of the total effective rate between the two groups was statistically significant （P < 0.05）. In the TCM symptom scores， the TCM symptom scores in the treatment group after treatment were lower than those before treatment （P < 0.05）， which were lower than those of control group， the difference between the two groups was statistically significant （P < 0.05）. In the TCM symptom scores efficacy， the total effective rate was 96.7% in the treatment group and 76.7% in the control group， the difference of the total effective rate between the two groups was statistically significant （P < 0.05）. There were no significant differences in liver function， renal function， blood routine， urine routine， regular routine before and after treatment in both groups. Conclusion Guipi Decoction can effectively relieve myocardial ischemia in patients with arrhythmia and improve clinical symptoms.

[Key words] Guipi Decoction； Arrhythmias； Dynamic electrocardiogram； TCM symptoms

心律失常是心血管系统疾病中的常见病、多发病，是指心脏冲动的频率、节律、起源部位、传导速度与激动次序的异常[1]，属中医学“心悸”的范畴，病位在心，既可以是仅发于心的病变，也可以是由其他脏腑病变波及心的多脏腑病变。本病以虚证居多，亦由虚及实，虚实夹杂。本研究对中医辨证为心脾两虚所致的心律失常患者在西药常规治疗的基础上应用归脾汤加减治疗，取得了满意疗效。现报道如下：

1 资料与方法

1.1 一般资料

全部患者均为2014年10月～2017年6月北京小汤山医院中医二门诊患者，按治疗方法的不同将其分为治疗组和对照组，各30例。治疗组中男15例，女15例；年龄48～76岁，平均（65.03±8.13）岁；病程3～20年，平均（10.23±5.39）年；冠状动脉粥样硬化性心脏病14例，心肌炎后遗症3例，高血压病9例，风湿性心脏病4例。对照组中男13例，女17例；年龄50～78岁，平均（66.90±8.46）岁；……