黄家威 肖长江 黄伟强 张健

【摘要】 目的：探討旋覆花汤加味联合美托洛尔对肝心证心脏神经官能症患者的临床疗效，并观察其对情绪状态的影响。方法：收集2019年5月-2021年5月就诊于湖南省中医药研究院附属医院的肝心证心脏神经官能症患者82例，按照随机数字表法分为对照组和观察组，每组41例。对照组给予酒石酸美托洛尔片、氟哌噻吨美利曲辛片和/或阿普唑仑片，观察组给予美托洛尔+旋覆花汤加味煎汤内服。治疗4周后比较两组治疗后临床总有效率，治疗前后主要症状积分、汉密尔顿抑郁量表（HAMD）评分和汉密尔顿焦虑量表（HAMA）评分。结果：观察组总有效率高于对照组，但差异无统计学意义（P>0.05）。治疗后，两组各项主要症状积分较治疗前均降低（P<0.05），且观察组胸闷、胸痛、气短、失眠积分均低于对照组（P<0.05）。治疗后，两组HAMA、HAMD评分较治疗前均降低，且观察组均低于对照组（P<0.05）。结论：旋覆花汤加味治疗肝心证型心脏神经官能症临床有效，可明显降低主要症状积分，能显著改善患者的焦虑抑郁状态，为中医药治疗心脏神经官能症提供了切实的理论依据。

【关键词】 心脏神经官能症 旋覆花汤加味 肝心证

Clinical Effect Observation of Xuanfuhua Decoction Modified Combined with Metoprolol in the Treatment of Cardiac Neurosis with Liver-heart Syndrome/HUANG Jiawei， XIAO Changjiang， HUANG Weiqiang， ZHANG Jian. //Medical Innovation of China， 2021， 18（34）： 0-071

[Abstract] Objective： To investigate the effect of Xuanfuhua Decoction Modified combined with Metoprolol in the treatment of cardiac neurosis with liver-heart syndrome， and observe its effect on emotional state. Method： A total of 82 patients with cardiac neurosis with liver-heart syndrome in the Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine from May 2019 to May 2021 were collected and divided into the control group and the observation group according to the random number table method， 41 cases in each group. The control group was given Metoprolol， Flupentixol and Melitroxine Tablets and/or Alprazolam Tablets， the observation group was given Metoprolol + Xuanfuhua Decoction Modified for oral administration. The clinical total effective rate after 4 weeks of treatment， the main symptom scores， the Hamilton depression scale （HAMD） score and the Hamilton anxiety scale （HAMA） score of two groups before and after treatment were compared. Result： The total effective rate of the observation group was higher than that of the control group， but the difference was not statistically significant （P>0.05）. After treatment， the all scores of major symptoms in two groups were lower than those before treatment （P<0.05）， and the scores of chest tightness， chest pain， shortness of breath and insomnia in the observation group were lower than those in the control group （P<0.05）. After treatment， the HAMA and HAMD scores in two groups were lower than those before treatment， and the observation group were lower than those in the control group （P<0.05）. Conclusion： Xuanfuhua Decoction Modified is clinically effective in the treatment of cardiac neurosis with liver-heart syndrome， it can significantly reduce the main symptom scores and significantly improve the anxiety and depression of patients， it provides a practical theoretical basis for the treatment of cardiac neurosis with traditional Chinese medicine.

[Key words] Cardiac neurosis Xuanfuhua Decoction Modified Liver-heart syndrome

First-author’s address： Hunan University of Traditional Chinese Medicine， Changsha 410208， China

doi：10.3969/j.issn.1674-4985.2021.34.016

心脏神经官能症（cardiac neurosis）又称心血管神经官能症，西方常称之为神经性循环系统功能障碍，主要是由于中枢神经系统功能紊乱，导致自主神经功能失调，以心悸、胸闷胸痛、呼吸困难等心血管系统症状为典型临床表现的疾病，但常规检查又无心脏器质性病变[1-2]。目前治疗手段主要是以地西泮、谷維素和/或β受体阻滞剂等药物对症治疗，患者依从性差，副作用明显，效果欠理想[3]。……