李怡 王磊 邓子卡

【关键词】 强心通脉汤 射血分数保留性心力衰竭 血清BNP 心功能指标

[Abstract] Objective： To investigate the effects of Qiangxin Tongmai Decoction combined with western medicine on BNP level and cardiac function indexes in patients with heart failure with preserved ejection fraction. Method： A total of 88 patients with heart failure with preserved ejection fraction admitted to our hospital from January 2018 to December 2020 were selected， they were divided into observation group and control group according to random number table method， 44 cases in each group. The control group was treated with conventional western medicine， and the observation group was treated with Qiangxin Tongmai Decoction on the basis of control group. The clinical efficacy were compared between two groups， cardiac function indexes （SV， LVEDD， LVEF and CI）， serum BNP and 6MWT before and after treatment were compared between two groups. Result： Before treatment， there were no statistically significant differences in SV， LVEDD， LVEF and CI between two groups （P>0.05）; after treatment， SV， LVEF and CI of both groups were higher than those of before treatment， and LVEDD was lower than that of before treatment， SV， LVEF and CI of the observation group were higher those of the control group， and LVEDD was lower than that of the control group， the differences were statistically significant （P<0.05）. Before treatment， there were no significant differences in serum BNP level and 6MWT between two groups （P>0.05）; after treatment， the serum BNP level of both groups were lower than those of before treatment， and 6MWT were higher than those of before treatment， and the BNP level of the observation group was lower than that of the control group， and 6MWT was higher than that of the control group， the differences were statistically significant （P<0.05）. The total effective rate of the observation group was 90.9%， it was higher than 75.0% of the control group， the difference was statistically significant （P<0.05）. Conclusion： Qiangxin Tongmai Decoction combined with western medicine can promote the recovery of cardiac function and increase patient activity tolerance， which is worthy of popularization and application.

[Key words] Qiangxin Tongmai Decoction Heart failure with preserved ejection fraction Serum BNP Cardiac function index

First-author’s address： Pingxiang Traditional Chinese Medicine Hospital， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2021.21.036

在心力衰竭的类型中，射血分数保留性心力衰竭（heart failure with preserved ejection fraction，HFpEF）是以左心室舒张期充盈受损和左心室舒张末压升高、心搏出量降低为特点的血流动力学状态，因心脏顺应性降低，不能正常为机体活动所需而增加心排血量[1-2]。目前对于HFpEF的病理机制尚未有统一的观点，临床对该病常在治疗原发性疾病的基础上，联合经验性西药治疗如美托洛尔缓释片、伊伐布雷定等，但未能取得理想效果[3-4]。HFpEF在祖国传统中医学属于“心悸”“胸痹”的范畴，常见证型为气虚血瘀水停证，治疗应以益气活血，行气利水为治法，选用强心通脉汤辨证治疗HFpEF患者，能有效改善临床症状[5]。本文旨在探讨强心通脉汤联合西药治疗HFpEF患者BNP水平和心功能指标的影响。现报道如下。

1 资料与方法

1.1 一般资料 选取2018年1月-2020年12月本院收治的88例HFpEF患者。纳入标准：（1）临床症状、体征及超声心动图等检查符合射血分数保留性心力衰竭的诊断标准[6];（2）辨证符合中医气虚血瘀水停证标准[7];（3）有扩张型心肌病、风湿性心脏病及冠心病等心脏病史。排除标准：（1）合并先天性心脏病、急性冠状动脉综合征等其他心血管疾病;（2）合并严重心、肝、肾等重要脏器功能不全;（3）合并神经系统性疾病。根据随机数字表法分为对照组与观察组，每组44例。本研究已经院伦理委员会审核批准，患者均知情同意。

1.2 方法 根据患者的原发病的不同给予合适的药物，比……