摘要
目的 探讨慢性心力衰竭(CHF)患者中医证候分布及与心肺功能的关系.方法 回顾性分析2018年6月-2023年6月陕西省中医医院心病科220例CHF住院患者的一般资料及心肺功能检测结果,按中医证候诊断标准分为本虚证95例、标实证125例.观察不同中医证候患者心肺功能指标的差异,分析患者中医证候分布与心肺功能指标的相关性.结果 本虚证患者中以气虚证(21.82％,48/220)占比最高,标实证患者中以水饮证(39.09％,86/220)占比最高.本虚证患者左心室射血分数(LVEF)[(48.84±5.14)％比(56.55±6.01)％,t=10.02]、每搏心输出量(SV)[(55.99±6.23)ml 比(62.86±6.47)ml,t=7.93]、心输出量(CO)[(2.60±0.59)Umin 比(2.99±0.51)Umin,t=5.25]、心脏指数(CI)[(1.54±0.39)Umin·m2比(1.82±0.42)Umin·m2,t=5.05]低于标实证患者(P＜0.001).本虚证患者FVC[(2.16±0.37)L 比(2.51±0.48)L,t=5.90]、最大肺活量(VCmax)[(2.66±0.42)L 比(3.01±0.49)L,t=5.58]、FEV1[(2.73±0.42)L 比(3.15±0.53)L,t=6.35]低于标实证患者(P＜0.001).Point-biserial相关分析表明,标实证CHF患者与LVEF、SV、CO、CI、FVC、VCmax、FEV1有显著性相关9r值分别为0.698、0.705、0.684、0.675、0.719、0.742、0.640,P＜0.05).结论 CHF患者本虚证以气虚证,标实证及水饮证居多;本虚证较标实证患者心肺功能均处于较低水平,且标实证患者与心肺功能水平呈显著性相关.可通过对心肺功能的监测,为CHF患者中医证候诊断提供参考.
Abstract
Objective To explore correlation between the distribution of TCM syndromes in patients with chronic heart failure(CHF)and its cardiopulmonary function.Methods The general data and cardiopulmonary function test results of 220 hospitalized patients with CHF in the Cardiology Department of Shaanxi Provincial Hospital of Traditional Chinese Medicine from June 2018 to June 2023 were retrospectively analyzed,and they were divided into 95 cases with deficiency in nature syndrome and 125 cases with excess in superficiality syndrome according to TCM syndrome diagnosis criteria.The difference of cardiopulmonary function indexes among patients with different TCM syndromes was observed,and the correlation between the distribution of TCM syndromes and cardiopulmonary function indexes was analyzed.Results In 95 patients with deficiency in nature syndrome,qi-deficiency syndrome(21.82％,48/220)accounted for the highest proportion,and in 125 patients with excess in superficiality,water-drinking syndrome(39.09％,86/220)accounted for the highest proportion.Left ventricular ejection fraction(LVEF)[(48.84±5.14)％vs.(56.55±6.01)％,t=10.02],stroke cardiac output(SV)[(55.99±6.23)ml vs.(62.86±6.47)ml,t=7.93],cardiac output(CO)[(2.60±0.59)L/min vs.(2.99±0.51)L/min,t=5.25],cardiac index(CI)[(1.54±0.39)L/min·m2 vs.(1.82±0.42)L/min·m2,t=5.05]of patients with deficiency in nature syndrome were lower than patients with excess in superficiality syndrome(P＜0.001).FVC[(2.16±0.37)L vs.(2.51±0.48)L,t=5.90],maximum vital capacity(VCmax)[(2.66±0.42)L vs.(3.01±0.49)L,t=5.58],FEV1[(2.73±0.42)L vs.(3.15±0.53)L,t=6.35]of patients with deficiency in nature syndrome were lower than those in patients with excess in superficiality syndrome(P＜0.001).Point-biserial correlation analysis showed that patients of CHF excess in superficiality syndrome were significantly correlated with LVEF,SV,CO,CI,FVC,VCmax,and FEV1(r values are 0.698,0.705,0.684,0.675,0.719,0.742,and 0.640,respectively,P＜0.05).Conclusions The deficiency in nature syndrome of CHF patients is qi-deficiency syndrome,and the excess in superficiality syndrome is water-drinking syndrome.The cardiopulmonary function of patients with excess in superficiality syndrome is at a lower level,and there is a significant correlation between patients with excess in superficiality syndrome and cardiopulmonary function.It can provide reference for TCM syndrome diagnosis of CHF patients by monitoring cardiopulmonary function.
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