摘要
目的 探究环磷腺苷葡胺联合温阳泻肺保心汤治疗老年慢性肺源性心脏病合并心力衰竭对临床疗效及血液流变学指标的影响.方法 选取淮北市中医医院2022年1月至2024年1月收治的102例老年肺源性心脏病合并心力衰竭患者,采用随机摸红蓝色球的方式,分为观察组(红球,51例)和对照组(蓝球,51例),其中对照组接受环磷腺苷葡胺治疗,观察组在对照组的基础上联合温阳泻肺保心汤治疗,比较两组患者治疗前后、临床疗效、心肌损伤情况[脑钠肽(BNP)、心肌肌钙蛋白T(cTnT)]、肺功能[第1秒用力呼气容积(FEV1)、用力呼气量占用力肺活量比值(FEV1/FVC)]和血液流变学指标[低切变率下全血黏度(WBVL)、高切变率下全血黏度(WBVH)、血小板聚集率(PAR)、红细胞聚集指数(RAI)]中医证候积分的变化情况.结果 治疗后,观察组的总有效率为90.20%(46/51)高于对照组68.63%(35/51)(χ2=7.256,P<0.05);观察组、对照组心肌损伤标志物血浆BNP[(873.34±145.66)pg·mL-1、(981.89±234.98)pg·mL-1]、血清cTnT[(12.24±2.35)ng·mL-1、(13.76±3.01)ng·mL-1]、血液流变学各指标WBVL、WBVH、PAR、RAI水平[分别是(9.21±1.34)mPa·s、(4.34±2.19)mPa·s、(40.13±4.77)%、(2.19±1.11)和(9.86±1.08)mPa·s、(5.31±1.38)mPa·s、(42.96±5.14)%、(2.78±1.02)]和中医证候积分各指标动则气促、面浮肢肿、心悸自汗、口唇青紫评分[分别是(1.08±0.13、1.34±0.35、1.23±0.57、1.35±0.65)分和(1.24±0.44)分、(1.51±0.19)分、(1.55±0.39)分、(1.68±0.38)分]均较治疗前降低,且观察组低于对照组(均P<0.05);两组肺功能指标FEV1[分别是(1.88±0.78)L、1.54±0.44)L]和FEV1/FVC比值[(67.24±4.56)、(64.77±4.11)],均较治疗前升高,且观察组高于对照组(均P<0.05).结论 环磷腺苷葡胺联合温阳泻肺保心汤治疗老年肺源性心脏病合并心力衰竭疗效明显,患者临床症状显著改善,有利于加强心肌及肺功能,并促进血液流变学指标趋于正常.
Abstract
Objective To investigate the efficacy of cyclic adenosine monophosphate combined with Wenyang Xiefei Baoxin decoction in treatment of elderly patients with chronic cor pulmonale complicated with heart failure and its impact on hemorheological indicators.Methods A total of 102 elderly patients with cor pulmonale complicated with heart failure admitted to Huaibei Hospital of Traditional Chinese Medicine from May 2021 to May 2023 were enrolled in this study.Using a random red and blue ball drawing method,these patients were divided into an observation group(red ball,n=51)and a control group(blue ball,n=51).The patients in the control group were treated with meglumine adenosine cyclophosphate while those in the observation group were given Wenyang Xiefei Baoxin decoction on the basis of the regimen in the control group.The changes in TCM syndromes score,clinical efficacy,myocardial injury(brain natriuretic peptide(BNP),cardiac troponin T(cTnT)),pulmonary function(forced expiratory volume in one second(FEV1),forced expiratory volume to forced vital capacity ratio(FEV1/FVC))and hemorheological indicators(whole blood viscosity at low shear rate(WBVL),whole blood viscosity at high shear rate(WBVH),platelet aggregation rate(PAR),red blood cell aggregation index(RAI))were compared between the two groups before and after treatment.Results After treament,the total effective rate in the observation group was 90.20%(46/51),which was higher than 68.63%(35/51)in the control(χ2=7.256,P<0.05).Both groups showed significant reductions in myocardial injury markers:plasma BNP((873.34±145.66)pg·mL-1 vs(981.89±234.98)pg·mL-1)and serum cTnT((12.24±2.35)ng·mL-1 vs(13.76±3.01)ng·mL-1),hemorheological indicators WBVL、WBVH,PAR,RAI((9.21±1.34)mPa·s,(4.34±2.19)mPa·s,(40.13±4.77)%,(2.19±1.11)vs(9.86±1.08)mPa·s,(5.31±1.38)mPa·s,(42.96±5.14)%,(2.78±1.02)),and TCM syndrome score,shortness of breath upon exertion,facial and limb edema,palpitations with spontaneous sweating,and cyanotic lips((1.08±0.13),(1.34±0.35),(1.23±0.57),(1.35±0.65)vs(1.24±0.44),(1.51±0.19),(1.55±0.39),(1.68±0.38))compared to pre-treatment levels,with the observation group showing lower levels than the control(P<0.05).Both groups demonstrated improvements in pulmonary function indicators:FEV1((1.88±0.78)L vs(1.54±0.44)L)and FEV1/FVC ratio((67.24±4.56)vs(64.77±4.11)),with the observation group showing higher values than the control group(P<0.05).Conclusion The combination of cyclic adenosine monophosphate with Wenyang Xiefei Baoxin decoction demonstrates significant efficacy in treating elderly patients with cor pulmonale complicated with heart failure.This treatment markedly improves clinical symptoms,enhances cardiac and pulmonary function and promotes normalization of hemorheological indicators.
基金项目
安徽省卫生健康科研项目(AHWJ2021b044)
NETL
NSTL
万方数据