摘要
【目的】观察从“态靶辨证”角度运用靶方、靶药治疗心血瘀阻型非瓣膜病永久性房颤的临床疗效。【方法】将120例心血瘀阻型非瓣膜病永久性房颤患者随机分为对照组和试验组,每组各60例。对照组给予西医常规治疗,试验组在对照组的基础上配合靶方、靶药治疗(靶方用血府逐瘀汤,靶药用丹参、人参、西洋参等),总疗程为12周。观察2组患者治疗前后中医证候积分、24 h平均心室率、房颤生活质量量表(AFEQT)评分及左房内径的变化情况,比较2组患者靶剂量琥珀酸美托洛尔缓释片的每日使用量及血栓栓塞事件发生情况,评价2组患者的临床疗效和安全性。【结果】(1)研究过程中,共脱失5例,最终共纳入115例,其中试验组58例,对照组57例。(2)治疗12周后,试验组的总有效率为94.8%(55/58),对照组为86.0%(49/57);组间比较(Mann-Whitney U检验),试验组的临床疗效明显优于对照组(P<0.01)。(3)治疗后,2组患者的中医证候总积分和24 h平均心室率均较治疗前明显降低(P<0.01),AFEQT评分均较治疗前明显升高(P<0.01),且试验组的中医证候总积分和24 h平均心室率的降低幅度及AFEQT评分的升高幅度均明显优于对照组(P<0.01)。(4)12周后,试验组琥珀酸美托洛尔缓释片的每日使用量为(85.17±32.09)mg,明显低于对照组的(107.92±33.91)mg,差异有统计学意义(P<0.01)。(5)治疗后,2组患者的左房内径比较差异无统计学意义(P>0.05),但差值比较差异有统计学意义(P<0.05),初步提示试验组的改善幅度有优于对照组的趋势。(6)研究过程中,2组患者均未出现血栓栓塞事件,也均未出现中度及重度出血事件。【结论】从“态靶辨证”角度运用靶方、靶药治疗心血瘀阻型非瓣膜病永久性房颤患者疗效确切,其疗效明显优于单纯西医常规治疗。
Objective To observe the clinical efficacy of using target formula and target drugs in the treatment of permanent nonvalvular atrial fibrillation(NAF)of heart-blood stasis and obstruction type from the perspective of state-target syndrome differentiation.Methods A total of 120 patients with permanent NAF of heart-blood stasis and obstruction type were randomly divided into the control group and the trial group,60 patients in each group.The control group was given conventional western medicine treatment,while the trial group was treated with target formula of Xuefu Zhuyu Decoction and target medicines of Radix Salviae Miltiorrhizae,Radix Ginseng and Radix Panacis Quinquefolii on the basis of treatment for the control group.The treatment of both groups lasted for a total duration of 12 weeks.The changes in the traditional Chinese medicine(TCM)syndrome scores,24-hour mean ventricular rate,Atrial Fibrillation Effect on Quality-of-Life Questionnaire(AFEQT)scores and left atrial diameter in the two groups before and after treatment were observed,and the daily dosage of metoprolol succinate sustained-release tablets and the occurrence of thromboembolic events in the two groups were compared.After treatment,the clinical efficacy and safety in the two groups were evaluated.Results(1)During the trial,5 cases were lost and a total of 115 cases were eventually included,including 58 cases in the trial group and 57 cases in the control group.(2)After 12 weeks of treatment,the overall effective rate in the trial group was 94.8%(55/58)and that in the control group was 86.0%(49/57).The intergroup comparison showed that the clinical efficacy of the trial group was significantly superior to that of the control group(P<0.01).(3)After treatment,the total TCM syndrome scores and 24-hour mean ventricular rate in both groups were significantly decreased compared with those before treatment(P<0.01),and the AFEQT scores were significantly increased compared with those before treatment(P<0.01).The amplitude of decrease of the total TCM syndrome scores and 24-hour mean ventricular rate and the amplitude of increase of the AFEQT scores in the trial group were significantly superior to those in the control group(P<0.01).(4)After 12 weeks of treatment,the daily dosage of metoprolol succinate sustainedrelease tablets was(85.17±32.09)mg in the trial group,which was significantly lower than that of(107.92±33.41)mg in the control group,and the difference was statistically significant(P<0.01).(5)After treatment,the difference of the left atrial diameter between the two groups was not statistically significant(P>0.05),but the difference of the pre-and post-treatment difference of left atrial diameter was statistically significant(P<0.05),indicating that the improvement of left atrial diameter in the trial group tended to be superior to that in the control group.(6)During the trial,no thromboembolic events occurred in any patient of the two groups,neither moderate nor severe bleeding events occurred in any patient of the two groups.Conclusion The treatment of using target formula and target drugs based on state-target syndrome differentiation exerts certain effect for patients with heartblood stasis and obstruction type of permanent NAF,and its efficacy is significantly superior to that of the conventional western medical treatment alone.
作者
雷婷
李萍
陈铙
LEI Ting;LI Ping;CHEN Nao(Graduate School of Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Chongqing Beibei Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine,Chongqing 400700,China)
出处
《广州中医药大学学报》
CAS
2022年第9期2008-2014,共7页
Journal of Guangzhou University of Traditional Chinese Medicine
关键词
态靶辨证
靶方
靶药
血府逐瘀汤
丹参
人参
非瓣膜病永久性房颤
心血瘀阻型
state-target syndrome differentiation
target formula
target drugs
Xuefu Zhuyu Decoction
Radix Salviae Miltiorrhizae
Radix Ginseng
permanent nonvalvular atrial fibrillation(NAF)
heart-blood stasis and obstruction type
