强心合剂对慢性心力衰竭患者左室重构的干预作用(1)
【摘要】 目的:探讨强心合剂对慢性充血性心力衰竭(congestive heart failure,CHF)患者左室重构的干预作用。方法:临床上将120例CHF患者随机分为强心合剂组、地高辛组和开搏通组,观察临床总有效率、肾虚症状积分、心胸比例、超声心动图[射血分数(EF)、心输出量(CO)、室间隔厚度(IVST)、左室后壁厚度(PWT)、左室重量指数(LVMI)]和血浆内皮素(ET)、血管紧张素II(Ang II)、心钠素(ANP)水平等的改变。结果:强心合剂组的临床总有效率为82.5%,能显著提高EF和CO(P<0.05,与治疗前比较),还能降低IVST、PWT和LVMI(P<0.01,与治疗前比较),同时还能下调血浆ET、Ang II和ANP水平(P<0.01,与治疗前比较),其疗效与卡托普利相当。再者,本方还能显著改善肾虚症状,而地高辛或卡托普利组却未呈现该方面的作用。结论:强心合剂可能通过短期的加强心脏收缩功能、改善血流动力学及纠正长期的修复性指标,调节神经体液因子,干预心室重构发生、发展,从而延缓心力衰竭的进程。
, http://www.100md.com 【关键词】 强心合剂 充血性心力衰竭 左室重构 内皮素(ET) 血管紧张素II(Ang II) 心钠素(ANP)
The intervention effect of qiangxin mixture on left ventricular remodelingin patients with congestive heart failure
Chen Zhaoshan,et al
【Abstract】 Objective:To evaluate the intervention effect of qiangxin mixture on left ventricular remodeling in patients with congestive heart failure(CHF).Methods:120 cases of CHF were randomly divided into qiangxin mixture group,digoxin and captopril group. The total clinical effective rate, integra of the symptoms of renal asthenia, and echocardiogram [(ejection fraction(EF),cardiac output(CO), interventricular septal thickness(IVST),posterior wall thickness(PWT),left ventricular mass index(LVMI)]as well as the measurement of plasma endothelin, angiotensin II and atrial natriuretic peptide were observed in three groups.Results:The total clinical effective rate of qiangxin mixture group was 82.5%,EF、CO were significantly improved(P<0.05,vs before treatment), IVST、PWT and LVMI were also reduced significantly(P<0.01,vs before treatment). the level of plasma ET 、Ang II and ANP was totally decreased significantly(P<0.01,vs before treatment),Its efficacy acted as well as that of captopril. the integra of the symptoms of renal asthenia was also increased significantly(P<0.01,vs before treatment), however no significant difference in the captopril or digoxin group.Conclusion:The qiangxin mixture is effective in enhencing cardiac contraction,improving hemodynamics in the short-term and rectifying repair indexes in the long-term,regulating the neuroendocrine-factors,intervening left ventricular remodeling, so that it could postpone the processes of CHF.
, 百拇医药
【Key words】 Qiangxin mixture Congestive heart failureleft ventricular remodeling endothelinangiotensin IIatrial natriuretic peptide
充血性心力衰竭(Congestive Heart Failure)是一组复杂的临床征候群,是影响人们健康的非常重要的公共卫生问题。据我国50家医院住院病例调查,心力衰竭的住院率虽然占同期心血管病的20%,但其死亡率却占40%,其五年存活率与恶性肿瘤相仿,已成为心血管病死亡的主要原因[1]。因而,心力衰竭的防治成为21世纪心血管研究领域最热门的课题。
祖国医学在心力衰竭的长期医疗实践中,已经积累了不少的经验,且在提高心衰患者的生活质量方面有一定的优势。本研究试从心脏重构方面切入,探讨强心合剂对慢性心衰患者左室重构的影响。
, http://www.100md.com 1 资料和方法
1.1 研究对象。药物:强心合剂(颗粒冲剂):主要由鹿角、补骨脂等中药组成,由曙光医
院制剂室委托中药研究一厂按既定工艺制备。病例:2000年6月~2003年1月100例上海中医药大学附属曙光医院心内专科门诊及住院的心衰病人及20例上海市中医医院心内科住院病人。
1.1.1 病例纳入标准:采用病证相结合的方法,以心力衰竭兼有肾虚的病人为观察对象:①符合Framingham心力衰竭诊断标准;②中医辨证属肾虚;③病史6个月以上;④纽约心脏病协会(NYHA)分级标准及美国心脏病协会(AHA)修订的心衰Ⅱ级及Ⅱ级以上;⑤胸部X片及超声心动图有左室增大的证据。
1.1.2 排除标准:①由肝、肾等重要脏器功能衰竭导致心力衰竭;②妊娠或哺乳期妇女,对本药过敏者;③合并有肝、肾和造血系统等严重原发性疾病、精神病患者。
1.2 分组及用药。120例患者随机分为强心合剂组(qiangxin Group)、地高辛组(digoxin Group)与开搏通组(captoprilGroup)。强心合剂组:强心合剂1包(4.5克)冲服,3次/日,连续三月,治疗前一周停用洋地黄、开搏通等药物。开搏通组:口服开搏通12.5mg,3次/日,连续三月,治疗前一周停用洋地黄类药物。地高辛组:口服地高辛0.125mg,1次/日,连续三月为一疗程,治疗前一周停用开搏通等ACEI类药物。三组均接受适量的利尿剂或其他扩血管药物作基础治疗。, 百拇医药(陈兆善 董耀荣 周 华 胡婉英)
, http://www.100md.com 【关键词】 强心合剂 充血性心力衰竭 左室重构 内皮素(ET) 血管紧张素II(Ang II) 心钠素(ANP)
The intervention effect of qiangxin mixture on left ventricular remodelingin patients with congestive heart failure
Chen Zhaoshan,et al
【Abstract】 Objective:To evaluate the intervention effect of qiangxin mixture on left ventricular remodeling in patients with congestive heart failure(CHF).Methods:120 cases of CHF were randomly divided into qiangxin mixture group,digoxin and captopril group. The total clinical effective rate, integra of the symptoms of renal asthenia, and echocardiogram [(ejection fraction(EF),cardiac output(CO), interventricular septal thickness(IVST),posterior wall thickness(PWT),left ventricular mass index(LVMI)]as well as the measurement of plasma endothelin, angiotensin II and atrial natriuretic peptide were observed in three groups.Results:The total clinical effective rate of qiangxin mixture group was 82.5%,EF、CO were significantly improved(P<0.05,vs before treatment), IVST、PWT and LVMI were also reduced significantly(P<0.01,vs before treatment). the level of plasma ET 、Ang II and ANP was totally decreased significantly(P<0.01,vs before treatment),Its efficacy acted as well as that of captopril. the integra of the symptoms of renal asthenia was also increased significantly(P<0.01,vs before treatment), however no significant difference in the captopril or digoxin group.Conclusion:The qiangxin mixture is effective in enhencing cardiac contraction,improving hemodynamics in the short-term and rectifying repair indexes in the long-term,regulating the neuroendocrine-factors,intervening left ventricular remodeling, so that it could postpone the processes of CHF.
, 百拇医药
【Key words】 Qiangxin mixture Congestive heart failureleft ventricular remodeling endothelinangiotensin IIatrial natriuretic peptide
充血性心力衰竭(Congestive Heart Failure)是一组复杂的临床征候群,是影响人们健康的非常重要的公共卫生问题。据我国50家医院住院病例调查,心力衰竭的住院率虽然占同期心血管病的20%,但其死亡率却占40%,其五年存活率与恶性肿瘤相仿,已成为心血管病死亡的主要原因[1]。因而,心力衰竭的防治成为21世纪心血管研究领域最热门的课题。
祖国医学在心力衰竭的长期医疗实践中,已经积累了不少的经验,且在提高心衰患者的生活质量方面有一定的优势。本研究试从心脏重构方面切入,探讨强心合剂对慢性心衰患者左室重构的影响。
, http://www.100md.com 1 资料和方法
1.1 研究对象。药物:强心合剂(颗粒冲剂):主要由鹿角、补骨脂等中药组成,由曙光医
院制剂室委托中药研究一厂按既定工艺制备。病例:2000年6月~2003年1月100例上海中医药大学附属曙光医院心内专科门诊及住院的心衰病人及20例上海市中医医院心内科住院病人。
1.1.1 病例纳入标准:采用病证相结合的方法,以心力衰竭兼有肾虚的病人为观察对象:①符合Framingham心力衰竭诊断标准;②中医辨证属肾虚;③病史6个月以上;④纽约心脏病协会(NYHA)分级标准及美国心脏病协会(AHA)修订的心衰Ⅱ级及Ⅱ级以上;⑤胸部X片及超声心动图有左室增大的证据。
1.1.2 排除标准:①由肝、肾等重要脏器功能衰竭导致心力衰竭;②妊娠或哺乳期妇女,对本药过敏者;③合并有肝、肾和造血系统等严重原发性疾病、精神病患者。
1.2 分组及用药。120例患者随机分为强心合剂组(qiangxin Group)、地高辛组(digoxin Group)与开搏通组(captoprilGroup)。强心合剂组:强心合剂1包(4.5克)冲服,3次/日,连续三月,治疗前一周停用洋地黄、开搏通等药物。开搏通组:口服开搏通12.5mg,3次/日,连续三月,治疗前一周停用洋地黄类药物。地高辛组:口服地高辛0.125mg,1次/日,连续三月为一疗程,治疗前一周停用开搏通等ACEI类药物。三组均接受适量的利尿剂或其他扩血管药物作基础治疗。, 百拇医药(陈兆善 董耀荣 周 华 胡婉英)