标题：益气复脉注射液联合瓜蒌薤白半夏汤治疗气虚痰瘀型冠心病的效果及对左心室结构与功能及血清NT-proBNP的影响

      作者：王卫国 1，石云霄 1，王慧玲 2，寇绍杰 3    开封市中医院心病科 1、中医内科 2、身心医学科 3，河南 开封 475001

      卷次： 2024年35卷2期

      【摘要】 目的 观察益气复脉注射液联合瓜蒌薤白半夏汤治疗气虚痰瘀型冠心病(CHD)的疗效，并探讨其对患者左心室结构与功能及血清N末端B型脑钠尿肽前体(NT-proBNP)的影响。方法 选取2021年4月至2022年5月开封市中医院收治的106例气虚痰瘀型CHD患者作为研究对象，按随机数表法分为对照A组35例、对照B组35例和联合组36例。三组患者均给予西医常规治疗，在此基础上，对照A组给予益气复脉注射液治疗，对照B组给予瓜蒌薤白半夏汤治疗，联合组给予益气复脉注射液联合瓜蒌薤白半夏汤治疗，疗程两周。治疗两周后比较三组患者的临床疗效，以及治疗前后的中医证候积分、心电图指标[心率变异性频域指标高频成分(HF)/低频成分(LF)比值、时域指标期间标准差(SDNN)、均值标准差(SDANN)、差值均方的平方差(RMSSD)]、左心室结构与功能[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、E波与A波峰值速度(E/A)比值]和血清NT-proBNP水平，同时比较两组患者治疗期间的不良反应发生情况。结果 联合组患者的临床治疗总有效率为94.44%，明显高于对照A组的72.29%和对照B组的72.29%，差异均有统计学意义(P<0.05)；三组患者治疗两周后的心悸、气短、胸痛积分较治疗前下降，且联合组患者的心悸、气短、胸痛积分分别为(1.02±0.16)分、(1.13±0.16)分、(0.83±0.13)分，均明显低于对照A组[(1.34±0.23)分、(1.46±0.22)分、(1.10±0.19)分]和对照B组[(1.31±0.20)分、(1.44±0.25)分、(1.08±0.21)分]，差异均有统计学意义(P<0.05)；治疗两周后，三组患者的HF/LF比值较治疗前下降，且联合组患者的HF/LF比值为 1.03±0.22，明显低于对照A组的 1.45±0.28和对照B组的 1.48±0.31，而 SDNN、SDANN、RMSSD、LVEF、E/A比值均较治疗前升高，且联合组患者分别为(118.79±13.51) ms、(106.68±15.13) ms、(45.48±10.47) ms、(47.38±3.26)%、1.18±0.15，明显高于对照A组[(109.88±10.22) ms、(95.72±12.60) ms、(33.65±8.73) ms、(44.20±3.10)%、1.04±0.11]和对照B组[(110.15±10.64) ms、(96.10±12.39) ms、(34.03±9.15) ms、(44.15±3.49)%、1.06±0.10]，差异均有统计学意义(P<0.05)；治疗两周后，三组患者的血清NT-proBNP水平较治疗前下降，且联合组为(842.53±51.20) pg/mL，明显低于对照A组的(971.48±58.97) pg/mL和对照B组的(968.20±60.24) pg/mL，差异均有统计学意义(P<0.05)；三组患者治疗期间的不良反应总发生率比较差异均无统计学意义(P>0.05)。结论 益气复脉注射液联合瓜蒌薤白半夏汤治疗气虚痰瘀型 CHD可减轻患者的临床症状，改善心电图和左心功能，降低血清NT-proBNP水平，临床应用疗效显著，且不增加不良反应。
      【关键词】 冠心病；气虚痰瘀型；益气复脉注射液；瓜蒌薤白半夏汤；心电图；左心室结构与功能；N末端B型脑钠尿肽前体
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2024）02—0168—06

Efficacy of Yiqi Fumai Injection combined with Gualou Xiebai Banxia Decoction in the treatment of coronaryheart disease of Qi-asthenia phlegm stagnant type and its influence on left ventricular structure and function, aswell as serum NT-proBNP.
WANG Wei-guo 1, SHI Yun-xiao 1, WANG Hui-ling 2, KOU Shao-jie 3. Department ofCardiology 1, Department of Traditional Chinese Medicine Internal Medicine 2, Department of Psychosomatic Medicine 3,Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng 475001, Henan, CHINA
【Abstract】 Objective To observe the efficacy of Yiqi Fumai Injection combined with Gualou Xiebai BanxiaDecoction in the treatment of coronary heart disease (CHD) of Qi-asthenia phlegm stagnant type, and to explore its ef-fects on the structure and function of the left ventricle and serum N-terminal pro-brain natriuretic peptide (NT-proBNP).Methods A total of 106 patients with CHD of Qi-asthenia phlegm stagnant type admitted to Kaifeng Hospital of Tradi-tional Chinese Medicine from April 2021 to May 2022 were selected as the research objects. According to the randomnumber table method, they were divided into three groups: control group A (n=35), control group B (n=35), and com-bined group (n=36). All the three groups were given conventional Western medical treatment. On this basis, the patientsin the control group A were treated with Yiqi Fumai Injection, the patients in the control group B were treated with Gua-lou Xiebai Banxia Decoction, and the patients in the combined group were treated with Yiqi Fumai Injection combinedwith Gualou Xiebai Banxia Decoction, all for 2 weeks. After 2 weeks of treatment, the clinical efficacy was comparedamong the three groups of patients, as well as the TCM syndrome scores, electrocardiogram indicators [high-frequencycomponent (HF)/low-frequency component (LF) ratio of frequency domain indicators of heart rate variability, standarddeviation of normal to normal (SDNN), standard deviation of all normal to normal (SDANN), root mean square of suc-cessive differences (RMSSD)], left ventricular structure and function [left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), E/A ratio of peak velocity], andserum NT-proBNP levels before and after treatment. The incidence of adverse reactions during treatment was comparedbetween the two groups. Results The total clinical efficacy rate of patients in the combined group was 94.44%, whichwas significantly higher than 72.29% in the control group A and 72.29% in the control group B (P<0.05). After 2 weeksof treatment, the scores of palpitations, shortness of breath, and chest pain in the three groups decreased comparedwith those before treatment, and the scores in the combined group were (1.02±0.16) points, (1.13±0.16) points, and(0.83±0.13) points, respectively, which were significantly lower than (1.34±0.23) points, (1.46±0.22) points, and (1.10±0.19) points in the control group A and (1.31±0.20) points, (1.44±0.25) points, and (1.08±0.21) points in the controlgroup B (P<0.05). After 2 weeks of treatment, the HF/LF ratios in the three groups decreased compared with those be-fore treatment, and the ratio in the combined group was 1.03±0.22, which was significantly lower than 1.45±0.28 in thecontrol group A and 1.48±0.31 in the control group B (P<0.05); SDNN, SDANN, RMSSD, LVEF, and E/A ratios in-creased compared with those before treatment, and the values in the combined group were (118.79±13.51) ms, (106.68±15.13) ms, (45.48±10.47) ms, (47.38±3.26)%, and 1.18±0.15, respectively, significantly higher than (109.88±10.22) ms,(95.72±12.60) ms, (33.65±8.73) ms, (44.20±3.10)%, 1.04±0.11 in the control group A and (110.15±10.64) ms, (96.10±12.39) ms, (34.03±9.15) ms, (44.15±3.49)%, 1.06±0.10 in the control group B (P<0.05). After 2 weeks of treatment, theserum NT-proBNP levels in the three groups decreased compared with those before treatment, and the level in the com-bined group was (842.53±51.20) pg/mL, which was significantly lower than (971.48±58.97) pg/mL in the control groupA and (968.20±60.24) pg/mL in the control group B (P<0.05). There was no significant difference in the total incidenceof adverse reactions among the three groups during treatment (P>0.05). Conclusion Yiqi Fumai Injection combinedwith Gualou Xiebai Banxia Decoction can alleviate the clinical symptoms of CHD patients of Qi-asthenia phlegm stag-nant type, improve electrocardiogram and left ventricular function, and reduce serum NT-proBNP levels, without increas-ing adverse reactions, which has significant efficacy in clinical application.
      【Key words】 Coronary heart disease; Qi-asthenia phlegm stagnant type; Yiqi Fumai Injection; Gualou XiebaiBanxia Decoction; Electrocardiogram; Left ventricular structure and function; N-terminal pro-brain natriuretic peptide(NT-proBNP)