世界中医药

目的：探讨益气养心汤联合西医常规治疗对慢性心力衰竭（CHF）患者的疗效及对心功能、心肌酶谱的影响。方法：选取广西壮族自治区灵山中医院2015年2月至2016年10月收治的CHF患者122例，随机分为对照组及观察组，各61例，对照组进行西医常规治疗，观察组在对照组基础上服用中药益气养心汤进行治疗，2组均治疗4周。比较2组临床疗效；检测并比较2组心功能、心肌酶谱、神经内分泌激素和血管内皮功能指标水平；采用明尼苏达生活量表（MHL）评价2组治疗前后的生命质量。结果：观察组总有效率90.16%明显高于对照组的78.69%（P<0.05）。治疗后观察组LVESD与ESV均显著降低，且低于对照组（P<0.05或P<0.01），SV、CI、LVEF、FS均显著升高（P<0.05或P<0.01），且LVEF、FS明显高于对照组（P<0.05或P<0.01）。治疗后2组心肌酶谱中CK、CK-MB、LDH及α-HBDH水平均显著降低，且观察组显著低于对照组（P<0.05或P<0.01）。与治疗前比较，治疗后观察组PRA、Ang Ⅱ、ET、ALD水平均明显降低，NO明显升高，且2组间差异有统计学意义（P<0.01）。治疗后2组MHL评分均较治疗前所降低（P<0.01），且观察组明显低于对照组（P<0.01）。结论：常规治疗的基础上加用益气养心汤治疗CHF可延缓心肌损伤程度，改善患者心功能，抑制神经内分泌系统的过度活化，保护血管内皮功能，从而提高临床疗效，值得在临床上推广应用。

English Summary:

To investigate the effect of yiqiyangxin decoction combined with conventional western medicine therapy on cardiac function and myocardial enzymes in the treatment of patients with chronic heart failure （CHF）. Methods:All 122 cases of CHF patients in Lingshan County hospital of TCM from February 2015 to October 2016 were randomly divided into a control group and an observation group, 61 cases in each group, and the control group received conventional western medicine treatment, the observation group extra yiqiyangxin decoction, both treated for 4 weeks. The clinical effects were compared between 2 groups. The cardiac function, myocardial enzymes, neuroendocrine hormones and vascular endothelial function were measured and compared between 2 groups. The quality of life （QOL） of the patients before and after treatment in 2 groups was evaluated by the Minnesota Life Scale （MHL）. Results:The total effective rate of observation group was 90.16%, which was significantly higher than 78.69% of control group （P<0.05）. After treatment, the LVESD and ESV in observation group were significantly lower than those of the control group （P<0.05 or P<0.01）. SV, CI, LVEF, FS in the observation group were significantly higher （P<0.05 or P<0.01）, and LVEF, FS was significantly higher than those of control group （P<0.05 or P<0.01）. After treatment, the CK, CK-MB, LDH and α-HBDH in 2 groups were significantly decreased, and the observation group was significantly lower than the control group （P<0.05 or P<0.01）. Compared with before treatment, the levels of PRA, AngⅡ, ET, ALD in observation group significantly reduced, and the difference between 2 groups was significant （P<0.01）. After treatment, the MHL scores of 2 groups were lower than those before treatment （P<0.01）, and observation group was significantly lower than that of control group （P<0.01）. Conclusion:The use of yiqiyangxin decoction in the treatment of CHF on the basis of routine treatment can delay the degree of myocardial injury, improve cardiac function, inhibit excessive activation of the neuroendocrine system, and protect vascular endothelial function, so as to improve the clinical efficacy, worthy of clinical application.

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