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[目的]观察温肾益心方联合西药治疗心肾脾阳虚水泛兼瘀浊内蕴终末期肾病合并慢性心力衰竭疗效。[方法]使用随机平行对照方法,将40例住院及门诊患者按就诊顺序号抽签方法简单随机分为两组。对照组20例,缬沙坦80mg/次,1次/d,口服;美托洛尔25mg/次,2次/d,口服;硝苯地平缓释片10mg/次,2次/d,口服;单硝酸异山梨酯片20mg/次,2次/d,口服。治疗组20例,温肾益心方:中药配方颗粒,炒附片6g,白芍、白术各10g,茯苓20g,葶苈子、大枣各10g,黄芪20g,当归、肉苁蓉各10g,温水少许混匀冲服,1剂/d,分2次服。西药治疗同对照组。治疗4周(28d)为1疗程,连续治疗3疗程(84d)。观测心功能、心脏血流动力学、射血分数(EF)、每搏输出量(SV)、二尖瓣口舒张期E峰速度与A峰速度比值(E/A)、不良反应。[结果]心功能疗效:4周治疗组优于对照组(P<0.05),8周、12周两组间无明显差异(P>0.05)。射血分数(EF):连续治疗4周,治疗组明显改善(P<0.05),对照组无明显变化(P>0.05);连续治疗8周,两组均明显改善(P<0.01),组间无明显差异(P>0.05);连续治疗12周,两组均明显改善(P<0.01),治疗组改善优于对照组(P<0.01)。每搏输出量(SV):连续治疗4周、8周,治疗组明显改善(P<0.01),对照组无明显变化(P>0.05);连续治疗12周,两组均明显改善(P<0.01,P<0.05),治疗组改善优于对照组(P<0.01)。二尖瓣口舒张期E峰速度与A峰速度比值(E/A):连续治疗4周、8周、12周,E/A两组均明显升高(P<0.01),治疗组升高优于对照组(P<0.01)。[结论]温肾益心方联合西药治疗心肾脾阳虚水泛兼瘀浊内蕴终末期肾病合并慢性心力衰竭,疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of Wenshen Yixin prescription combined with Western medicine in treating heart-kidney-spleen-yang deficiency and flood-end intrinsic kidney disease combined with chronic heart failure. [Methods] Using randomized parallel control method, 40 cases of inpatients and outpatients were randomly divided into two groups randomly according to the lot number sequence of visiting doctor. Control group of 20 patients, valsartan 80mg / times, 1 time / d, oral; metoprolol 25mg / times, 2 times / d, orally; nifedipine sustained release tablets 10mg / time, 2 times / d, ; Isosorbide mononitrate tablets 20mg / time, 2 times / d, orally. Treatment group of 20 cases, Wenshen Yixin Fang: Chinese medicine formula particles, fried appendix 6g, white peony root, Atractylodes each 10g, Poria 20g, razor clam, jujube 10g, Astragalus 20g, Angelica, Cistanche each 10g, warm water a little Blend blunt, 1 / d, 2 times service. Western medicine treatment with the control group. Treatment for 4 weeks (28d) for a course of treatment, continuous treatment of 3 courses (84d). Cardiac function, cardiac hemodynamics, ejection fraction (EF), stroke volume (SV), mitral E-peak velocity and A-peak velocity ratio (E / A) [Results] The curative effect of cardiac function was better in the 4 weeks treatment group than in the control group (P <0.05). There was no significant difference between the two groups in 8 weeks and 12 weeks (P> 0.05). The ejection fraction (EF) was significantly improved in the treatment group (P <0.05) and the control group (P> 0.05) after continuous treatment for 4 weeks. (P> 0.05). After continuous treatment for 12 weeks, both groups were significantly improved (P <0.01), the treatment group improved better than the control group (P <0.01). Stroke volume per pulse (SV): After 4 and 8 weeks of continuous treatment, the treatment group was significantly improved (P <0.01), but there was no significant change in the control group (P> 0.05) 0.01, P <0.05), the treatment group improved better than the control group (P <0.01). The ratio of E peak velocity to peak velocity (A / A) in mitral valve diastole was significantly higher in E / A group than in E / A group at 4, 8 and 12 weeks of continuous treatment (P <0.01) Better than the control group (P <0.01). [Conclusion] Wenshen Yixin Decoction combined with western medicine can treat heart-kidney-spleen-yang deficiency and flood end-stage nephropathy combined with chronic heart failure with satisfactory results and no serious side effects. It is worth promoting.