心水通胶囊对慢性心力衰竭患者利尿剂抵抗的临床研究(1)
摘 要：目的：观察心水通胶囊(XST)对慢性心力衰竭(CHF)患者利尿剂抵抗的临床治疗效果。方法：将74例被诊为CHF伴利尿剂抵抗患者随机分为治疗组38例和对照组34例。两组均采用常规西药治疗，治疗组在此基础上加服XST，每次3粒，每日3次，7天为一疗程，共观察两个疗程。在第7天和第14天分别对两组的心功能分级、左室射血分数、血清电介质、肝肾功能，以及日尿量、呼吸困难、体重、心率和血压等进行评价。结果：第1个疗程治疗组在尿量、呼吸困难和心功能改善效率分别为61%、33%和36%，明显优于对照组28%、19%和17%(P<0.05)。综合两个疗程计量指标发现，XST在有效利尿的同时，能明显改善左室射血分数、心率及体重(P<0.05)，对肝肾功能及水电介质未发现不良影响，也未发现不良反应。结论：XST对CHF利尿剂抵抗患者具有明显的利尿作用，能改善CHF患者的心功能和症状，不良反应少，值得进一步深入研究。
关键词：心水通胶囊；慢性心力衰竭；利尿剂抵抗
中图分类号：R541.6文献标识码：B 文章编号：1673-7717(2011)04-0837-03
, 百拇医药
Clinical Research of Xinshuitong Capsule on Chronic Heart Failure in
Patients with Diuretic Resistance
TAN Chun-jiang【sup】1, 2【/sup】，CHEN Wen-lie【sup】1, 2【/sup】，LIN Jiu-mao【sup】1, 2【/sup】，LIN Ru-hui【sup】1, 2【/sup】，TAN Ning-feng【sup】3【/sup】
(1.Fujian University of Traditional Chinese Medicine,Fuzhou 350108，Fujian, China
2.Fujian Academy of Integrative Medicine, Fuzhou 350108，Fujian, China
, 百拇医药
3.Cardiovascular Department of Xintian People's Hospital, Xintian 425700,Hunan,China)
Abstract:Objective: Evaluate the effects of Xinshuitong Capsule (XST) on chronic heart failure (CHF) in patients with diuretic resistance. Methods and Results: 74 CHF patients with diuretic resistance were randomized into treatment group (TG, n38) and control group (CG, n34). Both groups were treated with conventional western medicine for CHF, while TG added XST (3 capsules po. tid) with 7 days for a course, two courses were observed altogether. At day 7 or 14, cardiac function, left ventricular ejection fraction, serum dielectric, liver and kidney functions, and the volume of urine output, dyspnoea, bodyweight, heart rate and blood pressure were evaluated. Results: In TG at course 1, urine output, dyspnoea and heart function improved significantly (61%, 33% and 36%, respectively) than the control group (28%, 19% and 17%) (P<0.05). Averaged the data from two courses, in addition to improve urine output, XST was effective in improvement the left ventricular ejection fraction, heart rate and body weight (P <0.05), while no adverse effects of hepatic/renal functions, serum dielectric and no other side effects were found in the experiments. Conclusion: XST was effective on CHF patients with diuretic resistance and improved cardiac functions and symptoms with little adverse reactions, which was worthy of further study.
, http://www.100md.com
Key words:Xinshuitong Capsule；chronic heart failure；diuretic resistance
收稿日期：2010-11-26
基金项目：福建省自然科学基金资助项目(2008J0326)；福建省教育厅A类科技项目(JA08114)；福建省高校中西医结合基础重点实验室开放课题(ZXY2008005)；陈可冀中西医结合发展基金(CKZ2008009)
作者简介：谭春江(1967-)，男，湖南人，副教授，博士研究生，研究方向:心血管疾病的中西医结合防治。
慢性心力衰竭(CHF)患者常伴有体液潴留，利尿剂在CHF的治疗中起着关键作用，多数患者通过利尿治疗能有效地改善CHF症状。但随着病情发展，部分患者在足量应用利尿剂治疗的情况下，心源性水肿得不到有效控制，钠水潴留现象仍然存在，这种现象临床称为利尿剂抵抗【sup】[1-2]【/sup】，目前，利尿剂抵抗的机制尚未阐明，缺乏有效的治疗手段。笔者在多年的临床实践中发现，利尿剂抵抗患者中医辨证多为阳虚水泛，气虚血瘀。基于此，根据苓桂术甘汤之意，针对气虚血瘀配制成XST，取得了满意的效果，现报道如下。
, 百拇医药
1 临床资料与方法
1.1 一般资料 收住在本院心内科监护室的CHF患者共74例，其中男44例，女30例；年龄55～82岁，平均(66.7±9.5)岁。其中，51例患者有冠心病史，高心病病史48例，38例伴有血脂异常，2糖尿病患者10例，扩张型心肌病患者17例，肺心病患者16例。
1.2 入选标准和排除标准
1.2.1 入选标准 (1)符合《实用内科学》(第13版)CHF诊断标准【sup】[3]【/sup】，心功能分级按照纽约心脏病学会(NYHA)心功能Ⅳ级；(2)呼吸困难，不能平卧，口唇发绀；(2)颈静脉怒张、肝脏肿大及双下肢水肿；(3)胸片证实心影增大和双肺淤血；(4)意识清楚；(6)BP>90/60mmHg；(7)经静脉持续泵入呋塞米(120mg/d)72h仍然无效，表现为呼吸困难、尿少(<20mL/h)、全身浮肿，被诊为利尿剂抵抗的CHF患者。, 百拇医药(谭春江 陈文列 林久茂 林如辉 谭宁锋)
关键词：心水通胶囊；慢性心力衰竭；利尿剂抵抗
中图分类号：R541.6文献标识码：B 文章编号：1673-7717(2011)04-0837-03
, 百拇医药
Clinical Research of Xinshuitong Capsule on Chronic Heart Failure in
Patients with Diuretic Resistance
TAN Chun-jiang【sup】1, 2【/sup】，CHEN Wen-lie【sup】1, 2【/sup】，LIN Jiu-mao【sup】1, 2【/sup】，LIN Ru-hui【sup】1, 2【/sup】，TAN Ning-feng【sup】3【/sup】
(1.Fujian University of Traditional Chinese Medicine,Fuzhou 350108，Fujian, China
2.Fujian Academy of Integrative Medicine, Fuzhou 350108，Fujian, China
, 百拇医药
3.Cardiovascular Department of Xintian People's Hospital, Xintian 425700,Hunan,China)
Abstract:Objective: Evaluate the effects of Xinshuitong Capsule (XST) on chronic heart failure (CHF) in patients with diuretic resistance. Methods and Results: 74 CHF patients with diuretic resistance were randomized into treatment group (TG, n38) and control group (CG, n34). Both groups were treated with conventional western medicine for CHF, while TG added XST (3 capsules po. tid) with 7 days for a course, two courses were observed altogether. At day 7 or 14, cardiac function, left ventricular ejection fraction, serum dielectric, liver and kidney functions, and the volume of urine output, dyspnoea, bodyweight, heart rate and blood pressure were evaluated. Results: In TG at course 1, urine output, dyspnoea and heart function improved significantly (61%, 33% and 36%, respectively) than the control group (28%, 19% and 17%) (P<0.05). Averaged the data from two courses, in addition to improve urine output, XST was effective in improvement the left ventricular ejection fraction, heart rate and body weight (P <0.05), while no adverse effects of hepatic/renal functions, serum dielectric and no other side effects were found in the experiments. Conclusion: XST was effective on CHF patients with diuretic resistance and improved cardiac functions and symptoms with little adverse reactions, which was worthy of further study.
, http://www.100md.com
Key words:Xinshuitong Capsule；chronic heart failure；diuretic resistance
收稿日期：2010-11-26
基金项目：福建省自然科学基金资助项目(2008J0326)；福建省教育厅A类科技项目(JA08114)；福建省高校中西医结合基础重点实验室开放课题(ZXY2008005)；陈可冀中西医结合发展基金(CKZ2008009)
作者简介：谭春江(1967-)，男，湖南人，副教授，博士研究生，研究方向:心血管疾病的中西医结合防治。
慢性心力衰竭(CHF)患者常伴有体液潴留，利尿剂在CHF的治疗中起着关键作用，多数患者通过利尿治疗能有效地改善CHF症状。但随着病情发展，部分患者在足量应用利尿剂治疗的情况下，心源性水肿得不到有效控制，钠水潴留现象仍然存在，这种现象临床称为利尿剂抵抗【sup】[1-2]【/sup】，目前，利尿剂抵抗的机制尚未阐明，缺乏有效的治疗手段。笔者在多年的临床实践中发现，利尿剂抵抗患者中医辨证多为阳虚水泛，气虚血瘀。基于此，根据苓桂术甘汤之意，针对气虚血瘀配制成XST，取得了满意的效果，现报道如下。
, 百拇医药
1 临床资料与方法
1.1 一般资料 收住在本院心内科监护室的CHF患者共74例，其中男44例，女30例；年龄55～82岁，平均(66.7±9.5)岁。其中，51例患者有冠心病史，高心病病史48例，38例伴有血脂异常，2糖尿病患者10例，扩张型心肌病患者17例，肺心病患者16例。
1.2 入选标准和排除标准
1.2.1 入选标准 (1)符合《实用内科学》(第13版)CHF诊断标准【sup】[3]【/sup】，心功能分级按照纽约心脏病学会(NYHA)心功能Ⅳ级；(2)呼吸困难，不能平卧，口唇发绀；(2)颈静脉怒张、肝脏肿大及双下肢水肿；(3)胸片证实心影增大和双肺淤血；(4)意识清楚；(6)BP>90/60mmHg；(7)经静脉持续泵入呋塞米(120mg/d)72h仍然无效，表现为呼吸困难、尿少(<20mL/h)、全身浮肿，被诊为利尿剂抵抗的CHF患者。, 百拇医药(谭春江 陈文列 林久茂 林如辉 谭宁锋)