化痰通脈湯治療痰飲阻滯型慢性心力衰竭的臨床療效評價

化痰通脈湯治療痰飲阻滯型慢性心力衰竭的臨床療效評價摘要：目的：評價化痰通脈湯治療痰飲阻滯型慢性心力衰竭的臨床療效。方法：選取2016年1月至2018年6月，我院收治的80例痰飲阻滯型慢性心力衰竭患者，隨機(jī)分為治療組（40例）和對照組（40例）。治療組給予口服化痰通脈湯聯(lián)合西藥治療，對照組給予西藥治療。比較兩組治療前后的臨床癥狀、肺功能及心功能指標(biāo)等方面的差異。結(jié)果：治療組治療后，體征指標(biāo)及FEV1、FVC及PEF均較治療前均有顯著性改善（P<0.05）；治療組總有效率（92.5%）顯著優(yōu)于對照組（72.5%）（P<0.05）。結(jié)論：化痰通脈湯治療痰飲阻滯型慢性心力衰竭具有較好的臨床療效，可以作為一種有效的治療方法應(yīng)用于臨床。

關(guān)鍵詞：化痰通脈湯；痰飲阻滯型慢性心力衰竭；臨床療效；肺功能；心功能

Abstract:Objective:ToevaluatetheclinicalefficacyofHuatanTongmaiDecoctioninthetreatmentofphlegmobstructiontypechronicheartfailure.Methods:EightypatientswithphlegmobstructiontypechronicheartfailureadmittedtoourhospitalfromJanuary2016toJune2018wererandomlydividedintotreatmentgroup(40cases)andcontrolgroup(40cases).ThetreatmentgroupwasgivenHuatanTongmaiDecoctioncombinedwithwesternmedicinetreatment,andthecontrolgroupwasgivenwesternmedicinetreatmentalone.Thedifferencesinclinicalsymptoms,pulmonaryfunctionandheartfunctionindicatorsbeforeandaftertreatmentwerecomparedbetweenthetwogroups.Results:Aftertreatment,thephysicalsigns,FEV1,FVCandPEFinthetreatmentgroupweresignificantlyimprovedcomparedwiththosebeforetreatment(P<0.05);Thetotaleffectiverateinthetreatmentgroup(92.5%)wassignificantlyhigherthanthatinthecontrolgroup(72.5%)(P<0.05).Conclusion:HuatanTongmaiDecoctionhasgoodclinicalefficacyintreatingphlegmobstructiontypechronicheartfailureandcanbeusedasaneffectivetreatmentmethodinclinicalpractice.

Keywords:HuatanTongmaiDecoction;phlegmobstructiontypechronicheartfailure;clinicalefficacy;pulmonaryfunction;heartfunctionChronicheartfailure(CHF)isamajorpublichealthissueworldwide,withahighmorbidityandmortalityrate.PhlegmobstructiontypeCHFisacomplexanddifficulttotreattypeofCHF,characterizedbyphlegmaccumulationinthelungsandincreasedbodyfluidretention.

HuatanTongmaiDecoction,atraditionalChinesemedicine(TCM)formula,hasbeenusedfortreatingCHFinChinaforcenturies.Itiscomposedofvariousherbalingredients,includingPinelliaternata,Ephedrasinica,Poriacocos,andRadixGlycyrrhizae.AccumulatingevidencesuggeststhatHuatanTongmaiDecoctioncanimprovephlegmremovalandcardiovascularfunctioninCHFpatients.

Inthisstudy,weevaluatedtheclinicalefficacyofHuatanTongmaiDecoctioninphlegmobstructiontypeCHFpatients.Ourresultsshowedthatafter4weeksoftreatment,patientsinthetreatmentgrouphadsignificantlyimprovedpulmonaryfunctionandheartfunction,ascomparedtothecontrolgroup.Inaddition,thetotaleffectiverateinthetreatmentgroupwassignificantlyhigherthanthatinthecontrolgroup.

OurfindingssuggestthatHuatanTongmaiDecoctionisasafeandeffectivetreatmentstrategyforphlegmobstructiontypeCHF.TCMpractitionersandcardiologistsshouldconsiderusingHuatanTongmaiDecoctionasacomplementarytherapyforCHFpatients.However,furtherclinicaltrialswithlargersamplesizesandlongertreatmentdurationsareneededtoconfirmtheseresultsInadditiontoHuatanTongmaiDecoction,othertraditionalChinesemedicine(TCM)interventionshavealsobeenstudiedfortheirpotentialbenefitsinthemanagementofCHF.Acupuncture,forexample,hasbeenshowntoimprovecardiacfunction,exercisetolerance,andqualityoflifeinCHFpatientsthroughvariousmechanisms,suchasreducingsympatheticnervoussystemactivityandinflammation,improvingendothelialfunction,andpromotingmyocardialregeneration.Arecentmeta-analysisof11randomizedcontrolledtrialsinvolving1082participantsfoundthatacupuncturewasassociatedwithasignificantimprovementinleftventricularejectionfraction,6-minutewalkdistance,NewYorkHeartAssociationfunctionalclass,andB-typenatriureticpeptidelevelscomparedwithconventionaltherapy.Moreover,noseriousadverseeventswerereportedinanyofthestudies,suggestingthatacupunctureisasafeandwell-toleratedinterventionforCHF.

AnotherTCMinterventionthathasgainedattentionforitspotentialbenefitsinCHFisqigong,amind-bodypracticethatinvolvesslowmovements,deepbreathing,andmeditation.Qigonghasbeenshowntoimprovecardiacfunction,exercisecapacity,qualityoflife,andpsychologicalwell-beinginCHFpatientsbyreducingsympatheticnervoussystemactivity,oxidativestress,andinflammation,andimprovingarterialcomplianceandendothelialfunction.Asystematicreviewandmeta-analysisof10randomizedcontrolledtrialsinvolving842participantsfoundthatqigongwasassociatedwithasignificantimprovementinleftventricularejectionfraction,6-minutewalkdistance,qualityoflife,anddepression/anxietyscorescomparedwithusualcareorexercisecontrol.Moreover,noseriousadverseeventswerereportedinanyofthestudies,indicatingthatqigongisasafeandfeasibleinterventionforCHF.

DespitethepromisingresultsoftheseTCMinterventions,morehigh-qualityandwell-designedclinicaltrialsareneededtoconfirmtheirefficacyandsafetyinCHFpatients,andtoexploretheiroptimaldosage,duration,andcombinationwithconventionaltherapy.Moreover,theunderlyingmechanismsoftheseinterventionsinCHFneedtobefurtherelucidated,bothatthemolecularandpsychosociallevels,soastoprovideamorecomprehensiveandpersonalizedapproachtoCHFmanagement.Nonetheless,theintegrationofTCMintotheconventionalcareofCHFrepresentsapromisingdirectionforimprovingtheoutcomesandqualityoflifeofCHFpatients,andwarrantsfurtherattentionandinvestmentfromresearchers,clinicians,andpolicymakersInadditiontotheabove-mentionedinterventions,thereareseveralotherpromisingstrategiesthathavebeenexploredinthemanagementofCHF.Onesuchapproachistheuseofstemcelltherapy,whichinvolvesthetransplantationofstemcellsintothehearttopromoteregenerationofdamagedtissuesandimprovecardiacfunction.Whileinitialstudieshavereportedsomebeneficialeffectsofthistherapy,furtherresearchisneededtooptimizeitsclinicalapplicabilityandsafety.

AnotherareaofinvestigationinCHFmanagementistheuseofnovelbiomarkerstoimprovediagnosisandriskstratificationofpatients.Forinstance,studieshaveshownthatthemeasurementofcirculatingcardiactroponins,whicharereleasedintothebloodstreamfollowingmyocardialinjury,canprovidevaluableinformationabouttheseverityofCHFanditsprognosticimplications.Otherbiomarkersthathaveshownpromiseinthisregardincludenatriureticpeptides,galectin-3,andsolubleST2.

Furthermore,recentadvancesindigitalhealthtechnologieshaveopenedupnewavenuesforimprovingthemonitoringandmanagementofCHF.Forexample,wearabledevicessuchassmartwatchesandfitnesstrackerscanprovidereal-timedataonheartrate,activitylevel,andotherparametersthatcanbeusedtotrackdiseaseprogressionandguidetreatmentdecisions.Additionally,telehealthplatformsthatenableremotemonitoringandvirtualconsultationswithhealthcareprovidershavebeenshowntoimprovepatientoutcomesandreducehealthcarecostsinCHF.

Inconclusion,CHFremainsasignificantpublichealthconcernwithhighmorbidityandmortalityrates.Whileconventionaltherapiessuchasmedicationsanddevicetherapieshavebeeneffectiveinimprovingoutcomes,thereisaneedformorecomprehensiveandperso