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目的探讨参松养心胶囊联合螺内酯片治疗慢性心力衰竭的临床疗效。方法选取2016年2月—2017年2月北京同仁医院收治的慢性心力衰竭患者106例为研究对象,所有患者随机分为对照组和治疗组,每组各53例。对照组口服螺内酯片,40 mg/次,1次/d。治疗组在对照组的基础上口服参松养心胶囊,4粒/次,3次/d。两组患者均连续治疗1个月。观察两组的临床疗效,比较两组的心电图指标、心率变异性指标、心功能指标、血清N端前脑钠肽(NT-pro BNP)和超敏C-反应蛋白(hs-CRP)水平。结果治疗后,对照组和治疗组的总有效率分别为69.81%、86.79%,两组比较差异有统计学意义(P<0.05)。治疗后,两组QT离散度(QTd)、校正QT离散度(QTcd)和QRS显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组全程窦性心搏NN间期的标准差(SDNN)、全程每5分钟NN间期平均值的标准差(SDANN)、全部相邻NN之差的均方根(r MSSD)和相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)均显著升高,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标明显高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组左心室射血分数(LVEF)显著升高,而左室舒张末期内径(LVEDD)显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组NT-pro BNP和CRP水平显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论参松养心胶囊联合螺内酯片治疗慢性心力衰竭具有较好的临床疗效,可改善心功能,降低心率变异性,安全性较好,具有一定的临床推广应用价值。
Objective To investigate the clinical efficacy of Shensong Yangxin Capsule combined with spironolactone in the treatment of chronic heart failure. Methods A total of 106 patients with chronic heart failure admitted to Beijing Tongren Hospital from February 2016 to February 2017 were selected as study objects. All patients were randomly divided into control group and treatment group, with 53 cases in each group. Control group oral spironolactone tablets, 40 mg / time, 1 / d. The treatment group on the basis of the control group oral Shensong Yang Xin Capsule, 4 / time, 3 times / d. Two groups of patients were treated for 1 month. The clinical efficacy of the two groups were observed. The ECG, heart rate variability, cardiac function, serum NT-proBNP and hs-CRP levels were compared between the two groups. Results After treatment, the total effective rates of the control group and the treatment group were 69.81% and 86.79%, respectively, with significant difference between the two groups (P <0.05). After treatment, the QTd, QTcd and QRS were significantly decreased in both groups (P <0.05), and the observation group was significantly lower than the control group Group, the difference between the two groups was statistically significant (P <0.05). After treatment, the standard deviations (NNNs) of sinus beats throughout the two groups, the standard deviations (SDANNs) of the average NNs throughout the entire 5 min, the rmsSD of all the adjacent NNs The percentage of PNN50> 50 ms in NN group was significantly higher than that in PNN50 group (P <0.05), and those in the treatment group were significantly higher In the control group, the difference between the two groups was statistically significant (P <0.05). After treatment, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) significantly decreased in both groups, with statistical significance (P <0.05) before and after treatment in the two groups; and these observations in the treatment group The improvement of the index was obviously better than that of the control group, the difference between the two groups was statistically significant (P <0.05). After treatment, the levels of NT-pro BNP and CRP in the two groups were significantly lower than those in the control group (P <0.05), and the difference between the two groups was statistically significant Significance (P <0.05). Conclusion Shensong Yangxin Capsule combined with spironolactone in the treatment of chronic heart failure has good clinical efficacy, can improve cardiac function, reduce heart rate variability, safety is good, and has some clinical application value.