冬芪五苓汤加减及超滤治疗对老年慢性心力衰竭急性失代偿期病人心肾功能的影响

····临临临临床床床床医医医医学学学学论论论论著著著著····冬芪五苓汤加减及超滤治疗对老年慢性心力衰竭急性失代偿期病人心肾功能的影响王翔云,马晓昌,赵阳,张颖,冯新庆,徐凤芹摘要:目的观察冬芪五苓汤加减及血液超滤对老年慢性心力衰竭急性失代偿期病人心肾功能的影响。方法将49例慢性心力衰竭急性失代偿期老年住院病人分为中药治疗组与血液超滤组,在常规西药治疗的基础上,中药治疗组配合使用益气养阴、活血利水中药冬芪五苓汤加减治疗;血液超滤组配合血液超滤治疗。观察两组治疗前后心功能分级、N端脑钠肽前体(NTproBNP)、肾小球滤过率估算值(eGFR)的变化。结果中药治疗组和血液超滤组治疗后NTproBNP较治疗前均明显下降(P<0.01),分别下降(33.2±33.8)%、(41.1±25.5)%,但组间下降百分数比较差异无统计学意义(P>0.05);两组治疗前后eGFR差异无统计学意义(P>0.05),两组eGFR下降百分数比较差异无统计学意义(P>0.05);中药治疗组或血液超滤组治疗前后心功能改善总有效率分别为84.6%、91.3%,两组比较差异无统计学意义(P>0.05)。结论在常规西药治疗的基础上,配合以益气养阴、活血利水为法的中药复方冬芪五苓汤加减或血液超滤治疗,均能明显改善心功能、降低NTproBNP,同时不会引起eGFR下降。关键词:慢性心力衰竭;急性失代偿期;冬芪五苓汤加减;血液超滤;N端脑钠肽前体;肾小球滤过率估算值中图分类号:R541.6R289.5文献标识码:Adoi:10.12102/j.issn.1672-1349.2018.17.002文章编号:1672-1349(2018)17-2445-04EffectofDongqiWulingDecoctionandExtracorporealUltrafiltrationonHeartandRenalFunctioninElderlyPatientswithDecompen-satedAcuteAttackofChronicHeartFailureWangXiangyun,MaXiaochang,ZhaoYang,ZhangYing,FengXinqing,XuFengqinXiyuanHospital,ChinaAcademyofChineseMedicalSciences,Beijing100091,ChinaCorrespondingAuthor:ZhangYing,FengXinqingAbstract:ObjectiveToobservetheeffectofDongqiWulingdecoction(DWD)andextracorporealultrafiltrationonheartandrenalfunctioninelderlypatientswithdecompensatedacuteattackofchronicheartfailure(DAACHF).MethodsFortynineelderlypatientswithDAACHFwererandomlydividedintotwogroups:DWDgrouptreatedwithDWD,andextracorporealultrafiltrationgrouptreatedwithextracorporealultrafiltrationinthebasisofroutinetreatment.Thecardiacfunction,Nterminalpro–Btypenatriureticpeptide(NTproBNP)andestimatedglomerularfiltrationrate(eGFR)wereobservedbeforeandafterthetreatment.ResultsTheNTproB-NPleveldecreasedsignificantlyinDWDgroupandextracorporealultrafiltrationgroupafterthetreatment(P<0.01),andthepercent-ageofNTproBNPdeclinewere(33.2±33.8)%and(41.1±25.5)%,respectively.Therewasnosignificantdifferenceinthepercent-ageofNTproBNPdeclinebetweentwogroups(P>0.05).TherewasnosignificantdifferenceineGFRbetweentwogroupsbeforeandaftertreatment(P>0.05).Therewasnosignificantdifferenceinthep