八段锦联合西药治疗射血分数保留慢性心力衰竭随机平行对照研究
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摘要
[目的]观察八段锦联合西药治疗射血分数保留慢性心力衰竭疗效。[方法]使用随机平行对照方法,将100例住院患者按随机数字表法随机分两组。对照组50例吸氧、卧床休息、血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)、醛固酮受体拮抗剂、利尿剂等。治疗组50例八段锦健身功法,入院第2天起,由熟练掌握八段锦医护人员教授,20～30min/次,1次/d,≥5d/周,以运动后心率、脉搏稳定,次日无明显疲劳感为度;西药治疗同对照组。连续治疗3个月为1疗程。观测临床表现、嗜铬粒蛋白A(CgA)、脑钠肽(BNP)、生活质量评分、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效27例,有效20例,无效3例,总有效率94.00%(47/50);对照组显效22例,有效18例,无效10例,总有效率80.00%(40/50);治疗组疗效优于对照组(P<0.05)。生活质量评分(MLHFQ)治疗组均有明显降低(P<0.01),对照组无明显差异(P>0.05)。CgA、BNP两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]八段锦联合西药治疗射血分数保留慢性心力衰竭,疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of Baduanjin combined with western medicine in the treatment of heart failure with preserved ejection fraction. [Method] Using random parallel controlmethod, 100 cases of hospitalized patients were randomly divided into two groups. In control group, 50 cases were given oxygen absorption, rest on bed, angiotensin converting enzyme inhibitors or angiotensin receptor blocker, aldosterone receptor antagonist and diuretics. In the treatment group, 50 cases were given the Baduanjin fitness exercises promulgated by the State Sports General Administration in 2003. After exercise, the patient's heart rate and pulse were stable, and there was no obvious fatigue on the next day. From the second day of admission, the patient is taught by a medical staff who is proficient in Baduanjin, 20-30 minutes each time, 1 time/d, ≥5 d/week; western medicine treatment is the same as the control group. Continuous treatment for 3 months is a course of treatment. The clinical symptoms, chromogranin A(CgA), brain natriuretic peptide(BNP), Minnesota Living with Heart Failure Questionnaire(MLHFQ) and adverse reaction were observed. The 1 course of treatment was treated and the curative effect was determined. [Results] The treatment group was markedly effective in 27 cases, effective in 20 cases, ineffective in 3 cases, the total effective rate was94.00%(47/50);the control group was markedly effective in 22 cases, effective in 18 cases, ineffective in 10 cases, the total effective rate was 80.00%(40/50); the treatment group was better than the control group(P<0.05). MLHFQ scores were significantly decresed in the treatment group(P<0.01), the control group had no significant change(P>0.05), the treatment group decreased better than that of the control group(P<0.01). CgA and BNP were improved in both groups(P<0.01), The treatment group improved better than the control group(P<0.01). [Conclusion] The therapeutic effect of Baduanjin combined with western medicine on heart failure with preserved ejection fraction is satisfactory, and there is no serious adverse reaction, so it is worthy of promotion.
[Objective] To observe the effect of Baduanjin combined with western medicine in the treatment of heart failure with preserved ejection fraction. [Method] Using random parallel controlmethod, 100 cases of hospitalized patients were randomly divided into two groups. In control group, 50 cases were given oxygen absorption, rest on bed, angiotensin converting enzyme inhibitors or angiotensin receptor blocker, aldosterone receptor antagonist and diuretics. In the treatment group, 50 cases were given the Baduanjin fitness exercises promulgated by the State Sports General Administration in 2003. After exercise, the patient's heart rate and pulse were stable, and there was no obvious fatigue on the next day. From the second day of admission, the patient is taught by a medical staff who is proficient in Baduanjin, 20-30 minutes each time, 1 time/d, ≥5 d/week; western medicine treatment is the same as the control group. Continuous treatment for 3 months is a course of treatment. The clinical symptoms, chromogranin A(CgA), brain natriuretic peptide(BNP), Minnesota Living with Heart Failure Questionnaire(MLHFQ) and adverse reaction were observed. The 1 course of treatment was treated and the curative effect was determined. [Results] The treatment group was markedly effective in 27 cases, effective in 20 cases, ineffective in 3 cases, the total effective rate was94.00%(47/50);the control group was markedly effective in 22 cases, effective in 18 cases, ineffective in 10 cases, the total effective rate was 80.00%(40/50); the treatment group was better than the control group(P<0.05). MLHFQ scores were significantly decresed in the treatment group(P<0.01), the control group had no significant change(P>0.05), the treatment group decreased better than that of the control group(P<0.01). CgA and BNP were improved in both groups(P<0.01), The treatment group improved better than the control group(P<0.01). [Conclusion] The therapeutic effect of Baduanjin combined with western medicine on heart failure with preserved ejection fraction is satisfactory, and there is no serious adverse reaction, so it is worthy of promotion.
引文
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[3]权林芳,张亚萍.射血分数保留的心力衰竭的诊治[J].中西医结合心血管病杂志,2018,6(26):17-18.
[4]Bui AL,Iiorwich TB,Fonarow GC.Epidemiology and risk profile of heart failure[J].Nat Rev Cardiol,2011,8:30-41.
[5]梁峰,胡大一,方全,等.左室射血分数保留的心力衰竭[J].中国循证心血管医学杂志,2015,7(5):706-709.
[6]戴玫,付珞,赵新,等.步行运动对左心室射血分数保留心力衰竭患者的运动耐力的影响[J].重庆医学,2016,45(12):1627-1631.
[7]张晓羽,赵海滨.八段锦结合虚拟康复训练系统在老年稳定型心绞痛运动康复中的应用[J].环球中医药,2018,11(8):1233-1237.
[8]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2013-05-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[9]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:77-85.
[11]国家体育总局健身气功管理中心.健身气功·八段锦[M].北京人民体育出版社,2008:56.
[12]关敬树,周云,缪志静.血清CysC、CgA在慢性心力衰竭患者中的表达及其与心室重塑的相关性[J].心脑血管病防治,2017,17(6)439-445.
[13]贾兴泽,赵婷丽,高静,等.联合检测心型脂肪酸结合蛋白、脑钠肽对慢性心力衰竭的诊断价值[J].心血管康复医学杂志,2018,27(6):703-707.
[14]王贤良,刘洪伟,毛静远,等.基于中国文化改良明尼苏达心力衰竭生存质量量表的测评[J].中国中西医结合杂志,2016,36(9)1072-1075.
[15]Miljkovik LV,Spirosk V.Heart failure with preserved ejection fraction-Concept,pathophysiology,diagnosis and challenges for treatment[J].Open Access Maced J Med Sci,2015,3(3);521-527.
[16]高秀荣,吉宗珊,李孟娇,等.射血分数保留的老年心力衰竭患者的临床特征[J].现代生物医学进展,2019,19(4):724-728.
[17]陈航,刘童,王浩,等.慢性心力衰竭患者标准有氧训练与组合式训练的效果比较[J].重庆医学,2015,44(24):3370-3373.
[18]刘正文.老年慢性心衰患者进行有氧运动的康复疗效[J].心血管康复医学杂志,2015,24(4):356-359.
[19]谢明,张丹,任国胜.嗜铬粒蛋白A及其衍生多肽在天然免疫系统中的作用[J].医学综述,2013,19(6):967-969.
[20]Ceconi C,Ferrari R,Bachetti T,et al.Chromogranin A in heart failure;a novel neurohumoral factor and a predictor for mortality[J].Eur Heart J,2002,23(12):967-974.
[21]许华娟.慢性心力衰竭患者血浆B型脑钠肽水平与左室射血分数相关性分析[J].医药论坛杂志,2018,39(11):121-122.
[22]王艳,刘艳丽,洪艳春,等.老年慢性心力衰竭患者肌钙蛋白I、超敏C-反应蛋白、氨基末端B型脑钠肽前体的变化及其预后评估价值[J].中国卫生检验杂志,2017,27(22):3279-3281.
[23]曹进浩,潘华山,张怡,等.八段锦运动治疗功能性消化不良患者25例[J].环球中医药,2016,9(11):1382-1385.
[24]李智滨,齐丽丽,赵磊,等.八段锦在2型糖尿病患者有氧运动治疗中的优势[J].辽宁中医杂志,2013,40(9):1858-1860.
[2]中国心力衰竭诊断及治疗指南[J].中华心血管病杂志,2014,44(5):1-5.
[3]权林芳,张亚萍.射血分数保留的心力衰竭的诊治[J].中西医结合心血管病杂志,2018,6(26):17-18.
[4]Bui AL,Iiorwich TB,Fonarow GC.Epidemiology and risk profile of heart failure[J].Nat Rev Cardiol,2011,8:30-41.
[5]梁峰,胡大一,方全,等.左室射血分数保留的心力衰竭[J].中国循证心血管医学杂志,2015,7(5):706-709.
[6]戴玫,付珞,赵新,等.步行运动对左心室射血分数保留心力衰竭患者的运动耐力的影响[J].重庆医学,2016,45(12):1627-1631.
[7]张晓羽,赵海滨.八段锦结合虚拟康复训练系统在老年稳定型心绞痛运动康复中的应用[J].环球中医药,2018,11(8):1233-1237.
[8]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2013-05-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[9]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:77-85.
[11]国家体育总局健身气功管理中心.健身气功·八段锦[M].北京人民体育出版社,2008:56.
[12]关敬树,周云,缪志静.血清CysC、CgA在慢性心力衰竭患者中的表达及其与心室重塑的相关性[J].心脑血管病防治,2017,17(6)439-445.
[13]贾兴泽,赵婷丽,高静,等.联合检测心型脂肪酸结合蛋白、脑钠肽对慢性心力衰竭的诊断价值[J].心血管康复医学杂志,2018,27(6):703-707.
[14]王贤良,刘洪伟,毛静远,等.基于中国文化改良明尼苏达心力衰竭生存质量量表的测评[J].中国中西医结合杂志,2016,36(9)1072-1075.
[15]Miljkovik LV,Spirosk V.Heart failure with preserved ejection fraction-Concept,pathophysiology,diagnosis and challenges for treatment[J].Open Access Maced J Med Sci,2015,3(3);521-527.
[16]高秀荣,吉宗珊,李孟娇,等.射血分数保留的老年心力衰竭患者的临床特征[J].现代生物医学进展,2019,19(4):724-728.
[17]陈航,刘童,王浩,等.慢性心力衰竭患者标准有氧训练与组合式训练的效果比较[J].重庆医学,2015,44(24):3370-3373.
[18]刘正文.老年慢性心衰患者进行有氧运动的康复疗效[J].心血管康复医学杂志,2015,24(4):356-359.
[19]谢明,张丹,任国胜.嗜铬粒蛋白A及其衍生多肽在天然免疫系统中的作用[J].医学综述,2013,19(6):967-969.
[20]Ceconi C,Ferrari R,Bachetti T,et al.Chromogranin A in heart failure;a novel neurohumoral factor and a predictor for mortality[J].Eur Heart J,2002,23(12):967-974.
[21]许华娟.慢性心力衰竭患者血浆B型脑钠肽水平与左室射血分数相关性分析[J].医药论坛杂志,2018,39(11):121-122.
[22]王艳,刘艳丽,洪艳春,等.老年慢性心力衰竭患者肌钙蛋白I、超敏C-反应蛋白、氨基末端B型脑钠肽前体的变化及其预后评估价值[J].中国卫生检验杂志,2017,27(22):3279-3281.
[23]曹进浩,潘华山,张怡,等.八段锦运动治疗功能性消化不良患者25例[J].环球中医药,2016,9(11):1382-1385.
[24]李智滨,齐丽丽,赵磊,等.八段锦在2型糖尿病患者有氧运动治疗中的优势[J].辽宁中医杂志,2013,40(9):1858-1860.