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Article(id=1322925126274121849, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.05.043, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339528864, onlineDateStr=2026-10-30, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339528864, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339528864, creator=13701087609, updateTime=1793339528864, updator=13701087609, issue=Issue{id=1322923490592043032, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='5', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339138887, creator='13701087609', updateTime=1793340572227, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929502539612595, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929502539612596, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=230, endPage=233, ext={EN=ArticleExt(id=1322925127524024442, articleId=1322925126274121849, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Fuling Sini Decoction（茯苓四逆汤）Combined with Danggui Shaoyao Powder（当归芍药散）on Serum Cardiac Troponin Levels in Patients with Chronic Heart Failure of Yang Deficiency and Blood Stasis Syndrome, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the effect of Fuling Sini Decoction（茯苓四逆汤）combined with Danggui Shaoyao Powder（当归芍药散）on serum cardiac troponin levels in patients with chronic heart failure of Yang deficiency and blood stasis syndrome.

Methods

Ninety-eight patients with chronic heart failure of Yang deficiency and blood stasis syndrome treated in the hospital from September 2022 to June 2023 were selected as the research objects. All patients were randomly divided into two groups according to the order of admission. There were49 patients in the control group and the observation group. The patients in the control group were treated with conventional anti-heart failure treatment，and the observation group was treated with Fuling Sini Decoction and Danggui Shaoyao Powder on the basis of the control group. After 2 weeks of treatment，the cardiac function classification，TCM syndrome scores，cardiac ultrasound indexes［left ventricular end-systolic diameter（LVESD），left ventricular end-diastolic diameter（LVEDD），left ventricular ejection fraction（LVEF）］，serum detection indexes［high-sensitivity cardiac troponin I（hs cTnI），plasma N-terminal pro-brain natriuretic peptide（NTproBNP）］and adverse reactions were compared between the two groups.

Results

There was no significant difference in cardiac function classification between the two groups before treatment（P>0.05）. After treatment，the cardiac function classification of the observation group was better than that of the control group（P<0.05）. After treatment，the scores of TCM syndromes in the two groups were significantly decreased，and the score of the observation group was significantly lower than that of the control group（P<0.05）. There was no significant difference in cardiac ultrasound indexes between the two groups before treatment（P>0.05）. After treatment，the values of LVESD and LVEDD decreased and LVEF increased in both groups. The above indexes in the observation group were significantly better than those in the control group（P<0.05）. After treatment，the levels of serum hs cTnI and NT proBNP in the two groups decreased significantly，and those in the observation group were significantly lower than those in the control group（P<0.05）.

Conclusion

The treatment of chronic heart failure with Yang deficiency and blood stasis syndrome by Fuling Sini Decoction and Danggui Shaoyao Powder can better improve the cardiac function and TCM syndromes，promote the recovery of cardiac ultrasound indexes and the levels of serum hs cTnI and NT proBNP，and the application effect is satisfactory.

, authors=Meng JI, Dongjing LIN, Pinhui LI, authorsList=Meng JI, Dongjing LIN, Pinhui LI, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322925134629175429, articleId=1322925126274121849, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对血清心肌钙蛋白水平的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

研究茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对患者血清心肌肌钙蛋白水平的影响。

方法

选取2022年6月—2023年6月医院治疗的98例慢性心力衰竭阳虚血瘀证患者作为研究对象，将所有患者按照入院顺序随机分为两组，对照组和观察组各49例，对照组患者常规抗心力衰竭治疗，观察组在对照组基础上采用茯苓四逆汤合当归芍药散治疗，治疗2周后，比较两组患者的心功能分级、中医证候积分、心脏超声指标［左心室收缩末期内径（Left ventricular end systolic diameter，LVESD）、左心室舒张末期内径（Left ventricular end diastolic diameter，LVEDD）、左心室射血分数（Left ventricular ejection fraction，LVEF）］、血清检测指标［超敏心肌肌钙蛋白I（Hypersensitive cardiac troponin I，hs cTnI）、血浆N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT proBNP）］。

结果

治疗前两组心功能分级情况差异无统计学意义（P>0.05），治疗后观察组患者心功能分级情况优于对照组（P<0.05）。治疗前两组患者的中医证候气短/喘息、乏力、心悸、畏寒肢冷、口唇/面色紫黯积分差异无统计学意义（P>0.05），治疗后两组患者以上各项中医证候积分均显著下降，观察组显著低于对照组（P<0.05）。治疗前两组患者心脏超声指标差异无统计学意义（P>0.05），治疗后两组患者LVESD、LVEDD均降低、LVEF升高，观察组患者的以上各指标显著优于对照组（P<0.05）。治疗前两组患者血清hs cTnI、NT proBNP水平差异无统计学意义（P>0.05），治疗后两组患者血清hs cTnI、NT proBNP水平显著降低，观察组显著低于对照组（P<0.05）。

结论

茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证能够更好地改善患者心功能及中医证候，促进心脏超声指标及血清hs cTnI、NT proBNP水平恢复，应用效果满意。

, authors=及孟, 林冬晶, 李品慧, authorsList=及孟, 林冬晶, 李品慧, authorCompany=null, correspAuthors=null, authorNote=

及孟（1974-），女，河北武邑人，副主任中医师，硕士，研究方向：中西医结合治疗心力衰竭、冠心病、心律失常等心内科疾病。

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及孟（1974-），女，河北武邑人，副主任中医师，硕士，研究方向：中西医结合治疗心力衰竭、冠心病、心律失常等心内科疾病。

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及孟（1974-），女，河北武邑人，副主任中医师，硕士，研究方向：中西医结合治疗心力衰竭、冠心病、心律失常等心内科疾病。

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组别例数治疗前治疗后
Ⅰ级Ⅱ级Ⅲ级Ⅳ级Ⅰ级Ⅱ级Ⅲ级Ⅳ级
对照组490（0.00）0（0.00）39（79.59）10（20.41）22（44.90）10（20.41）9（18.37）8（16.33）
观察组490（0.00）0（0.00）39（79.59）10（20.41）29（59.18）19（38.78）1（2.04）0（0.00）
Z值0.0002.587
P值1.0000.010
), ArticleFig(id=1322925155965599918, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=CN, label=表1, caption=

两组慢性心力衰竭阳虚血瘀证患者治疗前后心功能分级情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后
Ⅰ级Ⅱ级Ⅲ级Ⅳ级Ⅰ级Ⅱ级Ⅲ级Ⅳ级
对照组490（0.00）0（0.00）39（79.59）10（20.41）22（44.90）10（20.41）9（18.37）8（16.33）
观察组490（0.00）0（0.00）39（79.59）10（20.41）29（59.18）19（38.78）1（2.04）0（0.00）
Z值0.0002.587
P值1.0000.010
), ArticleFig(id=1322925156057874608, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数气短/喘息乏力心悸畏寒肢冷口唇/面色紫黯
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组493.87±1.131.80±0.61*3.98±1.222.31±0.84*3.90±1.311.89±0.62*3.07±1.051.93±0.59*3.04±0.901.59±0.52*
观察组493.92±1.051.49±0.54*4.06±1.101.94±0.73*3.85±1.291.48±0.72*3.11±0.951.56±0.42*2.97±0.711.31±0.46*
t值0.2272.6640.3412.3270.1903.0210.1983.5760.4272.823
P值0.8210.0090.7340.0220.8490.0030.8440.0010.6700.006
), ArticleFig(id=1322925156364058802, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=CN, label=表2, caption=

两组慢性心力衰竭阳虚血瘀证患者治疗前后中医证候积分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数气短/喘息乏力心悸畏寒肢冷口唇/面色紫黯
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
对照组493.87±1.131.80±0.61*3.98±1.222.31±0.84*3.90±1.311.89±0.62*3.07±1.051.93±0.59*3.04±0.901.59±0.52*
观察组493.92±1.051.49±0.54*4.06±1.101.94±0.73*3.85±1.291.48±0.72*3.11±0.951.56±0.42*2.97±0.711.31±0.46*
t值0.2272.6640.3412.3270.1903.0210.1983.5760.4272.823
P值0.8210.0090.7340.0220.8490.0030.8440.0010.6700.006
), ArticleFig(id=1322925156460527795, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数LVESD/（mm）LVEDD/（mm）LVEF/（%）
治疗前治疗后治疗前治疗后治疗前治疗后
对照组4947.05±3.2346.11±3.08*61.94±2.9058.70±3.14*38.06±3.7042.95±4.21*
观察组4948.16±3.4943.74±2.26*62.03±3.7256.13±2.68*38.47±4.1845.08±3.91*
t值1.6344.3420.1344.3580.5142.595
P值0.1060.0000.8940.0000.6080.011
), ArticleFig(id=1322925156544413876, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=CN, label=表3, caption=

两组慢性心力衰竭阳虚血瘀证患者治疗前后LVESD、LVED、LVEF比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数LVESD/（mm）LVEDD/（mm）LVEF/（%）
治疗前治疗后治疗前治疗后治疗前治疗后
对照组4947.05±3.2346.11±3.08*61.94±2.9058.70±3.14*38.06±3.7042.95±4.21*
观察组4948.16±3.4943.74±2.26*62.03±3.7256.13±2.68*38.47±4.1845.08±3.91*
t值1.6344.3420.1344.3580.5142.595
P值0.1060.0000.8940.0000.6080.011
), ArticleFig(id=1322925156875763894, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数hs cTnI/（ng/mL）NT proBNP/（pg/mL）
治疗前治疗后治疗前治疗后
对照组490.20±0.040.11±0.02*9 269.65±1 587.303 122.46±932.81*
观察组490.19±0.050.09±0.03*9 378.04±1 649.531 826.71±790.58*
t值1.0933.8830.3317.418
P值0.2770.0000.7410.000
), ArticleFig(id=1322925156938678455, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925126274121849, language=CN, label=表4, caption=

两组慢性心力衰竭阳虚血瘀证患者治疗前后血清hs cTnI、NT proBNP水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数hs cTnI/（ng/mL）NT proBNP/（pg/mL）
治疗前治疗后治疗前治疗后
对照组490.20±0.040.11±0.02*9 269.65±1 587.303 122.46±932.81*
观察组490.19±0.050.09±0.03*9 378.04±1 649.531 826.71±790.58*
t值1.0933.8830.3317.418
P值0.2770.0000.7410.000
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茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对血清心肌钙蛋白水平的影响
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及孟 , 林冬晶 , 李品慧
中华中医药学刊 | 省级项目平台 2025,43(5): 230-233
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中华中医药学刊 |省级项目平台 2025 , 43 (5) : 230 -233
茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对血清心肌钙蛋白水平的影响
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及孟（1974-），女，河北武邑人，副主任中医师，硕士，研究方向：中西医结合治疗心力衰竭、冠心病、心律失常等心内科疾病。

"}, bioImg=null, bioContent=

及孟（1974-），女，河北武邑人，副主任中医师，硕士，研究方向：中西医结合治疗心力衰竭、冠心病、心律失常等心内科疾病。

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及孟, 林冬晶, 李品慧
作者信息
  • 广东省中医院海南医院，海南 海口 570203
作者简介:

及孟（1974-），女，河北武邑人，副主任中医师，硕士，研究方向：中西医结合治疗心力衰竭、冠心病、心律失常等心内科疾病。

Effect of Fuling Sini Decoction（茯苓四逆汤）Combined with Danggui Shaoyao Powder（当归芍药散）on Serum Cardiac Troponin Levels in Patients with Chronic Heart Failure of Yang Deficiency and Blood Stasis Syndrome
Meng JI, Dongjing LIN, Pinhui LI
Affiliations
  • Guangdong Provincial Hospital of Chinese Traditional Medicine，Hainan Hospital，Haikou 570203，Hainan，China
出版时间: 2025-05-10 doi: 10.13193/j.issn.1673-7717.2025.05.043
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摘要
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目的

研究茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对患者血清心肌肌钙蛋白水平的影响。

方法

选取2022年6月—2023年6月医院治疗的98例慢性心力衰竭阳虚血瘀证患者作为研究对象，将所有患者按照入院顺序随机分为两组，对照组和观察组各49例，对照组患者常规抗心力衰竭治疗，观察组在对照组基础上采用茯苓四逆汤合当归芍药散治疗，治疗2周后，比较两组患者的心功能分级、中医证候积分、心脏超声指标［左心室收缩末期内径（Left ventricular end systolic diameter，LVESD）、左心室舒张末期内径（Left ventricular end diastolic diameter，LVEDD）、左心室射血分数（Left ventricular ejection fraction，LVEF）］、血清检测指标［超敏心肌肌钙蛋白I（Hypersensitive cardiac troponin I，hs cTnI）、血浆N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT proBNP）］。

结果

治疗前两组心功能分级情况差异无统计学意义（P>0.05），治疗后观察组患者心功能分级情况优于对照组（P<0.05）。治疗前两组患者的中医证候气短/喘息、乏力、心悸、畏寒肢冷、口唇/面色紫黯积分差异无统计学意义（P>0.05），治疗后两组患者以上各项中医证候积分均显著下降，观察组显著低于对照组（P<0.05）。治疗前两组患者心脏超声指标差异无统计学意义（P>0.05），治疗后两组患者LVESD、LVEDD均降低、LVEF升高，观察组患者的以上各指标显著优于对照组（P<0.05）。治疗前两组患者血清hs cTnI、NT proBNP水平差异无统计学意义（P>0.05），治疗后两组患者血清hs cTnI、NT proBNP水平显著降低，观察组显著低于对照组（P<0.05）。

结论

茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证能够更好地改善患者心功能及中医证候，促进心脏超声指标及血清hs cTnI、NT proBNP水平恢复，应用效果满意。

慢性心力衰竭  /  阳虚血瘀证  /  茯苓四逆汤合当归芍药散  /  心功能  /  中医证候  /  心肌钙蛋白
Objective

To observe the effect of Fuling Sini Decoction（茯苓四逆汤）combined with Danggui Shaoyao Powder（当归芍药散）on serum cardiac troponin levels in patients with chronic heart failure of Yang deficiency and blood stasis syndrome.

Methods

Ninety-eight patients with chronic heart failure of Yang deficiency and blood stasis syndrome treated in the hospital from September 2022 to June 2023 were selected as the research objects. All patients were randomly divided into two groups according to the order of admission. There were49 patients in the control group and the observation group. The patients in the control group were treated with conventional anti-heart failure treatment，and the observation group was treated with Fuling Sini Decoction and Danggui Shaoyao Powder on the basis of the control group. After 2 weeks of treatment，the cardiac function classification，TCM syndrome scores，cardiac ultrasound indexes［left ventricular end-systolic diameter（LVESD），left ventricular end-diastolic diameter（LVEDD），left ventricular ejection fraction（LVEF）］，serum detection indexes［high-sensitivity cardiac troponin I（hs cTnI），plasma N-terminal pro-brain natriuretic peptide（NTproBNP）］and adverse reactions were compared between the two groups.

Results

There was no significant difference in cardiac function classification between the two groups before treatment（P>0.05）. After treatment，the cardiac function classification of the observation group was better than that of the control group（P<0.05）. After treatment，the scores of TCM syndromes in the two groups were significantly decreased，and the score of the observation group was significantly lower than that of the control group（P<0.05）. There was no significant difference in cardiac ultrasound indexes between the two groups before treatment（P>0.05）. After treatment，the values of LVESD and LVEDD decreased and LVEF increased in both groups. The above indexes in the observation group were significantly better than those in the control group（P<0.05）. After treatment，the levels of serum hs cTnI and NT proBNP in the two groups decreased significantly，and those in the observation group were significantly lower than those in the control group（P<0.05）.

Conclusion

The treatment of chronic heart failure with Yang deficiency and blood stasis syndrome by Fuling Sini Decoction and Danggui Shaoyao Powder can better improve the cardiac function and TCM syndromes，promote the recovery of cardiac ultrasound indexes and the levels of serum hs cTnI and NT proBNP，and the application effect is satisfactory.

chronic heart failure  /  Yang deficiency and blood stasis syndrome  /  Fuling Sini Decoction（茯苓四逆汤）combined with Danggui Shaoyao Powder（当归芍药散）  /  cardiac function  /  TCM syndrome  /  cardiac troponin
及孟, 林冬晶, 李品慧. 茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对血清心肌钙蛋白水平的影响. 中华中医药学刊, 2025 , 43 (5) : 230 -233 . DOI: 10.13193/j.issn.1673-7717.2025.05.043
Meng JI, Dongjing LIN, Pinhui LI. Effect of Fuling Sini Decoction（茯苓四逆汤）Combined with Danggui Shaoyao Powder（当归芍药散）on Serum Cardiac Troponin Levels in Patients with Chronic Heart Failure of Yang Deficiency and Blood Stasis Syndrome[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (5) : 230 -233 . DOI: 10.13193/j.issn.1673-7717.2025.05.043
正文
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慢性心力衰竭是指多种原因导致心脏结构和/或功能的异常改变，使心室收缩和/或舒张功能发生障碍，从而引起的一组复杂临床综合征，主要表现为呼吸困难、疲乏和液体潴留（肺淤血、体循环淤血及外周水肿）等。《中国心力衰竭诊断和治疗指南2018》指出患者病死和再住院率居高不下，并提示中西医结合已成为我国慢性心力衰竭治疗的基本模式[1]。中医理论认为，心力衰竭的发生主要是由于气阳虚乏，运血无力造成的，心气虚乏，心脏就会舒缩无力，从而不能很好地推动脉络中的血液畅通运行，津液不是渗出脉络之外成为水肿，就是停留在脉络之内成为瘀血，日久就会络息成积，瘀血、水肿等病理产物胶结在一起致使心脏变形，进一步影响阳气、血液运行，造成心力衰竭的发生，阳虚血瘀证多见[2-4]。中医治疗心力衰竭要立法选方，既要注意局部，又应重视整体，要求辨证论治在整体平衡的基础上应用[5-6]。在西医常规治疗基础上加以中医辨证处方，虽能改善患者心力衰竭的症状，但如何应用中医药手段控制疾病的疗效及进展，中医药应用对机体各项指标的作用还需深入研究。本研究分析茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对患者血清心肌肌钙蛋白水平的影响，现总结报道如下。
1　资料与方法
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1.1　一般资料
选取2022年6月—2023年6月医院治疗的98例慢性心力衰竭阳虚血瘀证患者作为研究对象，将所有患者按照入院顺序随机分为两组，对照组和观察组各49例。对照组中男27例，女22例；年龄38～79岁，平均（68.34±7.16）岁；体质量指数18.1～24.4 kg/m2，平均（22.93±1.46）kg/m2；病程1～9年，平均（5.61±1.89）年；基础疾病：冠状动脉粥样硬化性心脏病（冠心病）17例，原发性高血压病13例，心脏瓣膜病9例，肺源性心脏病6例，其他4例。观察组中男25例，女24例；年龄39～80岁，平均（68.10±6.71）岁；体质量指数18.0～24.6 kg/m2，平均（22.87±1.50）kg/m2；病程1～11年，平均（5.57±1.95）年；基础疾病：冠心病16例，原发性高血压病13例，心脏瓣膜病10例，肺源性心脏病7例，其他3例。两组患者的以上各项资料间差异均无统计学意义（P>0.05），一般资料具有均衡可比性。本研究经我院医学伦理委员会审核通过。
1.2　纳入与排除标准
纳入标准：①西医诊断符合《中国心力衰竭诊断和治疗指南2018》[7]中慢性心力衰竭标准；②中医诊断符合《慢性心力衰竭中医诊疗指南（2022年）》中阳虚血瘀证标准；③心功能Ⅲ～Ⅳ级；④成年患者，性别不限；⑤知情同意研究内容并自愿参与。
排除标准：①起搏器植入患者；②严重心律失常患者；③严重肝肾疾病患者；④血液系统疾病或其他影响研究项目的疾病患者；⑤研究药物过敏患者。
1.3　方法
对照组按照《中国心力衰竭诊断和治疗指南2018》[7]给予常规抗心力衰竭规范治疗，包括给予利尿剂呋噻米20 mg，1次/d口服，根据出入量情况调整利尿剂用量，螺内酯20 mg，1次/d，沙库巴曲缬沙坦100 mg，2次/d口服，根据血压调整用量。美托洛尔缓释片23.75 mg，1次/d，根据心率及液体潴留情况调整用量。
观察组在对照组治疗上加用茯苓四逆汤合当归芍药散，颗粒散剂：炮附子15 g，人参15 g，茯苓40 g，生白术20 g，干姜10 g，炙甘草10 g，赤芍10 g，当归10 g，川芎10 g，泽泻10 g，1剂/d，分2次加水100 mL冲服。
以上两组均治疗14 d。同时加用治疗基础心脏病药物，冠心病加用抗血小板、稳定斑块、扩冠等治疗，治疗期间常规调控血压及血糖，停用其他中药及中成药。
1.4　观察指标
（1）心功能分级。I级：活动不受限，日常体力活动不引起明显气促、疲乏或心悸；Ⅱ级：活动轻度受限，休息时无症状，日常活动或引起明显气促、疲乏或心悸；Ⅲ级：活动明显受限，休息时可无症状，轻于日常活动即引起显著的气促、疲乏或心悸；Ⅳ级：休息时也有症状，任何体力活动均会引起不适[7]。（2）中医证候积分。根据《慢性心力衰竭中医诊疗指南（2022年）》[8]中相关内容确定中医证候气短/喘息、乏力、心悸、畏寒肢冷、口唇/面色紫黯，症状无到严重依次对应0、2、4、6分[9]。（3）心脏超声指标。根据患者治疗前及治疗2周后的心脏超声检查报告单记录左心室收缩末期内径（Left ventricular end systolic diameter，LVESD）、左心室舒张末期内径（Left ventricular end diastolic diameter，LVEDD）、左心室射血分数（Left ventricular ejection fraction，LVEF）值。（4）血清检测指标。患者血清超敏心肌肌钙蛋白I（Hypersensitive cardiac troponin I，hs cTnI）、血浆N末端脑钠肽前体（N-terminal probrain natriuretic peptide，NT proBNP）水平取空腹静脉血以酶联免疫吸附法检测值。
1.5　统计学分析
采用SPSS 23.0软件包分析数据，计数资料用例（%）表示，等级资料比较用秩和检验，计量资料用表示，组内治疗前后或组间比较用t检验，以P<0.05表示差异有统计学意义。
2　结果
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2.1　心功能分级
治疗前两组心功能分级情况差异无统计学意义（P>0.05），治疗后观察组患者心功能分级情况优于对照组（P<0.05）。见表1。
2.2　中医证候积分
治疗前两组患者的中医证候气短/喘息、乏力、心悸、畏寒肢冷、口唇/面色紫黯积分差异无统计学意义（P>0.05），治疗后两组患者以上各项中医证候积分均显著下降，观察组显著低于对照组（P<0.05）。见表2。
2.3　心脏超声指标
治疗前两组患者心脏超声指标差异无统计学意义（P>0.05），治疗后两组患者LVESD、LVEDD均降低、LVEF升高，观察组患者的以上各指标显著优于对照组（P<0.05）。见表3。
2.4　血清hs cTnI、NT proBNP水平
治疗前两组患者血清hs cTnI、NT proBNP水平差异无统计学意义（P>0.05），治疗后两组患者血清hs cTnI、NT proBNP水平显著降低，观察组显著低于对照组（P<0.05）。见表4。
3　讨论
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慢性心力衰竭因心痹、肺胀、心瘅、胸痹（心痛）或风眩等病，病程日久，或过度劳累，损伤心气，阳气虚衰，搏血或运血无力，气虚血瘀，心脉不畅等引起[10-11]。或突发心动悸，本已虚弱之心气无力以应，而诱发或加剧心力衰竭。心阳不足，经气不利，血行不畅，水气内停，泛滥肌肤，凌心射肺，则发为心悸、喘促、水肿等症而为心力衰竭[12]。其是心脏疾病的终末阶段，病程长，病势重，病情复杂多变，有效治疗非常关键。
慢性心力衰竭其病位在心，涉及肺脾肾诸脏，是本虚标实之证，最基本的病机用“虚”“瘀”“水”概括，本质是真阳虚衰、元气不足、水饮停留[13]。阳虚血瘀证多见，患者胸闷气喘、心悸、咳嗽、肢冷、畏寒，尿少浮肿，自汗，汗出湿冷，舌质黯淡或绛紫，苔白腻，脉沉细或涩、结代[14-15]。研究中选取主症气短/喘息、乏力、心悸和次证畏寒肢冷、口唇/面色紫黯作为评估项目，结果表明，在西医基础上茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证能够更好地缓解患者症状，改善心功能分级状况。慢性心力衰竭表面看是心肌受损以后，心脏的收缩和舒张功能出现障碍，导致心排血量减少，患者出现水肿和瘀血，其实心力衰竭的根本在于人体的神经内分泌过度激活和心室重构[16-17]。因此，本研究还选取了心脏超声指标LVESD、LVED、LVEF和血清hs cTnI、NT proBNP水平为观察项目，结果表明西医基础上茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证对于以上各项指标的改善效果更显著。人体以五脏为中心，配合六腑，通过经络系统，配合五体、五官、九窍、四肢百骸而组成有机联系的整体系统，中医治疗遵循整体观念，辨证论治[18]。观察组所用茯苓四逆汤合当归芍药散中，炮附子具有回阳救逆、温里逐寒、温经止痛等功效；人参大补元气、复脉固脱、补脾益肺、生津安神；茯苓利水渗湿、健脾、宁心，《本草衍义》云：茯苓、茯神，行水之功多，益心脾不可阙也；生白术健脾益气，燥湿利水；干姜温中散寒，回阳通脉，温肺化饮，《本草纲目》载：干姜，能引血药入血分、气药入气分，又能去恶养新，有阳生阴长之意，故血虚者用之；炙甘草滋阴养血，益气通阳，复脉定悸；赤芍清热凉血，散瘀止痛；当归补血活血，调经止痛，润燥滑肠；川芎行气开郁，祛除风燥湿，活血止痛；泽泻利水渗湿，泄热，化浊降脂；以上诸药共同发挥益气温阳、活血化瘀、复脉固脱的作用。血清hs cTnI是一种心肌细胞损伤后释放的生物标志物，NT proBNP是用于监测心肌损伤、心力衰竭进展的指标，心脏不仅具有泵血功能，而且还具有内分泌功能，茯苓四逆汤合当归芍药散利于机体达到一种平衡状态，其祛邪扶正、促进气血流通。现代药理学研究也提示，炮附子经试验具有肾上腺皮质激素样作用[19]；人参能提高心脏的收缩能力和频率，兴奋心脏，使血液流动加快，促进体内的新陈代谢[20]；当归多糖可通过直接和/或间接途径激活造血微环境中的巨噬细胞、淋巴细胞等，也可刺激心肌组织，促进其产生造血调控因子，刺激骨髓粒单系造血[21-22]；泽泻还有降血脂及抗动脉粥样硬化及免疫调节作用[23-25]。以上均表明茯苓四逆汤合当归芍药散有利于改善慢性心力衰竭阳虚血瘀证患者心功能、心肌损伤及心力衰竭进展。
由上可见，茯苓四逆汤合当归芍药散治疗慢性心力衰竭阳虚血瘀证能够更好地改善患者心功能及中医证候，促进心脏超声指标及血清hs cTnI、NT proBNP水平恢复，应用效果满意。
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  • 海南省医药卫生科研项目(20A200506)
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参考文献 引证文献
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2025年第43卷第5期
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doi: 10.13193/j.issn.1673-7717.2025.05.043
  • 首发时间：2026-10-30
  • 出版时间：2025-05-10
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海南省医药卫生科研项目(20A200506)
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    广东省中医院海南医院，海南 海口 570203
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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