芪苈强心胶囊联合心脏康复对冠状动脉旁路移植术后心力衰竭患者心功能及心室重构的影响OA
Effects of Qili Qiangxin capsule combined with cardiac rehabilitation on cardiac function and ventricular remodeling in post-CABG patients with heart failure
目的 探讨芪苈强心胶囊联合心脏康复对冠状动脉旁路移植术(CABG)后射血分数降低的心力衰竭(HFrEF)患者心功能及心室重构的影响.方法 采用前瞻性随机对照试验设计.连续纳入2020年8月至2025年8月于青岛市中医医院心脏中心接受CABG、术后合并HFrEF患者160例,按随机数字表法分为对照组、康复组、中药组和联合组,每组40例.4组均接受指南指导的药物治疗(GDMT).康复组在此基础上增加为期12周的心脏康复治疗(包括运动训练、饮食指导、戒烟干预及双心治疗);中药组加用芪苈强心胶囊(口服,每次4粒,每天3次);联合组同时接受心脏康复及芪苈强心胶囊治疗.分别于治疗前、治疗12周后及治疗结束1、3、6个月时,评估各组患者中医证候积分,检测N末端B型脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)、左心房内径(LA)、二尖瓣口舒张早期血流速度峰值/二尖瓣环舒张早期运动速度峰值(E/e '),记录6分钟步行距离(6MWD),并采用SF-36生存质量量表评分评估生活质量.结果 治疗后,4组患者中医证候积分、NT-proBNP水平均较治疗前显著下降(均P<0.05),且联合组NT-proBNP水平显著低于其他3组(P<0.05).联合组LVEF、6MWD改善程度优于对照组、康复组和中药组(P<0.05).联合组LA、E/e'的改善显著优于对照组(P<0.05),但与康复组和中药组比较差异无统计学意义(P>0.05).联合组SF-36评分改善最显著(P<0.05).4组不良事件发生率差异无统计学意义(P>0.05).结论 在GDMT基础上,芪苈强心胶囊联合心脏康复可进一步改善CABG术后心衰患者的心功能,延缓心室重构,提高运动耐量及生活质量,安全性良好.
Objective To investigate the effects of Qili Qiangxin capsule combined with cardiac rehabilita-tion on cardiac function and ventricular remodeling in patients with heart failure with reduced ejection fraction(HFrEF)following coronary artery bypass grafting(CABG).Methods This prospective randomized controlled trial consecutively enrolled 160 patients with HFrEF following CABG between August 2020 and August 2025.Eligible patients were randomly allocated to four groups(40 patients per group):a control group receiving guideline-directed medical therapy(GDMT),a rehabilitation group receiving GDMT plus 12-week supervised cardiac rehabilitation,a traditional Chinese medicine(TCM)group receiving GDMT plus Qili Qiangxin capsule,and a combination group receiving GDMT plus both 12-week cardiac rehabilitation and Qili Qiangxin capsule.Outcome assessments including TCM syndrome scores,N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),left atrial diameter(LA),early diastolic mitral inflow velocity to early diastolic mitral annular velocity ratio(E/e'),6-minute walk distance(6MWD)and 36-item Short Form Health Survey(SF-36)scores were conducted at baseline,after 12 weeks of intervention,and at 1 month,3 months,and 6 months after treatment initiation.Results Following intervention,TCM syndrome scores and NT-proBNP levels decreased significantly in all four groups(all P<0.05),and the combination therapy group exhibited the lowest NT-proBNP level among all groups(P<0.05).Compared with the other three groups,the combination therapy group achieved significantly greater improvements in LVEF and 6MWD(P<0.05).Left atrial diameter(LA)and the E/e'ratio in the combination therapy group showed significantly more substantial improvements than those in the control group(P<0.05),while no statistically significant differences were detected when compared with the cardiac rehabilitation group and the TCM monotherapy group(all P>0.05).SF-36 score showed the most prominent improvement in the combination therapy group(P<0.05).No statistically significant difference in the incidence of adverse events was identified among the four groups(P>0.05).Conclusion On the basis of GDMT,Qili Qiangxin capsule combined with cardiac rehabilitation can further improve cardiac function,delay ventricular remodeling,and improve the quality of life of post-CABG patients with heart failure,with favorable safety profile.
生伟;杨海芹;赵振桐;邓浩;范坤;郑志强;孙龙
青岛市中医医院、青岛大学附属青岛市海慈医院心脏外科(山东 青岛 266000)青岛优抚医院心理干预科(山东 青岛 266000)青岛市中医医院、青岛大学附属青岛市海慈医院心脏外科(山东 青岛 266000)青岛市中医医院、青岛大学附属青岛市海慈医院心脏外科(山东 青岛 266000)青岛市中医医院、青岛大学附属青岛市海慈医院心脏外科(山东 青岛 266000)青岛市中医医院、青岛大学附属青岛市海慈医院心脏外科(山东 青岛 266000)青岛市市立医院心脏外科(山东 青岛 266000)
医药卫生
芪苈强心胶囊心脏康复冠状动脉旁路移植术心力衰竭心功能心室重构
Qili Qiangxin capsulecardiac rehabilitationcoronary artery bypass graftingheart failurecardiac functionventricular remodeling
《实用医学杂志》 2026 (16)
2883-2890,8
山东省自然科学基金项目(编号:ZR2023QH160)山东省中医药科技项目(编号:M-2023033)
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