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目的:探讨补肾平肝方内服和浴足配合西医常规疗法治疗难治性高血压肝火亢盛证的疗效及作用机制。方法:将93例患者采用随机按数字法分为对照组46例和观察组47例。对照组采用氯沙坦钾片,50 mg/次,1次/d;硝苯地平片,10mg/次,1次/d;氢氯噻嗪片,25 mg/次,2次/d。观察组在对照组治疗的基础上采用补肾平肝方内服和浴足。两组疗程均为8周。进行治疗前后血压水平测量,并计算治疗后血压达标率,;检测治疗前后一氧化氮(NO),内皮素1(ET-1),血清胱抑素(Cys C)和β2微球蛋白(β2-MG)水平。结果:治疗后观察组收缩压(SBP)和舒张压(DBP)水平低于对照组(P<0.01);经Ridit分析,观察组血压控制疗效优于对照组(P<0.05);治疗后对照组血压达标率为41.3%,低于观察组的65.9%(P<0.05);治疗后观察组Cys C和β2-MG低于对照组(P<0.01);治疗后两组ET-1水平下降,观察组下降更为显著(P<0.01);治疗后两组NO水平均上升,观察组NO上升更明显(P<0.01)。结论:在西医常规治疗的基础上,补肾平肝方内服和浴足能进一步控制难治性高血压(肝火亢盛证)患者的血压水平,提高血压达标率,并对高血压早期肾损害有一定的保护作用,其机制可能与调节血管内皮功能有关。
Objective: To investigate the curative effect and mechanism of Bushen Pinggan decoction and footbath combined with western medicine conventional therapy on refractory hypertensive liver-fire syndrome. Methods: Ninety-three patients were randomly divided into control group (n = 46) and observation group (n = 47) by digital method. The control group received losartan potassium tablets, 50 mg / time, once / d; nifedipine tablets, 10 mg / time, 1 / d; hydrochlorothiazide tablets, 25 mg / time, 2 times / d. The observation group was treated with Bushen Pinggan decoction and foot bath on the basis of the control group. The two groups were treated for 8 weeks. Blood pressure was measured before and after treatment, and blood pressure was calculated after treatment. The levels of nitric oxide (NO), endothelin-1 (ET-1), serum cystatin (Cys C) and β2 microglobulin -MG) level. Results: After treatment, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were lower than those in the control group (P <0.01). The Ridit analysis showed that the blood pressure control in the observation group was better than that in the control group The blood pressure compliance rate was 41.3%, lower than that of the observation group (65.9%, P <0.05). After treatment, the Cys C and β2-MG levels in the observation group were lower than those in the control group (P <0.01) , The observation group decreased more significantly (P <0.01). After treatment, the NO level increased in both groups, and the increase of NO in the observation group was more obvious (P <0.01). Conclusion: On the basis of routine treatment of Western medicine, Bushen Pinggan decoction and bathfoot can further control the blood pressure of patients with refractory hypertension (liver fire and hyperactivity syndrome), improve the rate of blood pressure compliance, and have a certain degree of early renal damage in hypertension The protective effect may be related to the regulation of vascular endothelial function.