黄连温胆汤加减治疗痰热内扰型冠心病稳定型心绞痛合并慢性失眠的疗效观察

Observation on the therapeutic effect of modified Huanglian Wendan Decoction in the treatment of stable angina pectoris of coronary heart disease with phlegm heat internal disturbance combined with chronic insomnia

关键词:  黄连温胆汤  痰热内扰  冠心病  稳定型心绞痛  失眠  匹兹堡睡眠质量指数  心率变异性  中医证候

Key words:  Huanglian Wendan Decoction  phlegm heat internal disturbance  coronary heart disease  stable angina pectoris  insomnia  Pittsburgh sleep quality index  heart rate variability  traditional Chinese medicine syndrome

摘要:

[目的] 评价黄连温胆汤加减方对痰热内扰型冠心病稳定型心绞痛合并慢性失眠患者的临床疗效。[方法] 收集2023年1月—2024年2月在中国中医科学院广安门医院南区心内科病房住院及门诊就诊的痰热内扰型冠心病稳定型心绞痛合并慢性失眠患者150例，试验组给予黄连温胆汤加减治疗，对照组给予佐匹克隆片治疗，疗程4周，对治疗前后匹兹堡睡眠质量指数（PSQI）、心率变异性（HRV）及中医证候积分的变化进行评价。[结果] 最终138例纳入统计分析，试验组70例，对照组68例。两组治疗前后PSQI得分指标均有下降，试验组优于对照组（P<0.05），试验组有效率为88.5%，对照组有效率为76.4%。试验组优于对照组（P<0.05）。试验组在胸痛、胸闷、入睡困难、多梦、易醒、脘腹痞闷方面有所改善，在心悸、头晕、烦躁、口干口苦方面有明显疗效，在头痛、纳差方面无明显疗效。对照组在入睡困难方面具有明显疗效，在头晕方面有所改善，其余方面无明显疗效。比较两组治疗前后中医证候总积分试验组优于对照组（P<0.05）。比较两组治疗前后HRV，窦性心搏间标准差（SDNN），相邻正常心动周期差值的均方根（RMSSD），全部窦性心搏RR间期的标准差（SDANN）试验组优于对照组（P<0.05）。[结论] 黄连温胆汤加减方对痰热内扰型冠心病稳定型心绞痛合并慢性失眠患者的中医证候、HRV以及失眠改善具有良好效果。

Abstract:

[Objective] Evaluate the clinical efficacy of Huanglian Wendan Decoction modified formula on patients with stable angina pectoris and chronic insomnia of phlegm heat internal disturbance type coronary heart disease. [Methods] Collect 150 patients with phlegm heat internal disturbance type coronary heart disease stable angina pectoris combined with chronic insomnia who were hospitalized and outpatient in the cardiology ward of Guang’anmen Hospital South Campus from January 2023 to February 2024. The patients in the experimental group were given modified Huanglian Wendan Decoction and the patients in the control group were given Zopiclone Tablets for a course of 4 weeks. The changes in Pittsburgh sleep quality index（PSQI），heart rate variability，and traditional Chinese medicine syndrome score were evaluated before and after treatment. [Results] The final 138 cases were included in the statistical analysis，with 70 cases in the experimental group and 68 cases in the control group. Both groups showed a decrease in PSQI scores before and after treatment. The experimental group was better than the control group（P<0.05），with an effective rate of 88.5% in the experimental group and 76.4% in the control group. The experimental group showed improvement in chest pain，chest tightness，difficulty falling asleep，excessive dreaming，easy awakening，and abdominal distension. There was a significant therapeutic effect on palpitations，dizziness，irritability，dry mouth，and bitter taste，but no significant therapeutic effect on headaches and poor appetite. The control group showed significant therapeutic effects in terms of difficulty falling asleep and improved dizziness，while there was no significant therapeutic effect in other aspects. Comparing the total score of traditional Chinese medicine syndromes before and after treatment between the two groups，the experimental group was better than the control group（P<0.05）. Comparing the heart rate variability（HRV） before and after treatment between two groups，the standard deviation of all normal to normal RR intervals（SDNN），root mean square of the difference between adjacent NN intervals（RMSSD） and standard deviation of all 5-minute RR intervals（SDANN），experimental groups were superior to the control group（P<0.05）. [Conclusion] The modified Huanglian Wendan Decoction has a good effect on traditional Chinese medicine syndrome，heart rate variability，and insomnia improvement in patients with stable angina pectoris and chronic insomnia caused by phlegm heat disturbance.