目的 探讨心脉通胶囊在轻、中度原发性高血压(瘀血阻滞兼阴虚阳亢证)的有效性及安全性.方法 采用随机、双盲双模拟、多中心临床试验方法,选择黑龙中医药大学附属第一医院、黑龙江中医药大学附属第二医院、洛阳市中医院、北京中医药大学第三附属医院、山东中医药大学第二附属医院、南阳市中医院六家医院2016年12月30日至2020年4月18日轻、中度原发性高血压(瘀血阻滞兼阴虚阳亢证)患者235例为研究对象,采用随机数表法分为两组.对照组59例采用心可舒片治疗,试验组176例采用心脉通胶囊治疗,两组均完成4周治疗,比较两组血压实测值变化、中医证候评分、血压达标率及药物安全性.结果 用药4周后,试验组收缩压和舒张压降低值大于对照组,差异有统计学意义(P<0.05);两组治疗前中医证候积分比较,差异无统计学意义(P>0.05);两组治疗12周后证候积分均降低,观察组头痛、眩晕、胸闷、心悸、手足麻木评分低于对照组,差异有统计学意义(P<0.05);两组用药过程中不良事件总发生率比较,差异无统计学意义(P>0.05).结论 心脉通胶囊用于轻、中度原发性高血压(瘀血阻滞兼阴虚阳亢证)患者中,能降低患者收缩压和舒张压,降低中医证候积分,且药物安全性较高,值得推广应用.

BACKGROUND:Hypertension is one of the most challenging public health problems worldwide. Previous studies suggested that the Songling Xuemaikang capsule (SXC)-a Chinese herbal formula-was effective for essential hypertension. However, the efficacy of SXC monotherapy for hypertension remains unclear. We aimed to compare the blood pressure (BP)-lowering efficacy and safety of SXC versus losartan in patients with essential hypertension. METHODS:In this multicenter, randomized, double-blind, noninferiority trial in China, patients 18 to 65 years of age with mild essential hypertension were randomly allocated to receive either SXC or losartan for 8 weeks. The primary outcome was the change in sitting diastolic BP from baseline to 8 weeks, with a predefined noninferiority margin of -2.5 mm Hg. RESULTS:Of the 755 patients who entered a 2-week run-in period, 628 patients (327 women and 301 men; mean [SD] age, 52.6 [9.2] years) were randomly assigned to the SXC (n=314) or losartan (n=314) group. The primary analysis based on the intention-to-treat principle showed that the change in diastolic BP from baseline to 8 weeks was similar between the SXC and losartan groups (-7.9 [8.0] versus -8.1 [7.9]). The lower boundary of 95% CI (mean difference, -0.24 [95% CI, -1.51 to 1.03]) was above the margin of -2.5 mm Hg, showing noninferiority. Results were consistent with per-protocol analysis. SXC produced greater improvements in total hypertension symptom score (-5.7 [4.2] versus -5.0 [4.0]; P=0.020) and total cholesterol (-0.1 [1.0] versus 0.1 [1.2]; P=0.025). There were no differences between groups in the other BP and patient-reported outcomes. Incidence and severity of adverse events were similar between groups. CONCLUSIONS:SXC was well tolerated and demonstrated noninferior to losartan in BP lowering in patients with mild hypertension. SXC might be an alternative for mild hypertension, particularly for patients with a preference for natural medicine. REGISTRATION:URL: www.chictr.org.cn; Unique identifier: ChiCTR-IPR-16008108.

目的:评价真武汤加减治疗慢性心衰的有效性.方法:检索中国知网(CNKI)、万方数据库、维普数据库,外文数据库Pubmed、Corchrane图书馆数据库等筛选出真武汤加减治疗慢性心衰的研究.以"真武汤"与"慢性心力衰竭""心力衰竭""心衰""心功能不全"分别组合为关键词,检索期限为2010年1月1日-10月31日,最终筛选出19篇随机对照试验(randomized controlled trials,RCTs)文献.根据Cochrane Handbook提供的方法,用Revman5.3对纳入的19篇文献进行质量评价,采用Stata15.1软件对数据进行合并分析,用TSA0.9软件对有效率进行序贯分析.结果:纳入19项研究1832例患者,纳入研究的质量偏低.Meta分析结果显示,真武汤加减联合西药治疗可更有效的提高慢性心衰患者左心室射血分数;更大程度缩小左心室舒张末期内径;真武汤加减联合西药治疗还可以更好的降低血浆NT-proBNP,并改善6min步行试验;在提高试验组有效率方面高于对照组,差异均有统计学意义.结论:真武汤加减联合西药常规治疗慢性心力衰竭,在提高左心室射血分数、减少左心室舒张末期内径、降低血浆NT-proBNP、延长6 min步行试验和提高总有效率方面优于常规西药治疗.序贯分析显示总有效率累积纳入的研究穿过了TSA界值和传统界值,进一步肯定了其临床疗效.

目的 系统阐明理气活血滴丸在冠心病慢性稳定型心绞痛人群广泛使用条件下的安全性和有效性.方法 2016年3月-2017年8月在上海长征医院等全国41家中心随机纳入冠心病慢性稳定型心绞痛病人2433例,口服理气活血滴丸,每次10粒,每日3次,连服4周进行治疗,评估疗效、安全性和生活质量等指标.结果 服用4周后,心绞痛症状总有效率为72.45％,硝酸甘油停减率为88.80％,心电图疗效总有效率为52.53％.共发生不良事件494例(20.27％),与药物可能有关的不良事件123例(5.06％).治疗4周后和筛选期相比,病人生活质量显著提高(P＜0.001).结论 理气活血滴九治疗冠心病稳定型心绞痛有效可靠,安全性好.

review systematically the safety and efficacy of Liqi Huoxue Gutta Pills administrated extensively in population of coronary heart disease-chronic stable angina pectoris (CHD-SAP) complicated by hypertension based on an analysis on the data from the patients in phase IV clinical study. Methods The patients with CHD-SAP (n=2433) were randomly chosen from 41 medical units including Shanghai Changzheng Hospital from Mar. 2016 to Aug. 2017, and among them there were 1117 cases of hypertension. All patients were treated with Liqi Huoxue Gutta Pills 10 pills a time and 3 times a day for 4 weeks. The indexes of efficacy and safety of Liqi Huoxue Gutta Pills and quality of life (QOL) were reviewed in patients with CHD-SAP complicated by hypertension. Results After 4 weeks, the effective rate for symptoms of CHD-SAP was 74.05%, stopping or reducing rate of nitroglycerin was 85.90% and effective rate of electrocardiogram curative effect was 68.60% in patients with CHD-SAP complicated by hypertension. There were 81 patients (7.25%) with drug-related adverse events. QOL was significantly improved after treatment for 4 weeks compared with screening period (P<0.001). Conclusion Liqi Huoxue Gutta Pills has reliable curative effect and higher safety in patients with CHD-SAP complicated by hypertension and patients’ QOL is significantly improved, which is well worth clinical application.

clarify the safety and efficacy of Liqi Huoxue Gutta Pills in extensive administration in population with chronic stable angina pectoris (SAP) of coronary heart disease (CHD) complicated by diabetes. Methods The patients with chronic SAP of CHD (n=2433) were randomly chosen from 41 medical units including Shanghai Changzheng Hospital from Mar. 2016 to Aug. 2017. All patients were treated with Liqi Huoxue Gutta Pills 10 pills a time and 3 times a day for 4 weeks. The indexes of efficacy and safety of Liqi Huoxue Gutta Pills and quality of life (QOL) of patients were analyzed. Results After 4 weeks, the effective rate for symptoms of angina pectoris was 70.80%, stopping or reducing rate of nitroglycerin was 83.00% and effective rate of electrocardiogram curative effect was 70.30% in patients with chronic SAP of CHD complicated by diabetes. There were 208 cases with new adverse events. QOL was significantly improved after treatment for 4 weeks compared with screening period (P<0.001). Conclusion Liqi Huoxue Gutta Pills has reliable curative effect and higher safety in population patients with chronic SAP of CHD complicated by diabetes and patients’ QOL is significantly improved, which is well worth clinical application.

目的:观察马来酸左旋氨氯地平与坎地沙坦酯联合和单独应用治疗原发性轻、中度高血压的临床疗效. 方法:将90例原发性高血压患者随机分为3组:马来酸左旋氨氯地平组(A组)、坎地沙坦酯组(B组)和联合治疗组(C组)各30例,观察3组降压效果,并观察对心率、血常规、尿常规、肝功、肾功、离子和心电等安全性指标的影响. 结果:A组和B组总有效率分别为66.66、63.33%,2组间比较差异无显著性,而C组总有效率为90%,与单独用药组比较差异均有显著性. 3组治疗前后安全性指标无明显变化. 结论:马来酸左旋氨氯地平与坎地沙坦酯联用在取得较理想降压效果的同时,对心率、离子、肝功、肾功、血常规、尿常规均无明显影响,是治疗高血压病较为理想的药物组合.

目的：探讨扶阳益心膏改善原发性高血压（ EH）合并左心室肥厚（ LVH）患者中医证候的疗效和对血液流变学的影响。方法：77例符合纳入标准的EH合并LVH患者随机分为治疗组（扶阳益心膏）与对照组（依那普利），疗程12周，观察比较两组患者的中医证候疗效和血液流变学指标。结果：治疗组、对照组治疗后左心室重量指数（ LVMI ）较治疗前明显减小（ P＜0．05），两组患者治疗后（ LVMI ）比较，差异无统计学意义（P＞0．05），但治疗组的中医证候疗效明显优于对照组（P＜0．05），治疗后血浆黏度、全血黏度高切、全血黏度低切较治疗前均明显降低（P＜0．05）。结论：扶阳益心膏能够明显改善高血压左心室肥厚患者的中医证候和血液流变学指标，有效逆转LVH。

目的:观察扶阳益心膏对高血压合并左心室肥厚（LVH）患者基质金属蛋白酶9（MMP-9）及其抑制剂金属蛋白酶组织抑制因子（TIMP-1）的影响。方法:将77例高血压合并LVH患者随机分为治疗组与对照组,分别服用扶阳益心膏和依那普利,用药12周后观察治疗前后左心室重量指数（LVMI）和血清MMP-9、TIMP-1水平的变化。结果:治疗组、对照组治疗后LVMI较治疗前明显减小（P＜0.01）,MMP-9水平较治疗前明显降低（P＜0.01）,TIMP-1水平较治疗前明显升高（P＜0.01）;治疗后两组LVMI、MMP-9水平比较,差异无统计学意义（P＞0.05）,而治疗组TIMP-1水平较对照组明显升高（P＜0.01）。结论:扶阳益心膏能够减小LVMI,降低血清MMP-9的水平,升高血清TIMP-1的水平,有效防治高血压LVM。

目的探讨银丹心脑通软胶囊在常规治疗冠心病心绞痛基础上的临床疗效及不良反应。方法采用随机对照研究方法,对照组予以常规治疗,治疗组在常规治疗基础上加用银丹心脑通软胶囊,3粒/次,3次/日。两组疗程均为8周。结果治疗组在改善心绞痛症状、心电图、中医证候等方面优于对照组(P<0.05)。结论银丹心脑通软胶囊治疗冠心病心绞痛疗效确切。

According to the characteristics of project teaching method and the course of Chinese Internal Medicine,this paper expounds the fea sibility and necessity of the project teaching method in the teaching of Chinese Internal Medicine,and it introduces the implementation steps of the teaching m ethod concerned with the particular case.In accordance with the teaching practi ce and course examination result,it summarizes the effect of project teaching m ethod in teaching Chinese Internal Medicine,and it also indicates that project teaching method is such a kind of way that can overcome the drawbacks of the tr aditional teaching mode,raise students' learning initiative and activity,impr ove students' clinical practice ability.

<正>1资料患者,男,58岁。因反复胸闷、憋气、心悸、活动后喘促、双下肢水肿10余年,加重伴不能平卧3 d,于2009年6月入院。症见:胸闷、憋气、心悸、稍事活动即喘促、夜间阵发性呼吸困难,双下肢水肿、尿少、食后腹胀、咳嗽、咯黄痰、大便干燥,已丧失劳动能力1年。既往史:主动脉瓣置换术后15年,肥厚型心肌病(HCM)10年,阵发房颤病史6年,否认高血压及糖尿病史。家

冠心病是冠状动脉粥样硬化性心脏病的简称,是指由于冠状动脉粥样硬化导致心肌缺血、缺氧而引起的心脏病,是一种严重危害人类健康和生命的常见病、多发病.心绞痛是其主要临床表现之一.本病属中医学"厥心痛""真心痛""胸痹"范畴.祖国医学对其治疗除内服药物外,还采用内病外治法.中医穴位外治法是在整体观念指导下,内病外治,通过肌表、穴位作用于经络、气血、脏腑,从而达到祛除机体内在疾患、调整和提高机体机能的一种治疗方法.

1资料 患者,男性,89岁.2008年11月4日入院.既往有高血压、糖尿病、冠心病病史.入院前1个月曾因胸闷、气短、心悸、活动后加重,咳嗽、咯白色泡沫痰,住院治疗.

高血压是常见的心血管疾病,有25%～30%高血压患者合并左室肥厚(left ventricular hypertrophy,LVH).LVH是增加心衰、心肌梗死、心律失常及猝死等心血管并发症及死亡率的一种独立的危险因素.所以使用各种药物逆转和预防LVH的发生,是高血压治疗目标之一.重新认识和积极防治逆转LVH已成为近年来中西医领域研究的焦点.近年来,中医药防治高血压LVH已取得了一定成效.

偏头痛是神经系统的常见病多发病,治疗方法较多疗效不一.1997～2005年,笔者以活血止痛汤治疗60例,疗效可靠,报告如下.

目的观察逍遥散加减治疗椎-基底动脉供血不足所致眩晕的临床疗效。方法选取我院门诊及病房的典型的椎-基底动脉供血不足病人,并以眩晕为表现者76例,给予逍遥散加减治疗,一剂日两次口服,十天为一个疗程。结果76例治疗临床痊愈32例,显效24例,好转10例,无效10例。总有效率86﹒8%。平均疗程1﹒5个疗程。结论逍遥散加减治疗椎-基底动脉供血不足所致眩晕具有疗效可靠,疗程短的特点,值得在临床推广应用。

1997～2000年我们应用滋阴补肾、平肝潜阳法治疗高血压病54例，疗效满意，报告如下。……