Effect of modified Zexie Decoction in treatment of elderly patients with grade 1 of essential hypertension differentiated as syndrome of excessive phlegm and dampness
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摘要:目的
观察泽泻汤加减对老年原发性高血压1级(极高危)痰湿壅盛证患者的临床疗效。
方法选取2021年5月-2023年4月本院老年病科收治的103例原发性高血压1级(极高危)老年患者为研究对象, 随机分为对照组(n=51)与研究组(n=52)。对照组给予生活方式干预, 研究组在对照组基础上使用泽泻汤加减治疗。治疗2周后, 比较2组疗效、中医证候积分、血压、血脂水平以及最大颈动脉内膜中层厚度(dIMTmax)。
结果研究组总有效率为90.38 %, 高于对照组的56.86 %, 差异有统计学意义(P < 0.05)。治疗后, 2组主症、次症积分均较治疗前降低, 且研究组主症、次症积分均低于对照组, 差异有统计学意义(P < 0.05)。治疗后, 2组收缩压、舒张压均较治疗前下降, 且研究组收缩压、舒张压低于对照组, 差异有统计学意义(P < 0.05)。治疗后, 2组总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均较治疗前降低, 高密度脂蛋白胆固醇水平较治疗前升高, 且研究组总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平低于对照组, 高密度脂蛋白胆固醇水平高于对照组, 差异有统计学意义(P < 0.05)。治疗后, 研究组dIMTmax为(0.92±0.12) mm, 小于对照组的(1.10±0.15) mm, 差异有统计学意义(P < 0.05)。
结论泽泻汤加减治疗能有效改善老年原发性高血压患者的临床症状, 调节血压、血脂水平, 减轻血管内皮损伤, 减小颈动脉内膜中层厚度。
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关键词:
- 原发性高血压 /
- 老年患者 /
- 泽泻汤 /
- 辨证施治 /
- 最大颈动脉内膜中层厚度
Abstract:ObjectiveTo observe the clinical efficacy of modified Zexie Decoction in treatment of elderly patients with grade 1 of essential hypertension (extremely high risk) differentiated as syndrome of excessive phlegm and dampness.
MethodsFrom May 2021 to April 2023, 103 elderly patients with grade 1 of essential hypertension (extremely high risk) in the Department of Geriatric Diseases in the authors' hospital were selected as research objects, and they were randomly divided into control group (n=51) and study group (n=52). The control group received lifestyle interventions, while the study group was treated with modified Zexie Decoction on the basis of the control group. After two weeks of treatment, the clinical efficacy, the score of traditional Chinese medicine symptoms, blood pressure, blood lipid level, and maximum intima-media thickness of the carotid artery (dIMTmax) were compared between the two groups.
ResultsThe total effective rate in the study group was 90.38 %, which was significantly higher than 56.86 % in the control group (P < 0.05). After treatment, the scores of primary and secondary symptoms in both groups decreased significantly when compared to those before treatment, and the scores of primary and secondary symptoms in the study group were significantly lower than those in the control group (P < 0.05). After treatment, the systolic and diastolic blood pressures in both groups decreased significantly when compared to those before treatment, and the systolic and diastolic blood pressures in the study group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of total cholesterol, triglycerides and low-density lipoprotein cholesterol decreased significantly in both groups, while high-density lipoprotein cholesterol level increased significantly, and the levels of total cholesterol, triglycerides and low-density lipoprotein cholesterol in the study group were significantly lower than those in the control group, but the high-density lipoprotein cholesterol level was significantly higher than that in the control group (P < 0.05). After treatment, the dIMTmax in the treatment group was (0.92±0.12) mm, which was significantly less than (1.10±0.15) mm in the control group (P < 0.05).
ConclusionModified Zexie Decoction can effectively improve clinical symptoms in elderly patients with essential hypertension, regulate blood pressure and lipid levels, alleviate vascular endothelial injury, and reduce the carotid intima-media thickness.
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表 1 2组疗效比较
组别 n 显效 有效 无效 总有效率/% 对照组 51 17 12 22 56.86 研究组 52 35 12 5 90.38* 与对照组比较, * P < 0.05。 
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表 2 2组中医证候积分比较(x±s)
分 组别 n 主症 次症 治疗前 治疗后 治疗前 治疗后 对照组 51 9.48±1.36 6.27±1.06* 5.22±0.78 4.02±0.60* 研究组 52 9.51±1.47 4.75±0.89*# 5.31±0.64 2.27±0.39*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组血压水平比较(x±s)
mmHg 组别 n 舒张压 收缩压 治疗前 治疗后 治疗前 治疗后 对照组 51 95.90±4.90 89.80±5.60* 149.70±10.80 145.30±11.90* 研究组 52 96.30±4.80 80.80±4.90*# 150.10±10.70 130.40±9.80*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组血脂指标水平比较(x±s)
mmol/L 指标 时点 对照组(n=51) 研究组(n=55) 甘油三酯 治疗前 1.97±0.48 2.03±0.51 治疗后 1.74±0.36* 1.51±0.30*# 总胆固醇 治疗前 4.36±0.85 4.42±0.88 治疗后 3.97±0.64* 3.64±0.52*# 高密度脂蛋白胆固醇 治疗前 1.22±0.27 1.20±0.25 治疗后 1.35±0.33* 1.54±0.26*# 低密度脂蛋白胆固醇 治疗前 2.68±0.71 2.75±0.70 治疗后 2.38±0.41* 2.01±0.51*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组dIMTmax比较(x±s)
mm 组别 n 治疗前 治疗后 对照组 51 1.11±0.14 1.10±0.15 研究组 52 1.12±0.16 0.92±0.12* dIMTmax: 最大颈动脉内膜中层厚度。
与对照组比较, * P < 0.05。
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