五类降压药对阴虚阳亢型高血压病的疗效分析

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1、中图分类号：R89；R36；R39硕士学位论文五类降压药对阴虚阳亢型高血压病的疗效分析院（系）、所中西医结合学院研究生姓名董守金学科、专业中医内科学导师姓名熊晓玲主任医师二Ο一二年三月目录1五类降压药对阴虚阳亢型高血压病的疗效分析„„„„„11.1中文摘要„„„„„„„„„„„„„„„„„„„„„11.2英文摘要„„„„„„„„„„„„„„„„„„„„„31.3英汉缩略词对照表„„„„„„„„„„„„„„„„„61.4前言„„„„„„„„„„„„„„„„„„„„„„„71.5临床研究„„„„„„„„„„„

2、„„„„„„„„„„91.6病例来源与选择„„„„„„„„„„„„„„„„„„91.7研究方法„„„„„„„„„„„„„„„„„„„„„171.8结果„„„„„„„„„„„„„„„„„„„„„„„231.9讨论„„„„„„„„„„„„„„„„„„„„„„„282结论„„„„„„„„„„„„„„„„„„„„„„„333问题与展望„„„„„„„„„„„„„„„„„„„344参考文献„„„„„„„„„„„„„„„„„„„„„355致谢„„„„„„„„„„„„„„„„„„„„„„„376中医辨证分型选用降压药物的

3、研究进展（综述）„„„„387附件„„„„„„„„„„„„„„„„„„„„„„„541五类降压药对阴虚阳亢型高血压病的疗效分析摘要目的：1、客观评价钙离子拮抗剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、利尿剂对阴虚阳亢型高血压病患者的疗效差异。2、初步探讨建立按照中医辩证分型选择降压药的方法，解决降压药选择的盲目性或尝试性的境况，增强高血压病选用降压药的针对性，提高其疗效。方法：采用双中心、随机的方法，将符合纳入标准的阴虚阳亢型高血压病患者118例，随机分成5组，再随机采用5类降压药

4、进行治疗，各组均观察4周。以临床总有效率、前后动态血压和中医症侯积分变化值作为疗效性指标，所得数据符合正态分布者，采用F检验进行统计分析，不符合正态分布者，采用秩和检验进行统计分析，计数资料2采用X检验。结果：(1)临床降压疗效比较：β受体阻滞剂组总有效率87.5%，血管紧张素转换酶抑制剂组总有效率95.9%，钙离子拮抗剂组总有效率100%，血管紧张素Ⅱ受体拮抗剂组总有效率95.4%，利尿剂组总有效率91.3%，血管紧张素转换酶抑制剂组、血管紧张素Ⅱ受体拮抗剂组、钙离子拮抗剂组优于其他两组，P＜0.02，

5、有显著性差异，具有统计学意义；且钙离子拮抗剂组＞血管紧张素转换酶抑制剂组＞血管紧张素Ⅱ受体拮抗剂组，3组组间比较相差不大，P＞0.02，无统计学意义。(2)血压变化的比较：收缩压：血管紧张素转换酶抑制剂组、血管紧张素Ⅱ受体拮抗剂组、钙离子拮抗剂组优于其他两组，P＜0.05，有显著性差异，具有统计学意义；且血压值下降程度由高到低依次为：钙离子拮抗剂组＞血管紧1张素转换酶抑制剂组＞血管紧张素Ⅱ受体拮抗剂组，3组组间比较相差不大，P＞0.05，无统计学意义。舒张压：血管紧张素转换酶抑制剂组、血管紧张素Ⅱ受体拮抗

6、剂组、钙离子拮抗剂组优于其他两组，P＜0.05，有显著性差异，具有统计学意义；且血压值下降程度由高到低依次为：钙离子拮抗剂组＞血管紧张素转换酶抑制剂组＞血管紧张素Ⅱ受体拮抗剂组，3组组间比较相差不大，P＞0.05，无统计学意义。（3）中医症候疗效比较：β受体阻滞剂组总有效率87.5%，血管紧张素转换酶抑制剂组总有效率79.2%，钙离子拮抗剂组总有效率73.1%，血管紧张素Ⅱ受体拮抗剂组总有效率81.0%，利尿剂组总有效率73.9%，β受体阻滞剂组优于其他4组，P＜0.02，有显著性差异，具有统计学意义。（

7、4）中医症候积分变化的比较：β受体阻滞剂组优于其他4组，P＜0.05，有显著性差异，具有统计学意义。(5)5组患者在临床观察期间均未出现明显不良反应。结论：5类降压药物治疗阴虚阳亢型高血压病，在降压疗效方面血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、钙离子拮抗剂优于β受体阻滞剂、利尿剂。而在中医症候改善方面β受体阻滞剂优于其他4类。由此可以推测在阴虚阳亢型高血压病的临床治疗中可以选用血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、钙离子拮抗剂与β受体阻滞剂联用，既可以降低血压使血压达标，又可以缓解患者

8、的临床症状，可收到较好效果。关键词：高血压病；阴虚阳亢；降压药物；临床研究2FiveAntihypertensiveDrugsOntheEfficacyofHyperactivityHypertensionAbstract:Objective:1.Objectiveevaluationofcalciumchannelblockers,angiotensinconvertingenzymeinhibitors,angiotens