达格列净联合血府逐瘀汤治疗气虚血瘀证冠心病合并慢性心力衰竭的临床疗效和预后分析

To Evaluate the Clinical Efficacy and Prognostic Outcomes of Dapagliflozin Combined with Xuefu Zhuyu Decoction in Patients with Coronary Heart Disease Complicated by Qi Deficiency and Blood Stasis Syndrome and Chronic Heart Failure

摘要: 目的：探讨达格列净联合血府逐瘀汤治疗气虚血瘀证冠心病合并慢性心力衰竭的临床疗效和预后分析。方法：纳入湖州市第一人民医院2021年5月至2025年5月期间就诊的320例气虚血瘀证冠心病合并慢性心力衰竭患者作为研究对象，并按随机分配原则将其分为观察组(n = 160)与对照组(n = 160)。两组均按冠心病和慢性心力衰竭基础药物治疗，观察组予达格列净 + 血府逐瘀汤治疗，对照组予达格列净治疗，干预治疗4周后比较两组患者治疗前后运动耐量、心功能、生活质量、不良反应及预后。结果：观察组西医、中医临床疗效总有效率均高于对照组的，6分钟步行距离、左室射血分数均高于对照组，左室收缩末期内径、左室收缩末期容量、NT-proBNP及生活质量评分低于对照组，差异均有统计学意义(P < 0.05)；观察组不良反应发生率与对照组相比差异无统计学意义(P > 0.05)。随访观察组慢性心力衰竭急性加重发生率、再住院率、心源性死亡率均低于对照组，差异均有统计学意义(P < 0.05)。结论：达格列净联合血府逐瘀汤治疗气虚血瘀证慢性心力衰竭，在西医和中医疗效上均有显著表现，能有效提升患者运动耐量，改善心功能与生活质量。

Abstract: Objective: To investigate the clinical efficacy and prognostic outcomes of dapagliflozin combined with Xuefu Zhuyu decoction in the treatment of coronary heart disease with qi deficiency and blood stasis syndrome accompanied by chronic heart failure. Methods: A total of 320 patients with coronary heart disease and concomitant chronic heart failure characterized by qi deficiency and blood stasis, admitted to The First People’s Hospital of Huzhou between May 2021 and May 2025, were enrolled in this study and randomly assigned to either the observation group (n = 160) or the control group (n = 160). The observation group received dapagliflozin in combination with Xuefu Zhuyu decoction, while the control group received dapagliflozin alone. Exercise tolerance, cardiac function, quality of life, adverse reactions and clinical prognosis were assessed and compared between the two groups before and after a 4-week intervention period. Results: The total effective rate of western medicine and traditional Chinese medicine in the observation group was higher than that in the control group, the 6-minute walking distance and left ventricular ejection fraction were higher than those in the control group, and the left ventricular end-systolic diameter, left ventricular end-systolic volume, NT-proBNP and quality of life score were lower than those in the control group, and the differences were statistically significant (P < 0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P > 0.05). The incidence of acute exacerbation of chronic heart failure, rehospitalization rate and cardiac mortality in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05). Conclusion: The combination of dapagliflozin and Xuefu Zhuyu decoction is highly effective in treating chronic heart failure associated with qi deficiency and blood stasis syndrome, demonstrating superior therapeutic outcomes in both Western and traditional Chinese medicine frameworks, and significantly improving exercise capacity, cardiac function, and quality of life in patients.