Clinical And Experimental Study On The Effect Of An Shen Ding Lv Decoction For Functional Premature Beat And Improvement Of Heart Rate Variability

Research purposes:With the quickening pace of modern life,people are facing increasing pressure of social competition,the prevalence of cardiovascular disease continues to rise,the incidence of functional premature beats is also increasing.The function of premature beats in mental stress,excessive drinking,tea,coffee,insomnia,fatigue and other factors induced and the typical symptoms include palpitation,shortness of breath,typical chest pain,insomnia,anxiety,irritability,fatigue and discomfort;some patients through the adjustment of life style and psychological symptoms can be alleviated,without special treatment.But now more and more functional premature beats patients because of frequent premature beats,overweight,or cardiac arrest patients and obvious sense of insufficient knowledge of disease cause anxiety,insomnia and other psychological symptoms,seriously affects the quality of life,mental and psychological burden,seeking hope is very urgent.Western medicinel commonly used anti premature beats has fast acting and high specific advantages,but the long-term use can inhibit myocardial and heart conduction system,at the same time,there is a potential risk for arrhythmias,easily lead to excessive treatment,so that the benefit of drug treatment is limited.The overall concept of TCM and syndrome differentiation and treatment and other advantages can make up for the pure western medicine in the treatment of functional premature beats,TCM syndrome differentiation and treatment of premature beats has become the trend of development.Chief physician of Feng Ling based on years of practical experience that the main pathogenesis of functional premature beats for yin and xue deficiency,heat disturbing of heart mind,in the treatment of various types of functional premature clinical use of clearing away heat and nourishing blood and sedative have certain curative effect,and according to the development law of An Shen Ding Lv Decoction.This study through clinical observation and animal experiment systematically to verify the efficacy and safety of An Shen Ding Lv Decoction in the treatment of functional premature beats,and its treatment mechanism and compatibility features are discussed,for better clinical treatment of the disease provide a strong basis.Methods:This study from March 2016 to May 2017,cardiovascular medicine outpatient hospital of Guanganmen Hospital of traditional Chinese medicine China test data sources were collected in accordance with the inclusion criteria(yin and xue deficiency,syndrome of heat disturbing heart mind)68 cases of patients with functional premature beats,24h dynamic electrocardiogram(Holter)examination,record the inspection results,fill in Chinese medicine syndrome quantitative evaluation form;inform patients of research purpose,content and methods,and sign informed consents.At the beginning of this study,health education and dietary guidance were carried out to reduce the other factors that might affect the clinical efficacy,and all the patients were required to stop other antiarrhythmic drugs during the study period.According to the order of visiting patients numbered 1 to 68,using the method of randomization were randomly divided into treatment group 35 cases,33 cases in the control group,treatment group was treated with An Shen Ding Lv Decoction granules of 150ml hot water brewing,one at a time,3 times a day,take after meals,the specific flavors are as follows:Suan zao ren 30g,Bai ziren 20g,Huang jing 20g,Dan shen 20g,Ku shen 10g,Zhen zhu mu 30g.The control group was given Metoprolol Tartrate Tablets(commercial name:Betaloc),each time 12.5mg,2 times a day,taken night and morning.The two groups record the general condition of the patien before treatment,treatment for two weeks and treatment for four weeks,including body temperature,respiration,heart rate and blood pressure,collect and record the signs and symptoms of TCM syndrome to quantitative evaluation table,and in accordance with the " Guideline of clinical research on new drugs of traditional Chinese medicine(Second Edition)",the grading scoring method was adopted to judge the scores of TCM symptoms and scoring standards for fourth weeks after treatment,second weeks after treatment and before the treatment.The symptom score for each case is the total score of the patient's symptoms.Before and after treatment were performed a 24 hour dynamic electrocardiogram,using computer automatic analysis combined with artificial dynamic electrocardiogram results,collecting atrial premature beats and ventricular premature beats before and after treatment and recording the HRV index:including SDNN,SDANN,RMSSD and PNN50.The effective time of dynamic ECG acquisition are more than 22 hours.The liver and kidney function,blood,urine and stool are observed before treatment and after treatment,in order to clarify the safety of Chinese medicine and to record the occurrence of adverse events.Baseline and clinical demographic and clinical characteristics of the two groups were compared before and after treatment using the SPSS20.0 statistical package,the two groups are analyzed before and after treatment,the number of premature beats,the total curative effect of premature beats,heart rate variability(SDNN,SDANN,RMSSD,PNN50)and TCM syndrome scores.Enumeration datas using row*column x2;measurement datas using t-test;all measurement datas to the x±s(standard±±deviation),P<0.05 for the difference is statistically significant,P<0.01 for the difference is statistically significant,P>0.05 for the difference is not statistically significant.Animal experiment with aconitine induced ventricular arrhythmia,select 40 male Wistar rats,according to the weight number,dividing into 4 groups randomly,10 rats in each group respectively.The blank group,Wen Xin Ke Li group,Amiodarone group,An Shen Ding Lv Decoction granules,are fed after 3 days adaptively and continue with the medication for 7 days,,the delivery volume of 1ml/100g.At the end of the last administration,10%kg-1 of chloral hydrate 3.5mL is injected into the abdominal cavity,and then connected to the MP150 ECG recorder to record the normal ECG and monitor the ECG ?.When the electrocardiogram is steady,cut side groin skin and show femoral vein after the presentation of the femoral vein,10 g/mL aconitine is injected with 10mg/(L = min)with a constant flow pump through the femoral vein,observe the arrhythmia after injection of aconitine in rats,record the occurrence time of premature ventricular beats(VP),ventricular tachycardia(VT)and ventricular fibrillation(VF)and the time of death.The experimental results are analyzed using SPSS20.0 software package,the measurement datas using t-test,all measurement datas to the x±S(standard deviation).Results:1.Clinical research results:The treatment group(35 cases)and control group(33 cases)of patients in baseline datas,including gender,age,course of disease,TCM symptoms,TCM syndrome integral,the type of premature beats,24h dynamic electrocardiogram,heart rate,blood pressure,heart rate variability have difference in statistical significance(P>0.05),that is comparable between the two groups.(1)Between the two groups of TCM syndrome total curative effect:After treatment,the clinical syndrome of TCM of treatment group 21 cases are markedly effective,6 cases effective,3 cases ineffective,the total efficiency of 90%;the clinical syndrome of TCM of control group 15 cases are markedly effective,7 cases effective,8cases ineffective,the total efficiency of 73.33%,after treatment the comparison between the two groups is statistically significant(P<0.01),the syndrome improvment of the treatment group is significantly better than the control group.(2)Comparison of TCM symptom scores of two groups:The TCM symptom scores of treatment group after treatment than before treatment significantly decrease,the difference before and after treatment is significant(P<0.01).After treatment,the TCM symptoms scores in the control group are significantly lower than those before the treatment,and there is a significant difference between before treatment and after treatment(P<0.01);The scores of TCM symptoms are significantly different between the two groups after treatment(P<0.01),the effect of treatment group is better than that of control group.(3)Comparison of the two groups of TCM individual symptoms after treatment:The chest tightness,shortness of breath,dry mouth and throat,dry stool after comparison between groups have differences(P<0.05).After treatment,the treatment group than the control group,especially in palpitation,insomnia,upset,fatigue the difference are significant(P<0.01),in particular,significantly improving palpitation,insomnia,irritability and other symptoms of heat disturbance of mind,it shows that the heat disturbance of mind is important in the pathogenesis of palpitation,and through clearing away heat and nourishing blood and sedative can improve the efficacy of the treatment of this disease.(4)Comparison of the number of premature beats:There are significant differences between the treatment group and the treatment group before and after the treatment(P<0.01).There is a significant difference between the treatment group and the control group(P<0.01).(5)Comparison of total curative effect of premature beats after treatment:In the treatment group,24 cases are markedly effective,4 cases effective,2 cases ineffective,the total effective rate is 93.33%;17 cases in the control group are markedly effective,5 cases effective,8 cases ineffective,the total effective rate is 73.33%.There is significant difference between the two groups after treatment of of total curative effect of premature beats(P<0.01).(6)Comparison of heart rate variability(SDNN,SDANN,RMSSD,PNN50):The treatment group before and after treatment,SDANN,RMSSD,SDNN and PNN50 are significantly different(P<0.01);treatment group and control group after treatment,the SDANN,SDNN and RMSSD between two groups have significant difference(P<0.01),the two groups after treatment of PNN50 is statistically significant(P<0.05).This shows that An Shen Ding Lv Decoction can obviously improve the HRV index of the patients with functional premature beats,regulate the imbalance of the autonomic nervous system,and play a role of anti arrhythmia.2.Experimental resultsCompared with the blank group,Wen Xin Ke Li group,amiodarone group,An Shen Ding Lv Decoction granules group can obviously delay the aconitine induced ventricular premature beats,ventricular tachycardia,ventricular fibrillation and time of death,prolong the survival time of rats,indicating that it has obvious antiarrhythmic effect,has statistically significant difference(P<0.01).It provides a solid experimental basis for the clinical treatment of functional premature beats.Conclusion:1.An Shen Ding Lv Decoction can markedly reduce the functional premature beats(yin and xue deficiency,syndrome of heat disturbing heart mind)with the number of premature.2.An Shen Ding Lv Decoction can effectively improve the symptoms of patients of functional premature beats(yin and xue deficiency,syndrome of heat disturbing heart mind)in palpitations,shortness of breath,chest pain,can effectively relieve insomnia,vexation,and other psychological symptoms caused by premature beats,double heart coherence,so as to achieve true health.3.An Shen Ding Lv Decoction on patients of atrial premature beats and ventricular premature beats(yin and xue deficiency,syndrome of heat disturbing heart mind)are very good.4.An Shen Ding Lv Decoction can significantly improve the patients of functional premature beats(yin and xue deficiency,syndrome of heat disturbing heart mind)of heart rate variability in,regulate the activities of cardiac autonomic nervous function.5.An Shen Ding Lv Decoction has a certain effect on the functional premature beats with different duration.6.An Shen Ding Lv Decoction in the treatment of patients of functional premature beats(yin and xue deficiency,syndrome of heat disturbing heart mind)have no adverse reactions and have better security.7.An Shen Ding Lv Decoction has an obvious counteraction that ventricular arrhythmias are induced by aconitine.