慢性心力衰竭治疗进展及中医药有效防治方法的思考  

Progress in treatment of chronic heart failure in Western medicine and treatment strategies in traditional Chinese medicine

作　　者：陈长勋[1] 高建平[1] 吴琦[1] 郭娟[1] 顾伟梁[1] 

机构地区：[1]上海中医药大学药理学教研室,上海201203

出　　处：《中西医结合学报》2010年第1期7-14,共8页Journal of Chinese Integrative Medicine

基　　金：国家自然科学基金资助项目(No.30572379)

摘　　要：近年现代医学对慢性心力衰竭(chronic heart failure,CHF)的治疗观念发生了巨大改变,治疗目标不再仅仅是暂时性改善症状,更重要的是防止和延缓心室重构的发生与发展,提高生活质量,延长患者寿命。交感神经、肾素-血管紧张素-醛固酮系统等神经内分泌和细胞因子的长期、慢性激活促进心肌重构,加重心肌损伤和心功能恶化。非洋地黄类正性肌力药物短期应用虽能改善血流动力学,但长期应用并不延长患者寿命,反使死亡率增加。血管紧张素转化酶抑制剂和β受体阻滞剂已成为CHF治疗的基石和首选药物。β受体阻滞剂已不再是CHF的禁忌药,长期应用可改善心室重构,增强心室功能,提高患者的生活质量,降低心衰患者死亡率。中医临床短期使用温阳益气药治疗CHF虽然可改善症状,但因这类药物能兴奋交感神经,长期使用可能会有不利影响。除晚期需要特殊干预外,慢性心衰患者早期使用寒凉药性中药治疗可能更加有利;清热、养阴法可能对防治CHF的发生与发展具有更积极的作用,在清热养阴中药或复方中可能发掘出具有较好疗效和应用价值的抗CHF药物。The concept of modern medicine in treating chronic heart failure （CHF） has changed markedly in recent years. To improve the quality of life and prolong life, the treatment goal is no longer just temporary improvement of symptoms, more importantly, is to prevent and delay the occurrence and development of ventricular remodeling. Long-term chronic over-activation of sympathetic system, renin-angiotensin-aldosterone system and other neuroendocrine factors promotes myocardial remodeling, increases myocardial injury and deteriorates cardiac function. Despite short-term use can significantly improve the blood flow dynamics, long-term use of β-adrenergJc receptor stimulators and phosphodiesterase inhibitors does not prolong life, but increases the rate of sudden death caused by cardiac arrhythmia. Angiotensin converting enzyme inhibitors and β-blockers have become the preferred drugs in treating chronic heart failure. In fact, after long-term use, β-blockers can significantly improve ventricular remodeling, enhance ventricular function and reduce the incidence of sudden death of patients with CHF. In traditional Chinese medicine practice,short-term use of drugs for warming yang and reinforcing qi can improve symptoms of CHF, but long-term use may have adverse effects, for these medicines can stimulate sympathetic system. Early treatment with medicines of cold and cool property may be more favorable to patients with CHF, except the advanced patients who need special intervention. Eliminating heat and nourishing yin may play more active role in controlling the occurrence and development of CHF, Drugs with good efficacy and value in treating CHF maybe developed from the Chinese herbal medicines with eliminating heat and nourishing yin property.

关 键 词：慢性心力衰竭 心室重构 神经内分泌 中医 治疗 中药 

分 类 号：R259[医药卫生—中西医结合]