中医药治疗脓毒症心肌能量代谢障碍的研究进展  

Research Progress on Treatment of Myocardial Energy MetabolismDisorders in Sepsis with Traditional Chinese Medicine

作　　者：刘迎庆 顼志兵[1] LIU Yingqing;XU Zhibing(The Affiliated Seventh People′s Hospital to Shanghai University of Traditional Chinese Medicine,Shanghai China 200137)

机构地区：[1]上海中医药大学附属第七人民医院,上海200137

出　　处：《中医学报》2023年第11期2293-2300,共8页Acta Chinese Medicine

基　　金：上海市中医优势病种培育项目(zybz-2017024)。

摘　　要：心肌能量代谢障碍是脓毒性心肌病重要的致病因素之一。中医学认为,脓毒症性心肌病所致心肌线粒体能量代谢与心阳关系密切,因此在辨证论治的基础上,以温补类药物的应用为主,根据不同分型及阶段佐以清热、活血疗法。中医药治疗脓毒性心肌能量代谢障碍具有多靶点、多重调节的优势,主要通过减轻氧化应激、维持线粒体膜电位、抑制凋亡、保护线粒体结构、调节呼吸酶活性及激素分泌、调整底物代谢比例等方面改善心肌细胞能量代谢。目前,脓毒症性心肌病病理因素的相关研究尚未完善,可进一步加强信号通路、分子信号等相关机制研究。此外,对于中医药治疗脓毒症心肌功能障碍的研究,除了单味中药或方剂有效成分的研究,亦可从整体观角度出发,对脓毒症心肌功能障碍的证型规律进行总结,归纳各证候相应的治法,以期达到更好的临床疗效。Myocardial energy metabolism disorder is one of the important pathogenic factors of septic cardiomyopathy.Traditional Chinese medicine often believes that the energy metabolism of myocardial mitochondria caused by septic cardiomyopathy is closely related to heart yang.Therefore,on the basis of syndrome differentiation and treatment,the application of warming and tonifying drugs is mainly emphasized,and heat clearing and blood activating therapies are supplemented according to different types and stages.Traditional Chinese medicine has the advantage of multi target and multi regulation in treating septic myocardial energy metabolism disorders.It mainly improves myocardial cell energy metabolism by reducing oxidative stress,maintaining mitochondrial membrane potential,inhibiting apoptosis,protecting mitochondrial structure,regulating respiratory enzyme activity and hormone secretion,and adjusting substrate metabolism ratio.At present,research on the pathological factors of septic cardiomyopathy is not yet complete,and further research on signal pathways,molecular signals,and other related mechanisms can be strengthened.In addition,for the research on the treatment of sepsis myocardial dysfunction with traditional Chinese medicine,in addition to the study of the effective ingredients of single traditional Chinese medicine or formulas,the syndrome patterns of sepsis myocardial dysfunction can also be summarized from a holistic perspective,and the corresponding treatment methods for each syndrome can be summarized,in order to achieve better clinical efficacy.

关 键 词：脓毒症 线粒体 能量代谢障碍 脓毒性心肌病 温补类中药 清热解毒类中药 活血化瘀类中药 

分 类 号：R256.2[医药卫生—中医内科学]