基于“双心同治”对冠状动脉血运重建术后胸痛的理论探讨  

Theoretical discussion on simultaneously treatment on psycho-cardiology in treating coronary artery revascularization postoperative cardiodynia

作　　者：张毅 王帅[2] ZHANG Yi

机构地区：[1]辽宁中医药大学,辽宁沈阳110032 [2]辽宁中医药大学附属医院,辽宁沈阳110847

出　　处：《中医临床研究》2023年第32期35-39,共5页Clinical Journal Of Chinese Medicine

基　　金：沈阳市科技局项目(21-174-9-15)。

摘　　要：冠状动脉血运重建术术后患者常伴有焦虑抑郁等不良情志,且这种不良情志又诱发或加重胸痛,临床中常将此类疾病称为“双心疾病”。术后出现胸痛的主要原因包括术后精神焦虑抑郁,血管再灌注损伤,介入性诊疗操作导致血管痉挛,炎性反应,桥血管狭窄甚至闭塞等。近年来,冠状动脉学运重建术后胸痛复发率日渐增加,常规的西医治疗已经不能满足临床需要。临床发现,此胸痛与焦虑抑郁等不良情绪已成为术后胸痛的独立危险因素,而中医治疗术后胸痛伴焦虑抑郁等不良情绪已有一定的疗效和进展。在医学模式已转变为“生物-心理-社会”的条件下,越来越多的人开始注重“双心同治”。文章基于传统医学对五脏生理功能与病理变化特点的阐述,在《黄帝内经》精气血神理论基础上,从“精气化神”“心主神明”与“心主血脉”角度进行探讨,在血脉失和的病机基础上,表明心肝精气失调致神明失守为另一重要病机。文章论治术后胸痛时,在益气和脉、疏调肝气、暖土益火、调和营卫、调气解毒以调和血脉的基础上,始终贯穿祛瘀养肝调神,得以“双心同治”,望为临床提供更多的思路。Patients with coronary revasectomy are often accompanied by anxiety,depression and other adverse emotions,and such adverse emotions can induce or aggravate chest pain,which is often referred to as psycho-cardiology disease in clinic.The main causes of postoperative chest pain include postoperative anxiety and depression,vascular reperfusion injury,vasospasm,inflammatory reaction,bridge stenosis or even occlusion caused by interventional treatment.In recent years,the recurrence rate of chest pain after coronary artery reconstruction is increasing,and the conventional western medicine treatment can no longer meet the clinical needs.Clinical findings show that this chest pain and anxiety and depression and other adverse emotions have become independent risk factors for postoperative chest pain,and TCM treatment of postoperative chest pain with anxiety and depression and other adverse emotions has a certain effect and progress.Under the condition that the medical model has been transformed into biopsychosocial,more and more people have begun to pay attention to simultaneously treatment on psycho-cardiology.Based on the traditional medicine’s description of the physiological functions and pathological changes of the five viscera,on the basis of the theory of essence Qi(气)and blood spirit in the Huangdi Neijing(《黄帝内经》).The paper discusses from the perspective of essence Qi transforms into spirit heart governs the spirit and heart ruling blood vessel,and on the basis of the pathogenesis of blood vessel disharmony,it shows that the disorder of heart,liver and essence Qi leading to the loss of spirit is another important pathogenesis.In the treatment of postoperative chest pain,on the basis of tonifying Qi and harmonizing pulse,thinning and regulating liver-Qi,warming earth and fire,harmonizing Ying(营)and Wei(卫),and regulating Qi and detoxifying to harmonize blood vessels,the author always runs through removing blood stasis,nourishing liver and regulating spirit,and hopes to provide more ideas for clin

关 键 词：冠状动脉血运重建术 血脉失和 精气化神 双心同治 

分 类 号：R256.2[医药卫生—中医内科学]