中西医结合辨治乳腺癌精神障碍并化疗所致心脏毒性个案报道  

Case Report of Integrative Traditional Chinese and Western Medicine Differentiation and Treatment of Breast Cancer Mental Disorder and Chemotherapy-Induced Cardiotoxicity

作　　者：王彦宠 焦源 赵远红[1,2] WANG Yanchong;JIAO Yuan;ZHAO Yuanhong(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China;National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院,天津300381 [2]国家中医针灸临床医学研究中心,天津300381

出　　处：《山东中医杂志》2024年第3期315-321,共7页Shandong Journal of Traditional Chinese Medicine

基　　金：中国高等教育学会教育科研课题项目(编号:2017JY006)。

摘　　要：乳腺癌化疗所致心脏毒性是乳腺癌专科治疗过程中最常见的不良反应,多与蒽环类药物化疗方案相关,可见心悸胸痛、胸闷气短等症状,通常伴发的焦虑、抑郁等精神障碍是癌症及心血管疾病的共同风险因素。其发病机制未明,现有诊疗策略尚缺乏针对性防治措施。文章通过1例三阴性乳腺癌精神障碍合并化疗所致心脏毒性病案的治疗回顾,基于“双心同治”的理论内涵剖析其辨治思路,认为本病属癌病、心系疾病及神志病三者共病,病机关键在肝郁脾虚阴伤,余毒伏损心络,郁毒扰伤心神,诊治过程应把握心系疾病为主,以扶正抗癌、宁心调神为总纲,病证结合,动态辨治,中西并举,经过综合治疗,不仅提高了疗效,抗肿瘤治疗相关不良反应亦明显降低,生存获益提高。Cardiotoxicity caused by chemotherapy for breast cancer is the most common adverse reaction in the course of specialized breast cancer treatment,which is mostly related to anthracycline chemotherapy regimen.Symptoms such as palpitations,chest pain,chest tightness and shortness of breath can be seen,and mental disorders such as anxiety and depression are common risk factors for cancer and cardiovascular diseases.The pathogenesis of the disease is unknown,and the existing diagnosis and treatment strategies lack targeted prevention and treatment measures.This article reviews the treatment of a case of cardio⁃toxicity caused by triple negative breast cancer mental disorder combined with chemotherapy,and analyzes its treatment ideas based on the theoretical connotation of“simultaneous cardiac and psychological treatment”.It is believed that the disease is a comorbidity of cancer disease,cardiovascular disease and mental disease,and the key pathogenesis is liver stagnation,spleen deficiency and yin injury,residual toxicity and collateral damage to the heart,and stagnated toxicity disturbs the heart collaterals.The process of diagnosis and treatment should focus on the heart system,with the general principle of strengthening healthy qi and anti-cancer,soothing the heart and regulating the spirit,combining disease and syndrome,dynamic differentiation and treatment,and integration of traditional Chinese and western medicine.After comprehensive treatment,not only the therapeutic effect is improved,but also the adverse reactions related to antitumor therapy are significantly reduced and the sur⁃vival benefit is improved.

关 键 词：乳腺癌 化疗 心脏毒性 精神障碍 焦虑抑郁 心主神明 双心同治 

分 类 号：R249[医药卫生—中医临床基础] R256.29[医药卫生—中医学]