李洁教授运用温阳祛瘀通脉汤治疗二度Ⅱ型房室传导阻滞经验  

Experience of Professor LI Jie in treating second degree typeⅡatrioventricular block with Wenyang Quyu Tongmai decoction

作　　者：王向阳 宋彦洁 吴赛[2] 李洁[2] WANG Xiangyang;SONG Yanjie;WU Sai;LI Jie

机构地区：[1]山东中医药大学,山东济南250355 [2]青岛大学附属青岛市海慈医院(青岛市中医医院),山东青岛266011

出　　处：《中医临床研究》2024年第15期127-130,共4页Clinical Journal Of Chinese Medicine

基　　金：山东省中医药科技项目(2020Q073);青岛市医药卫生科研计划项目(2021-WJZD052)。

摘　　要：二度Ⅱ型房室传导阻滞属于中医“心悸”范畴,是一种较为严重的缓慢性心律失常,临床表现为心悸、头晕、乏力、黑朦甚至晕厥,严重者可危及生命。二度Ⅱ型房室传导阻滞心电图表现为P波规律出现,PR间期恒定不变,部分P波后QRS波脱漏。西医在治疗二度Ⅱ型房室传导阻滞时主要应用抗心律失常药物和安装人工心脏起搏器,然而抗心律失常药物的不良反应及禁忌证较多,在临床用药时对医生及患者产生极大困扰;人工心脏起搏器的电极放电会直接导致心肌损伤,并会长期存在心肌细胞慢性炎症反应。西药治疗和介入治疗均存在不可避免的弊端,因此临床上患者接纳程度普遍偏低。李洁教授从中医角度分析认为本病为本虚标实之证,本虚的病机多为心阳不振或气血亏虚,标实的病机多为痰饮停滞或瘀血阻滞。温阳祛瘀通脉汤是李洁教授根据其治疗心血管疾病的30多年临床经验总结创立而成,具有温通心阳、活血化瘀、益气复脉之功,主要用于治疗二度Ⅱ型房室传导阻滞,可明显改善患者症状,阻止病情进展,收效甚佳。现根据一则验案分析李洁教授运用温阳祛瘀通脉汤诊治二度Ⅱ型房室传导阻滞的思路与经验。Second degree typeⅡatrioventricular block is a kind of serious bradycardia,belongs to the category of“palpitation”in traditional Chinese medicine.Its clinical manifestations are palpitation,dizziness,fatigue,amaurosis and even syncope,in severe cases,it can be life-threatening.The electrocardiogram of second degree typeⅡatrioventricular block shows that P waves appear regularly,PR intervals are constant,and part of QRS waves miss after P waves.In Western medicine,antiarrhythmic drugs and implantation of artificial heart pacemakers are used to treat second-degree type II atrioventricular block.However,there are many adverse reaction and contraindications of antiarrhythmic drugs,which cause great trouble to doctors and patients in clinical use.The discharge of the electrodes of the artificial heart pacemaker will directly cause myocardial damage,and there will be chronic inflammatory reaction of cardiac muscle cells for a long time.Both Western medicine treatment and interventional therapy have inevitable drawbacks,so the acceptance of patients in clinical practice is generally low.Professor LI Jie analyzes this disease from the perspective of traditional Chinese medicine and believes that it is a syndrome of deficiency in origin but excess in superficiality.Heart-yang(心阳)deficiency or Qi(气)and blood deficiency are the pathogenesis in origin,while stagnation of phlegm or blockage of blood are the pathogenesis in superficiality.Wenyang Quyu Tongmai decoction(温阳祛瘀通脉汤)was established by Professor LI according to 30 years of clinical experience in the treatment of cardiovascular diseases.It has the functions of warming heartyang,promoting blood circulation to remove blood stasis,invigorating Qi and restoring pulse.It is mainly used in the clinical treatment of second degree typeⅡatrioventricular block,can significantly improve the symptoms of patients,prevent the deterioration of the disease progress,the effect is remarkable.The article analyzes Professor LI’s thinking and experience of

关 键 词：温阳祛瘀通脉汤 二度Ⅱ型房室传导阻滞 心悸 临床经验 

分 类 号：R256.2[医药卫生—中医内科学]