急性心肌梗死心肌微循环“三部曲”防治策略构建  

Construction of the“Three-steps”Prevention and Treatment Strategy for Myocardial Microcirculation in Acute Myocardial Infarction

作　　者：刘凌云 何贵新[2] 秦伟彬 宋惠 张利文 唐伟智 杨斐斐 朱子一 欧阳彬 LIU Lingyun;HE Guixin;QIN Weibin;SONG Hui;ZHANG Liwen;TANG Weizhi;YANG Feifei;ZHU Ziyi;OUYANG Bin(Guangxi University of Chinese Medicine,Nanning 530001,Guangxi,China;The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,Guangxi,China)

机构地区：[1]广西中医药大学,广西南宁530001 [2]广西中医药大学第一附属医院,广西南宁530023

出　　处：《辽宁中医药大学学报》2025年第3期117-123,共7页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金地区基金项目(81960861);国家中医药传承创新中心项目(2013YSBZ012);广西中医药大学桂派中医药传承创新团队-疑难重症中医诊疗研究团队(2022A001)。

摘　　要：急性心肌梗死(acute myocardial infarction,AMI)是一种由冠状动脉粥样硬化引起的临床急症,其核心病理变化为不稳定斑块破裂或糜烂,导致急性血栓形成和冠状动脉血管闭塞。这种闭塞引发的心肌缺血及随后的坏死不仅严重影响心脏泵血功能,而且对心肌微循环系统——由微动脉、毛细血管和微静脉构成的复杂网络造成深远影响。心肌微循环障碍的主要机制包括微血管阻塞、缺血性损伤和再灌注损伤,这些因素相互作用,加剧了心肌损伤。作者团队在深入分析AMI的病理生理机制后,创新性地提出了基于中医“气虚痰瘀”学说的心肌微循环防治策略。该策略采用中西医结合“三部曲”方法,针对AMI的急性发作期、缓解期和稳定期,分别采取不同的治疗措施。急性期重点在于迅速祛邪和扶正,以控制病情发展;缓解期则在延长祛邪同时扶助正气,促进五脏功能恢复;稳定期则以扶正为主,调整阴阳平衡,提高生活质量,并恢复心功能。前期的临床应用结果表明,“三部曲”策略能显著改善AMI患者的临床症状和预后,具有较高的安全性和有效性。此外,研究还探讨了AMI的中医理论基础,以及气、血、痰、瘀之间的相互关系和作用机制。通过这一理论指导,研究不仅为AMI心肌微循环障碍提供了新的治疗思路,也为中医药在心血管疾病治疗中的应用提供了科学依据和临床证据。Acute myocardial infarction(AMI)is a clinical emergency caused by coronary atherosclerosis in which the core pathological changes are rupture or erosion of unstable plaques,leading to acute thrombosis and occlusion of coronary arteries.Myocardial ischemia and subsequent necrosis caused by this occlusion not only seriously affect the pumping function of the heart,but also have a profound impact on the myocardial microcirculatory system,a complex network of arterioles,capillaries,and venules.The main mechanism of myocardial microcirculation disturbance includes microvascular obstruction,ischemic injury and reperfusion injury,and these factors interact to aggravate myocardial injury.After an in-depth analysis of the pathophysiological mechanism of AMI,the author's team innovatively proposed a strategy of myocardial microcirculation prevention and treatment based on the theory of“Qi deficiency and phlegm stasis”in traditional Chinese medicine.The strategy adopts the“three-steps”method of integrated traditional Chinese and Western medicine,and takes different treatment measures for acute attack,remission and stable stage of AMI.In the acute phase,the focus is to quickly remove the evil and correct,in order to control the development of the disease;The remission period can prolong the removal of evil,help the healthy Qi,and promote the recovery of five viscera functions;In the stable period,it mainly focuses on righting the right,adjusting the balance of Yin and Yang,improving the quality of life,and restoring the heart function.Early clinical application results show that the“three-steps”strategy can significantly improve the clinical symptoms and prognosis of AMI patients,and has high safety and effectiveness.In addition,the theoretical basis of AMI in traditional Chinese medicine and the relationship and mechanism between Qi,blood,phlegm and stasis were also discussed.Through this theoretical guidance,this study not only provides a new treatment idea for myocardial microcirculation disorder of AMI,but al

关 键 词：急性心肌梗死 心肌微循环 气虚痰瘀 三期诊疗 中西医结合 

分 类 号：R256.22[医药卫生—中医内科学]