摘要
心肌桥属于心血管系统中的一类冠状动脉先天异常发育的情况。多数患者属于表浅型及1级的心肌桥,故而在平日生活中并无心肌缺血造成的胸痛等症状及心电图改变。但是由于心肌桥压迫血管导致收缩期冠状动脉重度狭窄,表现为纵深型及2/3级心肌桥。心肌的严重缺血造成的急性冠脉综合征、恶性心律失常,乃至猝死等严重临床病例于近些年来多有报道。鉴于西医在其药物、手术和介入治疗上的适应证、禁忌证的严苛性与预后短期内不良事件的频有发生,故心肌桥的中医辨证治疗对于临床具有心绞痛、急性冠脉综合征、心律失常等表现的病人就尤为重要。中医学根据其临床症状在《黄帝内经》和《金匮要略》中将其归为"胸痹""心悸"等范畴。症见胸闷、胸痛、气短、心悸等。"心悸"在《金匮要略》中还被称之为"心动悸""心下悸""心中悸""惊悸"等。其病因病机为阳微阴弦。必须要做到的是依据其临床表现及舌脉总结中医分型,可以有效准确地指导临床用药。因此,临床对心肌桥的辨治需要在西医诊断明确的基础上,合理利用中医学整体观念和辨证论治两大特色,进行有效的两者相结合。从心肌桥的西医诊断与治疗以及中医运用舌、脉辨证两方面进行简述,并提供临床病案举例证明此方法的临床有效性。
Myocardial bridge is a congenital anomaly of coronary artery development in the cardiovascular system.Most of the patients were superficial type and grade 1 myocardial bridge,and so there was no chest pain or ECG changes caused by myocardial ischemia in daily life.However,myocardial bridge compression can cause severe coronary artery stenosis in systole period,which shows deep type and grade 2/3 myocardial bridge.Acute coronary syndrome,malignant arrhythmia and even sudden death caused by myocardial ischemia have been reported in recent years.In view of the western medicine in its drugs,surgery and interventional treatment of the indications,contraindications and the severity of the prognosis in the short term adverse events occurred frequently,therefore,the TCM syndrome differentiation and treatment of myocardial bridge is particularly important for patients with angina pectoris,acute coronary syndrome,arrhythmia and other manifestations.According to its clinical symptoms,TCM classifies it into the categories of chest pain,heart palpitations and so on in Huangdi Neijing and Jinkui Yaolue.Symptoms include chest tightness,chest pain,shortness of breath,palpitations and so on.Heart palpitations in Jinkui Yaolue is also called severe palpitations,palpitations in heart,palpitations below theheart,palpitations with fear and so on.The etiology and pathogenesis of the disease is Yang-micro-Yin string.What must be done is to summarize the TCM syndrome typesaccording to its clinical manifestations and tongue and pulse conditions so as to effectively and accurately guide the clinical medication.Therefore,the treatment of myocardial bridge in clinic should be based on the definite diagnosis of western medicine,the rational use of the concept of TCM as a whole and the differentiation of symptoms and signs,and the combination of both.In this paper,the diagnosis and treatment of myocardial bridge in western medicine and the application of tongue and pulse in traditional Chinese medicine were reviewed.
作者
姜婷婷
庞敏
JIANG Tingting;PANG Min(Liaoning University of Tradional Chinese Medicine,Shenyang 110847,Liaoning,China;The Second Affiliated Hospital of Liaoning University of TCM,Shenyang 110034,Liaoning,China)
出处
《实用中医内科杂志》
2020年第3期28-31,共4页
Journal of Practical Traditional Chinese Internal Medicine
基金
辽宁省科学基金指导计划项目(201602441)。
关键词
心肌桥
发育异常
心肌缺血
西医诊断
临床症状
中医药
舌脉辨证
病案
优势
myocardial bridge
abnormal development
myocardial ischemia
western medicine diagnosis
clinical symptoms
traditional Chinese medicine
syndrome differentiation based on tongue and pulse
medical record
advantage
