基于心主血脉理论的滋阴养血法治疗脓毒症心肌病研究进展

Efficacy of Enriching Yin and Nourishing Blood Therapy on Sepsis-induced Cardiomyopathy Based on Heart Governing Blood and Vessel Method in TCM

脓毒症是常见的高病死率危重症,多脏器功能不全是其病程发展中的重要特征,而心脏是主要受累器官之一。这种由感染引发的心肌损伤被称为脓毒症心肌病,是影响预后的独立危险因素。近年来研究发现,内皮功能紊乱是其重要的发病机制之一,由脓毒症所引发的炎症因子风暴诱导内皮细胞异常活化,促使过多的中性粒细胞浸润心肌而发生损伤。中医藏象学说所提出的“心主血脉”理论恰与之契合,心司血脉却也依赖血脉的滋养,若血脉受损则心气亦虚,或是从中医角度对此病机的解释,故需养血以养脉,养脉以养心,并且在温病环境下,大多因热邪煎熬而阴津亏损,为“滋阴养血法”治疗脓毒症心肌病奠定了中医理论依据。文章将综述内皮功能紊乱在脓毒症心肌病发病机制中的研究进展以及基于中医“心主血脉”理论为指导的“滋阴养血法”或可成为其中医治则的理论分析。

Sepsis is a common critical disease with high mortality and multiple organ dysfunction is one of its most characteristic features during the process.Heart is one of its target organs.This myocardial injury in sepsis called sepsis-induced cardiomyopathy(SIC)is an independent risk factor for prognosis.Recent studies showed that endothelial dysfunction is the key pathogenesis.Sepsis-induced inflammatory cytokine storm triggers pathological endothelial activation initially,then occurs inflammatory infiltration on the myocardium caused by excessive neutrophils.Interestingly,the finding above is accord with the method of Viscera-State of TCM which regards the heart and vessel as a whole.It says“heart governing blood and vessel”which means heart is governing vessel while it also depends on vessels.Therefore,the injury of vessel usually causes insufficiency of heart-Qi.Furthermore,it always occurs that heat evil torments the body fluid in sepsis situation according to TCM method which lays the foundation of“enriching Yin”and“nourishing blood”therapies for SIC.This article reviewed the research progress on role of endothelial dysfunction in the pathogenesis of SIC,and theoretical analysis on treatment for SIC using“enriching Yin and nourishing blood”method which guided by“heart governing blood and vessel”method.