肢体动脉支架内再狭窄瘀毒病机的探讨

Discussion on the pathogenesis of stasis toxin in the arterial in-stent restenosis in the limbs

支架内再狭窄(ISR)指的是动脉支架植入后造影显示血管内径再狭窄≥50%。目前中医学术界普遍认为瘀血、痰浊是冠状动脉ISR的主要病机,而对肢体动脉ISR的病机却无统一的结论,冠状动脉与肢体动脉虽然同属于动脉系统,但解剖基础不同,因此在ISR的发病机制方面也存在差异。陈柏楠教授分别从宏观辨证角度和微观辨证角度详细阐述了肢体动脉支架再狭窄的"瘀毒"病机的演变过程。从宏观及微观辨证角度对肢体动脉支架内再狭窄瘀毒病机假说进行探讨,阐述了内生毒邪在支架再狭窄病机中的地位,从而重视在活血化瘀基础上对于各种毒邪的祛除,为防治再狭窄提供了新的思路,为解毒活血法在临床中的应用提供理论依据。

The in-stent restenosis refers to the restenosis of blood vessel diameter ≥50% shown in radiography after the arterial stent implantation. Currently,it is generally believed in TCM field that stasis and phlegm are the main pathogenesis of ISR of coronary artery. But there is no common conclusion on the pathogensis of arterial ISR in the limbs. Although the coronary artery and limb artery belong to the same arterial system,their anatomic foundations are different. Hence,the differences are existed in term of ISR pathogenesis mechanism. Prof Chen Bainan elaborated the evolution of stasis toxin pathogen of limb arterial ISR in view of macroscopic and microcosmic differentiations. The discussion focused on the hypothesis on stasis toxin pathogen of limb arterial ISR in view of macroscopic and microcosmic differentiations. The importance of the internal production of toxic pathogen was explained ISR. As a result,based on activating blood circulation and resolving stasis,various toxic pathogens could be eliminated,which provides a new approach to the prevention and treatment of ISR as well as the theoretic evidences of the detoxification and blood activation therapy in the clinical application.