冠心病支架术后再狭窄的中医药研究治疗进展

Research and Treatment of Restenosis after Stent Implantation

古代中医认为冠心病的基本病机是"阳微阴弦",后世认为其病机关键是本虚标实。现代中医对冠心病支架术后再狭窄有了新认识,提出了理论学说。冠心病发作期的病机以标实为主,经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)不会改变冠心病本虚标实的基本病机,PCI术后冠心病的病机表现各异,PCI术后冠心病病机的变化取决于机体正邪相争的结果。中医对冠心病PCI术后再狭窄(in-stent restenosis,ISR)的病机认识众说纷纭,笔者认为冠心病PCI术后ISR的基本病机仍然是:本虚标实、正虚邪盛,根本病机是:气虚血瘀,对PCI术后ISR的防治具有重要的指导意义。传统中医药对冠心病PCI术后ISR的治疗取得进展,中医药对冠心病PCI术后ISR的病理学、病理生理学研究均取得进展,中医药对冠心病PCI术后ISR的临床试验研究,无论是从经方、中成药、专方防治方面,还是从体质学研究方面都取得进展。目前对冠心病PCI术后ISR的根本病机的认识亟待统一,对PCI术后中医证候诊断缺乏统一的标准,缺乏有关中医药防治冠心病PCI术后再狭窄的大样本、前瞻性的随机对照试验研究,中医药作用机制有待研究,疗效需要提高。

Ancient Chinese medicine believed that the basic pathogenesis of coronary heart disease was " weak pulse at Yang and string-like pulse at Yin",and later generations believed that the key of its pathogenesis was deficiency and excess.Modern Chinese medicine has a new understanding of restenosis after stenting for coronary heart disease,and puts forward a theoretical theory. The pathogenesis of coronary heart disease in the onset period is mainly the syndrome with excessive pathological products. PCI will not change the basic pathogenesis of coronary heart disease. The pathogenesis of coronary heart disease after PCI varies. The changes of pathogenesis of coronary heart disease after PCI depend on the results of the body’s disputes between the vital Qi and evil. There are different opinions on the pathogenesis of ISR after PCI in traditional Chinese medicine. The author believes that the basic pathogenesis of ISR after PCI in coronary heart disease is still deficiency of the original and excess of the evils. The basic pathogenesis is deficiency of Qi and blood stasis,which has important guiding significance for the prevention and treatment of ISR after PCI. Traditional Chinese medicine has made progress in the treatment,pathophysiology and pathophysiology of ISR after PCI. The clinical experimental study of ISR after PCI has made progress in the aspects of the ancient prescriptions,Chinese patent medicine,special prescription prevention and treatment,as well as physique research. At present,there is an urgent need to unify the understanding of the underlying pathogenesis of ISR after PCI. There is no unified standard for the diagnosis of TCM syndromes after PCI. There is a lack of large samples,prospective randomized controlled trials on the prevention and treatment of restenosis after PCI. The mechanism of TCM action needs to be studied and the curative effect needs to be improved.