非ST段抬高型心肌梗死证候分布及其中医药干预策略

Distribution of Non-ST Segment Elevation Myocardial Infarction Syndromes and Traditional Chinese Medicine Intervention Strategies

目的:分析非ST段抬高型心肌梗死患者的证候特点和分布规律,以期指导临床实践,提高中医药的疗效。方法:选取符合诊断标准的非ST段抬高型心肌梗死住院患者,利用频数统计法分析中医证候要素的频次和常见程度,以及全部证候的分布特点。结果:263例非ST段抬高型心肌梗死患者的中医证候要素的频次和常见程度分析发现,非ST段抬高型心肌梗死病机多为本虚标实,虚实夹杂。其中本虚以气虚(171频次,32. 39%)最为常见,其次是阴虚(42频次,7. 95%)较为常见,阳虚(16频次,3. 03%)和血虚(1频次,0. 19%)相对少见;而标实则以血瘀(129频次,24. 4%)和痰浊(125频次,23. 7%)最为常见,其次是热蕴(42频次,7. 95%)较为常见,水饮(2频次,0. 38%)相对少见。根据证候要素组合的证候诊断分析,使用单一证候辨证者220例,占83. 65%,使用两个证候同时辨证者42例,占15. 97%,3个证候同时辨证者1例,占0. 38%。单一证候辨证者220例中,中气虚血瘀证(94例,42. 7%)最为常见,其次是痰瘀互结证(46例,20. 9%),气阴两虚证(41例,18. 6%)和心肾亏虚证(32例,14. 6%)较为常见,阳虚水泛证(6例,2. 73%)及心火炽盛证(1例,0. 45%)相对少见。根据证候分布规律,探讨中医治疗方法以补益正气、固护肾气为主,祛痰浊利水湿与活血化瘀并重。结论:非ST段抬高型心肌梗死病机属本虚标志、虚实夹杂,本虚多为气虚、阴虚,标实多为血瘀、痰浊、热蕴。中医治疗多运用益气养阴、活血化瘀、清热化痰等方法。

Objective: To analyze the syndrome characteristics and distribution regularity of patients with non-ST segment elevation myocardial infarction(NSTEMI),in order to guide clinical practice and improve the efficacy of traditional Chinese medicine. Method: Inpatients with non-ST segment elevation myocardial infarction in line with the diagnostic criteria were selected,and the frequency statistics method was used to analyze the syndrome elements and their frequency degree and distribution characteristics. Result:According to the analysis of syndrome elements and their frequency degree of 263 patients with NSTEMI,the pathogenesis of NSTEMI was mostly deficiency in origin and excess in superficiality. As for deficiency in origin,Qi deficiency(171 times,32. 39%)was the most common,which was followed by Yin deficiency(42 times,7. 95%),Yang deficiency(16 times,3. 03%),and blood deficiency(1 times,0. 19%). As for excess in superficiality,blood stasis(129 frequency,24. 4%)and phlegm turbidity(125 frequency,23. 7%)were the most common,which were followed by heat accumulation(42 frequency, 7. 95%), water drinking(2 frequency, 0. 38%).According to the syndrome diagnosis analysis of the combination of syndrome elements,220 cases(83. 65%)had single syndrome differentiation,42 cases(15. 97%)had two syndromes at the same time,and 1 case(0. 38%)had three syndromes at the same time. Among all the syndrome types,Qi deficiency and blood stasis syndrome(94 cases, 42. 7%) was the most common, which were followed by phlegm and blood stasis syndrome(46 cases,20. 9%),Qi and Yin deficiency syndrome(41 cases,18. 6%)and heart and kidney deficiency syndrome(32 cases,14. 6%). And Yang deficiency and water flooding syndrome(6 cases,2. 73%)and heart fire blazing syndrome(1 case,0. 45%)were relatively rare. According to the distribution regularity of syndrome,traditional Chinese medicine therapies were mainly for tonifying vital qi and protecting kidney Qi,with equal emphasis on removing phlegm,eliminating dampness and diuresis,activating blood circulation and removing blood stasis. Conclusion: The pathogenesis of NSTEMI is deficiency in origin and excess in superficiality. Deficiency in origin is mostly Qi deficiency and Yin deficiency,while excess in superficiality is mostly blood stasis,phlegm and heat accumulation. traditional Chinese medicine therapies are mostly for invigorating Qi and nourishing Yin,promoting blood circulation and removing blood stasis,clearing heat and resolving phlegm.