快速型心律失常病例证型-证素分布及用药规律研究

Study on the Distribution of Syndrome Types and Syndrome Elements Tachyarrhythmia Patients and Their Medication Rules

【目的】分析快速型心律失常患者的中医证型、证候要素的分布特点及用药规律,为快速型心律失常临床诊疗规范的制定提供参考。【方法】采用回顾性研究方法,对2012年1月至2021年1月就诊于深圳市中医院心血管科、综合科门诊,经中医或中西医结合治疗的468例快速型心律失常患者的临床资料,包括性别、年龄、中医证型、证候要素及中药用药情况等进行统计,并结合关联规则等数据挖掘方法分析其用药规律。【结果】(1)共纳入病例468例,其中以40~59岁年龄段患者为最多,共177例(37.82%)。(2)468例患者中,共涉及中医证型33种,其中出现频次最高的前4种证型依次为气阴两虚[118例(25.21%)]、心肾不足[45例(9.62%)]、心脾两虚[41例(8.76%)]、心气亏虚[40例(8.55%)]。(3)共涉及病位证素4个,分别为心、肾、脾、肝;病性证素11个,前4位分别为气虚、阴虚、痰、血瘀。(4)涉及中药227味,使用频数最高的3味药为甘草、白术、黄芪,其次为茯苓、党参、酸枣仁、五味子、当归等;核心药对有牡蛎—龙骨、甘草—麦冬、甘草—地黄、甘草—桂枝。【结论】心气虚为快速型心律失常的始动因素,气虚为该病的核心病机贯穿始终,痰湿、瘀血为其发生发展过程的驱动要素;治疗上以补虚与祛邪作为两大原则,补虚以益气、滋阴、养血为主,祛邪则以祛痰、行瘀、化湿为主,同时常配伍平肝潜阳药、养血安神药等。

Objective To investigate the distribution of traditional Chinese medicine(TCM)syndrome types and syndrome elements in patients with tachyarrhythmia as well as their medication rules,so as to provide reference for the establishment of clinical norms for the treatment of tachyarrhythmia.Methods The retrospective analysis was carried out in 468 patients with tachyarrhythmias who attended the outpatient clinics of Cardiovascular Department and Comprehensive Disease Department of Shenzhen Traditional Chinese Medicine Hospital from January 2012 to January 2021 and were treated with TCM or intergrated Chinese and western medicine.The clinical data of gender,age,TCM syndrome types,syndrome elements and medication of Chinese medicine in the patients were counted,and then the medication rules were explored by data mining method of association rule analysis.Results(1)A total of 468 cases were included,and 177 cases(37.82%)of patients were in the age group of 40-59 years old,being the largest proportion of the patients.(2)Among the 468 patients,a total of 33 TCM syndrome types were involved,of which the top 4 syndrome types with the high frequency were qi and yin deficiency type[118 cases(25.21%)],insufficiency of heart and kidney type[45 cases(9.62%)],heart and spleen deficiency type[41 cases(8.76%)]and heart qi depletion type[40 cases(8.55%)].(3)A total of 4 diseases-location syndrome elements were involved,namely heart,kidney,spleen and liver;11 disease-nature syndrome elements were involved,the top 4 being qi deficiency,yin deficiency,phlegm and blood stasis.(4)A total of 227 herbal medicines were used,with the top 3 frequently-used herbs being Glycyrrhizae Radix et Rhizoma,Atractylodis Macrocephalae Rhizoma,and Astragali Radix,followed by Poria,Codonopsis Radix,Ziziphi Spinosae Semen,Schisandrae Chinensis Fructus,and Angelicae Sinensis Radix.The core drug pairs were Ostreae Concha-Os Draconis,Glycyrrhizae Radix et Rhizoma-Ophiopogonis Radix,Glycyrrhizae Radix et Rhizoma-Rehmanniae Radix,Glycyrrhizae Radix et Rhizoma-Cinnamomi Ramulus.Conclusion Heart qi depletion is the initial factor for tachyarrhythmia,qi deficiency as the core pathogenesis exists through the whole process of disease,and phlegmdamp and blood stasis are the driving factors for the progression of tachyarrhythmia.For the treatment of tachyarrhythmia,the two therapeutic principles are to supplement the deficiency and to eliminate pathogens.Supplement the deficiency can be achieved by benefiting qi,nourishing yin and blood,eliminating pathogens can be achieved by removing phlegm and blood stasis,and resolving dampness,and drugs for calming the liver and subsiding yang,nourishing blood to calm the mind are often used for the compatibility.