王阶教授辨证治疗冠心病介入术后心绞痛的思路与经验

Professor Wang Jie′s Thought and Experience in Treating Angina Pectoris After Percutaneous Coronary Intervention

经皮冠状动脉介入治疗(Percutaneous coronary intervention, PCI)是当前冠心病治疗领域中重要且有效的治疗方法之一,但介入术后会出现慢血流与无复流、支架内再狭窄、支架内血栓形成等问题,单纯使用西药干预效果并不理想,严重影响患者术后的生活质量和远期疗效。研究表明,冠心病介入术后应用中医药干预具有明显优势。中西医结合治疗能有效预防或显著降低术后再狭窄的发生率。王阶教授提出冠心病主要病机为“痰、瘀、滞、虚”,4个证候要素紧密结合、互相转化,贯穿冠心病发生发展的全过程。基于证候要素的病证结合辨证治疗思路,王阶教授认为介入术后心绞痛的核心病机以气虚、肾虚为本,血瘀、痰浊为标;临床辨证治疗时,强调活血化痰以治标,益气补肾以固本的治疗原则,结合术后胸痛、胸闷、乏力等常见症状,总结了一系列方证主治规律,临床疗效显著。

Percutaneous coronary intervention(PCI)is one of the major effective therapies for coronary heart disease.However,complications such as slow blood flow and noreflow,in-stent restenosis(ISR),and in-stent thrombosis(IST)may occur following PCI.The treatment with western medicine alone has limited efficacy,which seriously affects the quality of life and long-term efficacy of the patients after surgery.Studies have indicated that traditional Chinese medicine(TCM)has significant advantages in treating the patients after PCI.Integrated traditional Chinese and western medicine treatment could effectively prevent or reduce the incidence of ISR.Professor Wang Jie believes that phlegm,stasis,stagnation,and deficiency are the core pathogenetic factors of coronary heart disease.The four syndrome elements are closely associated with each other and can transform into each other,playing a key role in the development of coronary heart disease.Professor Wang proposed that the angina pectoris after PCI is rooted in qi and kidney deficiency and manifested as blood stasis and phlegm turbidity.He thus proposes the treatment principle of activating blood and resolving phlegm to alleviate the symptoms and replenishing qi and tonifying kidney to consolidate the body.With consideration to the common symptoms such as chest pain,chest distress,and fatigue,Professor Wang develops a series of prescriptions and therapies,which demonstrate remarkable clinical effects.