心肌梗死后心室重构的治则治法探讨

An Exploration on the Therapeutical Principle for Ventricular Reconstruction After Myocardiac Infarction

心肌梗死后心室重构是远期发生心脏性死亡的重要危险因素之一。研究认为本病为本虚标实之证,以益气活血、祛瘀化痰、调气理脾、清热养阴等为主要治疗法则,其中益气为治本中之本,养阴为治本中之标;祛瘀化痰为治标中之本,理气清热为治标中之标。益气活血可通过减轻心室压力和体循环血管阻力,改善血流动力学而可能对防治心室重构有益;化痰散结可改善心肌梗死后心肌适应不良性肥厚和心肌外基质堆积和纤维化,长期使用可抗心肌梗死后心室重构。

The ventricular reconstruction after Myocanliae infarction is one of important critical conditions in remote cardiac dealth. The authors considered that the disease is deficiency in primary aspect and excess in secondary aspect and the therapeutical principles are qi-benefiting(GB) and blood-circulation-activat-ing(BCA), blood-stasis-removing and sputum-resolving (BRSR), qi-regulating(QR)and spleen-regulating, heat-clearing (HC) and yin-nourishing (YN). Among them, QB is the basis and YN is the supplement in primary aspect; BRSR is the basis and QR and HC are the supplement in secondary aspect. QB and BCA can reduce the ventricular pressure and the circulatory vascular resistance, improve the hemodynamics, which may be beneficial for ventricular reconstruction; sputum-resolving and mass-dispersing can improve the inadaptable myoeardial hypertrophy after Myocardiac infarction and reduce external stroma accumulation and fibrosis of eardiae museles. The long-term application can counteract the ventricular reconstruction.