急性心肌梗死病机特点探析

Analysis on Pathogenesis of Acute Cardiac Infarction

目的 研究急性心肌梗死中医病机的演变规律。方法 选择急性心肌梗死患者287例,分别于3个时间窗,即发病后12h内(超急性期)、发病后第3d至1周内(急性期)和发病超过3月后(陈旧性)采集临床资料,了解不同时间窗的病机构成。结果 急性心肌梗死超急性期病机以标实为主,多属寒凝痰阻;急性期除气虚痰瘀外,阴虚内热是此期特点;陈旧性心肌梗死以本虚为主,多气虚血瘀夹痰,脾肾不足水气内停亦较常见。结论 时间窗不同,急性心肌梗死的主要病机亦不相同。

Objective: Studying the pathogenetic evolvement of acute cardiac infarction in TCM. Methods: The clinical data were collected in 287 patients with cardiac infarction with the four diagnostic techniques of TCM in three time windows, i. e., within 12 hours after attack (super - acute period), from 3rd day to 1 week (acute period) and after 3 months(old cardiac infarction). The main factors, such as Qi Deficiency, Yang Deficiency, Yin (Blood) Deficiency, Blood Stasis, Phlegm, Cold- Evil Stagnation, Qi - Stagnation and Heat Stagnation, were analyzed for exploring which was the most important role in pathogenesis in each time window of cardiac infarction. Results: The main pathogenetic characteristics were, in the super - acute period, excess in superficiality such as Cold - Evil Stagnation and Phlegm - Block; in the acute period, Yin Deficiency and Heat - Stagnation in addition of Qi - Deficiency, Phlegm and Blood Stasis; in old cardiac infarction, deficiency in origin such as Qi- Deficiency with Phlegm and Blood stasis, deficiency of Spleen and Kidney with Fluid - Retention. Conclusion: The pathogenesis of cardiac infarction was different in different time windows.