冠心病冠状动脉搭桥术围手术期辨证规律探讨

作者	单位
吴焕林	广东省中医院心脏中心!广州510120
阮新民	广东省中医院心脏中心!广州510120
张敏州	广东省中医院心脏中心!广州510120
黄春林	广东省中医院心脏中心!广州510120
邓铁涛	广东省中医院心脏中心!广州510120

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中文摘要:

目的 :探讨冠心病冠状动脉搭桥术围手术期的辨证规律。方法 :常规全麻、中低温体外循环下 ,行冠状动脉搭桥 (内乳动脉、大隐静脉 ) ,术前术后作心电图、彩色多普勒超声心动图等检查 ,术中及术后作各项血流动力学指标监测 ,术后 1周内对冠状动脉搭桥术围手术期患者 37例进行了中医辨证。结果 :心气阴两虚证占 6 4 9%。兼夹证中兼痰浊壅肺证者 6 7 6 % ,兼瘀血内阻证者 6 2 2 %。提示搭桥术后气虚痰瘀是基本病机。此外 ,发现围手术期证候演变与术前冠状动脉病变程度、术前心功能、术前肺功能、术中体外循环时间等因素有关。结论 :冠脉搭桥术围手术期结合中医辨证 ,能够进一步探讨中医证候演变规律 ,为防治围手术期并发症、提高手术成功率打好基础。

英文摘要:

Objective: To explore the patterns of Syndrome Differentiation of coronary artery bypass graft (CABG) on the peri operative coronary heart disease (CHD) patients. Methods: One week after operation, thiry seven CHD patients, who received CABG of internal mammary artery or great saphenous vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, the pre and post operational ECG, color Doppler echocardiography as well as during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi Yin deficiencey, 67.6% were complicated with Phlegm Syndrome and 62.2% with Stasis in blood, suggesting that Qi deficiency, phlegm and stasis are the basic pathogenesis in patients after CABG. Moreover, the peri operative Syndrome was correlated with the condition of coronary arterial lesions, heart and lung functions before operation, and the time for extracorporeal circulation during the operation. Conclusion: TCM Syndrome Differentiation conducting in peri operative stage might be useful to explore the patterns of Syndrome alteration which provided a basis for preventing peri operational complication and elevating success rate of operation.

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