摘要
目的探讨急性心力衰竭中医证候规律。方法采用单中心回顾性病例分析,对纳入的730例患者,收集一般信息、症状体征、中医证候特点及相关辅助检查等并进行汇总分析。结果慢性心衰急性加重在急性心衰中所占比例最大,其次是急性肺水肿。中医证素以血瘀、气虚和阳虚、痰浊多见;血脂异常、动脉粥样硬化和高血压、冠心病、糖尿病是气虚证、血瘀证和痰浊证心衰患者常合并的基础疾病。气虚证患者多见纳差腹胀、端坐呼吸和双下肢浮肿;在痰浊证及血瘀证中,双下肢浮肿、肺部啰音和腹胀纳差较为常见。BNP、肌钙蛋白、平均动脉压和左室射血分数(LVEF)与中医证素具有一定相关性。患者中医证候多表现为复合证素,其比例由高到低排列依次为气虚血瘀证>阳气亏虚、瘀阻心脉证>饮凌心肺、心血瘀阻证>气阴亏虚、心血瘀阻证>热毒血瘀证>寒凝心脉、心血瘀阻证>元气败脱、神明散乱证。结论急性心衰中医证素以血瘀、气虚和阳虚、痰浊为主,临床多见复合证素,气虚血瘀证、阳气亏虚,瘀阻心脉证和饮凌心肺证尤为常见,应重视益气活血化痰法在急性心衰中的应用。
Objective:To explore the syndrome distribution rule of acute heart failure(AHF).Methods:A single center retrospective case analysis method was used to collect and analyze the general information,symptoms and signs,syndrome characteristics and related auxiliary examinations of 730 patients.Results:Acute decompensated heart failure accounted for the largest proportion of AHF,followed by acute pulmonary edema.Blood stasis,Qi deficiency,Yang deficiency and phlegm turbidity were the most common syndromes.Dyslipidemia,atherosclerosis and hypertension,coronary heart disease and diabetes were the underlying diseases of patients with Qi deficiency,blood stasis and phlegm turbidity.Patients with Qi deficiency syndrome often had poor appetite,abdominal distension,sitting breathing and edema of both lower limbs.However,in phlegm turbid syndrome and blood stasis syndrome,edema of both lower limbs,rales of lung and poor appetite were common.BNP,troponin,mean arterial pressure and LVEF had certain correlation with syndrome patterns.The syndromes of AHF were mostly complex syndrome elements,and the order of their proportion was Qi deficiency and blood stasis syndrome>Yang Qi deficiency,stagnation of heart meridians syndrome>Phlegm retention and heart blood stasis syndrome>Qi Yin deficiency with heart blood stasis syndrome>heat toxin and blood stasis syndrome>cold coagulation and heart blood stasis syndrome>Qi collapse syndrome.Conclusion:The syndrome elements of AHF are mainly blood stasis,Qi deficiency,Yang deficiency and phlegm turbidity.Compound syndrome elements are commonly seen in clinical practice.Qi deficiency and blood stasis,Yang deficiency,blood stasis and phlegm turbid syndrome are particularly common.Much attention should be paid for the application of supplementing Qi,activating blood circulation and resolving phlegm in AHF management.
作者
余锋
信梦雪
洪永敦
刘南
Yu Feng;Xin Mengxue;Hong Yongdun;Liu Nan(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong,Guangzhou 510405,China)
出处
《中国中医急症》
2022年第10期1749-1753,共5页
Journal of Emergency in Traditional Chinese Medicine
基金
广东省医学科学技术研究基金资助项目(A2020498)
广州中医药大学第一附属医院青年科研基金资助项目(2019QN19)。
关键词
急性心力衰竭
慢性心力衰竭急性加重
中医药
证候
Acute heart failure
Acute decompensated heart failure
Chinese Medicine
Syndrome
