“伏痰”论治经皮冠状动脉介入术后无复流现象的探讨

急性心肌梗死PCI再灌注治疗后,仍有许多患者存在心肌组织的无复流现象,涉及血管内皮损伤、炎症反应、氧自由基损伤、血小板激活等病理过程,这使主要心血管事件发生率增加,严重影响患者的预后。尽管现代医学针对其病理过程治疗无复流现象的药物众多,但是因其作用靶点单一而难以获得理想的疗效。如何改善急性心肌梗死血运重建后心肌微循环的血流灌注是目前急需解决的一个问题。虽然目前中医药对心肌组织无复流现象干预研究的报道比较少,但是具有独特的治疗作用。在前期中医关于无复流的多种病机理论研究的基础上,通过对相关文献的分析研究,我们认为“伏痰阻络”是心肌缺血再灌注无复流的主要病机,伏痰与血脂升高和炎症反应密切相关,其通过多种病理生理过程之间的相互作用体现了由痰致瘀,心络瘀阻的病机变化,是造成PCI疗效及预后较差的根本原因。而采用益气化痰、活血通络为主要治疗原则,进行早期干预,并在PCI术前或术后随证加减用药,阻断心肌缺血再灌注过程中的多种病理过程之间的多重叠加的效应,多靶点的干预是防治PCI术后无复流、慢血流等危险因素的重要手段;由此能够延缓各级病变向终点事件发展的趋势,最大程度上改善患者的生存质量,降低病死率。这极大拓宽了中医药临床防治PCI术后无复流思路和方法,具有一定的临床指导意义。

The Treatment of No-reflow Occurring During Percutaneous Coronary Intervention on the Pathogenesis of Insidious Phlegm

Myocardial no-reflow phenomenon still have induced the incidence of major cardiovascular events after percutaneous coronary intervention in patients with acute myocardial infarction and can severe affect the prognosis, and its pathological proecsses includes vascular endothelial injury, inflammatiory reaction, oxygen free radical damage and platelet activation, etc. Although many drugs have been studied for intervention of specific pathological proecsses in no-reflow phenomenon, the effects were rarely observed because of its single target intervention. So it is urgent to resolve that how to improve blood flow perfusion of myocardium microcirculation after revascularization for acute myocardial infarction. Traditional Chinese medicines have been taken on significant effects on myocardial no-reflow phenomenon although few reports are showed. We deduced that insidious phlegm blocking collaterals was the major pathogenesis of myocardial no-reflow phenomenon after myocardial ischemia reperfusion by analysis of related literature under the guidance of the basic theory of traditional Chinese medicine (TCM), and insidious phlegm could closely relate to the hyperlipidemia and inflammation. The interaction between the hyperlipidemia and inflammation in pathophysiological processes demonstrated pathogenic characteristics of the phlegm inducing blood stasis and phlegm-stasis blocking collaterals in TCM, that is basic cause leading to poor effects and prognosis of PCI. Thus, it is an important method to improve no-reflow or slow blood flow after PCI that applying treatment of boosting qi for resolving phlegm and promoting blood circulation for removing obstructionin collaterals. This method could combine multiple effects in pathological proecsses of myocardial ischemia reperfusion and delay the endpoint events, so that improve the quality of life and reduce mortality at maximun degree. There is no doubt that the effective methods of myocardial no-reflow prevention and treatment are well widen in clinical medicine of TCM, which has the certain directive meaning in clinically.