从冠脉搭桥术探讨体外循环的中医病机＊

目的 探讨体外循环的中医生理病理机制。方法 回顾广东省中医院2012年2月至2019年12月行CABG术的患者,以是否行体外循环为标准分为两组,对比两组患者在术后第1天、第3天及第7天的中医证型差异。结果 术后第1天及第3天,体外循环CABG组患者痰阻心脉证及心气亏虚证较非体外循环CABG组为多,差异具有显著性。术后第7天,两组患者痰阻心脉、心气亏虚等各证未见显著性差异。结论 体外循环并非导致血瘀、阳虚及血虚的因素,其病机是一个虚实夹杂的过程,虚者为心气亏虚,实者为内生痰浊。至术后1周左右,体外循环对机体的影响逐渐减轻,此时更应关注的是其他因素引起的术后病理改变。

Discussion on TCM Pathogenesis of Extracorporeal Circulation from Coronary Artery Bypass Grafting Surgery

Objective To explore the physio-pathological mechanism of traditional Chinese medicine (TCM) on extracorporeal circulation.Methods Patients who had CABG surgery from February 2012 to December 2019 in Guangdong Provincial Hospital of Chinese Medicine were included. They were divided into 2 groups based on whether or not they had extracorporeal circulation. The differences of TCM syndromes on the 1st, 3rd and 7th days after surgery were compared between the two groups of patients.Results On the 1^st and 3^rd postoperative days, patients with cardiopulmonary bypass CABG group had more sputum obstruction and heart-qi deficiency syndrome than those without cardiopulmonary bypass CABG group. On the 7th day after surgery, there was no significant difference between the two groups of patients.Conclusion Cardiopulmonary bypass is not a factor that causes blood stasis, yang deficiency, and blood deficiency. Its pathogenesis is a mixed process of excess and deficiency. The deficiency is the deficiency of heart qi, and the excess is the endogenous sputum. About one week after surgery, the effects of extracorporeal circulation on the body gradually reduced. At this time, more attention should be paid to other pathological changes caused by other factors.