李平教授治疗早期复极综合征经验
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摘要
早期复极综合征(ERS)是以心电图有明显的J波和ST段抬高及具有心悸、乏力、头晕、胸闷、心前区不适且常规实验室检查、心肌影像学检查、心导管检查均未发现异常的疾病。其发病机制目前尚不清楚,多认为其与迷走神经兴奋性增高有关。由于男性劳动量大,此病多发于男性。在发现早期复极后的80年里,其一直被认为是一种良性的心电图变异,近10年有研究发现了早期复极与心脏猝死之间有着紧密的联系。能够引起室颤导致心脏猝死的ERS,被归为恶性ERS,但是只要做到早发现、早预防,目前有一些药物及技术手段可以降低其风险。但是其症状明显,发作频繁者,ERS严重地影响了患者的生活及工作,大大降低了其生存质量,目前的医疗手段,尚无有效方法进行治疗。辨证论治、对症治疗是中医药疗法的强项。ERS根据症状当归属于中医"胸痹""心痛"范畴。中医认为胸痹心痛的主要病机是心脉闭阻,其病位在心,涉及肝脾肺肾等脏。由于现代生活方式的改变,其发作证型越来越趋向于以痰火扰心为主。李平教授在临床中遇到1例ERS患者,使用专利方连夏宁心颗粒,清热化痰法对症治疗后,取得良好疗效,为改善ERS患者症状,提高此类患者生存质量提供了宝贵的经验。
Early repolarization syndrome( ERS) is manifested as the obviously elevated J wave and ST segment in ECG,palpitation,lassitude,dizziness,chest oppression and precordial discomfort and no abnormality in the routine laboratory exam,myocardial imaging exam and cardiac catheterization exam. The pathogenesis of it is unknown. It is commonly believed that the increased excitability of vagus nerve is involved. Because of the high labor exertion,the disease is commonly seen in male. In the past 80 years,ERS has historically been considered as normal variant. But in recent 10 years,it has been discovered that ERS is closely related to the cardiac sudden death. ERS is malignant if ventricular vibration and cardiac sudden death are induced. The early discovery and early prevention with some medicines and technique approaches may reduce the risk. Due to the obvious symptoms and frequent attacks,ERS affects seriously the daily life and work and greatly reduces the quality of life. Currently,there is no effective medical approach to the treatment. The symptom differentiation and symptomatic treatment are the advantages of TCM. According to the symptoms of ERS,the disease is classified into the category of chest bi syndrome or heart bi syndrome in TCM. TCM believes that chest bi syndrome and cardiac pain result from the heart meridian obstruction. The location of disease is in the heart,with the liver,spleen,lung and kidney involved.With the change of the modern living pattern,the phlegm-fire disturbance is getting more dominant. Prof. Li Ping treated 1 case of ERS with the patent formula,lianxia ningxin granules. After the symptomatic treatment for clearing heat and resolving phlegm,the satisfactory effects were achieved. The case report provided the valuable experiences in relieving the symptoms of ERS and improving the quality of life in the patients.
Early repolarization syndrome( ERS) is manifested as the obviously elevated J wave and ST segment in ECG,palpitation,lassitude,dizziness,chest oppression and precordial discomfort and no abnormality in the routine laboratory exam,myocardial imaging exam and cardiac catheterization exam. The pathogenesis of it is unknown. It is commonly believed that the increased excitability of vagus nerve is involved. Because of the high labor exertion,the disease is commonly seen in male. In the past 80 years,ERS has historically been considered as normal variant. But in recent 10 years,it has been discovered that ERS is closely related to the cardiac sudden death. ERS is malignant if ventricular vibration and cardiac sudden death are induced. The early discovery and early prevention with some medicines and technique approaches may reduce the risk. Due to the obvious symptoms and frequent attacks,ERS affects seriously the daily life and work and greatly reduces the quality of life. Currently,there is no effective medical approach to the treatment. The symptom differentiation and symptomatic treatment are the advantages of TCM. According to the symptoms of ERS,the disease is classified into the category of chest bi syndrome or heart bi syndrome in TCM. TCM believes that chest bi syndrome and cardiac pain result from the heart meridian obstruction. The location of disease is in the heart,with the liver,spleen,lung and kidney involved.With the change of the modern living pattern,the phlegm-fire disturbance is getting more dominant. Prof. Li Ping treated 1 case of ERS with the patent formula,lianxia ningxin granules. After the symptomatic treatment for clearing heat and resolving phlegm,the satisfactory effects were achieved. The case report provided the valuable experiences in relieving the symptoms of ERS and improving the quality of life in the patients.
引文
[1]于淑芬.早复极综合征的发病率及意义[J].中国社区医师(医学专业),2013,15(8):39.
[2]孙丽.早复极现象及早复极综合征的认识[J].中国社区医师,2016,32(10):7,9.
[3]郑艳平,梁彦萍.早期复极综合征应用常规心电图与12导联动态心电图诊断的分组对照研究[J].心血管病防治知识(学术版),2015(12):68-69.
[4]杨剑滨. 58例早期复极综合征患者临床特点及心电图分析[J].健康之路,2016,15(4):280-281.
[5]黄震华.早期复极综合征研究进展[J].中国新药与临床杂志,2014,33(3):178-181.
[6]权志佳,李瑶,曾佳,等.早期复极与心源性猝死关系研究进展[J].西南国防医药,2015,25(9):1035-1037.
[7]杨钧国.早复极和早复极综合征的新概念及其危险分层[J].临床心血管病杂志,2012,28(11):801-803.
[8]胡冬裴.胸痹古今证型归类研究[J].上海中医药大学学报,2004,18(4):8-10.
[9]李先涛.对冠心病痰瘀互结证(胸痹心痛)临床辨证的认识[J].辽宁中医杂志,2016,43(1):10-12.
[10]马娜娜.清心化痰法治疗冠心病痰热证的病例系列研究[D].北京:北京中医药大学,2015.
[11]朱国东,代慧敏,李平,等.李平教授中医辨证治疗冠心病室性早搏经验总结[J].中西医结合心脑血管病杂志,2016,14(15):1816-1817.
[12]邵银.柴芩温胆汤治疗痰火扰心型室性早搏的临床研究[D].唐山:河北联合大学,2014.
[2]孙丽.早复极现象及早复极综合征的认识[J].中国社区医师,2016,32(10):7,9.
[3]郑艳平,梁彦萍.早期复极综合征应用常规心电图与12导联动态心电图诊断的分组对照研究[J].心血管病防治知识(学术版),2015(12):68-69.
[4]杨剑滨. 58例早期复极综合征患者临床特点及心电图分析[J].健康之路,2016,15(4):280-281.
[5]黄震华.早期复极综合征研究进展[J].中国新药与临床杂志,2014,33(3):178-181.
[6]权志佳,李瑶,曾佳,等.早期复极与心源性猝死关系研究进展[J].西南国防医药,2015,25(9):1035-1037.
[7]杨钧国.早复极和早复极综合征的新概念及其危险分层[J].临床心血管病杂志,2012,28(11):801-803.
[8]胡冬裴.胸痹古今证型归类研究[J].上海中医药大学学报,2004,18(4):8-10.
[9]李先涛.对冠心病痰瘀互结证(胸痹心痛)临床辨证的认识[J].辽宁中医杂志,2016,43(1):10-12.
[10]马娜娜.清心化痰法治疗冠心病痰热证的病例系列研究[D].北京:北京中医药大学,2015.
[11]朱国东,代慧敏,李平,等.李平教授中医辨证治疗冠心病室性早搏经验总结[J].中西医结合心脑血管病杂志,2016,14(15):1816-1817.
[12]邵银.柴芩温胆汤治疗痰火扰心型室性早搏的临床研究[D].唐山:河北联合大学,2014.