中西医结合治疗心肌梗死后缺血再灌注损伤的研究进展
Research Progress in the Treatment of Ischemia-reperfusion in Jury after Myocardial Infarction with Integrated Traditional Chinese and Western Medicine
肖立运 1许胜2
作者信息
- 1. 济宁市第一人民医院,山东 济宁 272000
- 2. 济宁北湖省级旅游度假区人民医院,山东 济宁 272000
- 折叠
摘要
心肌缺血是冠心病的重要病理改变,血流灌注量减少使心肌处于缺血、缺氧状态,导致能量代谢异常,心功能不同程度的降低等,严重者可诱发心肌梗死、猝死等不良事件.而急性心肌梗死(AMI)后冠心病最为严重的心肌缺血类型,以胸口疼痛、呼吸困难、胸闷、呕吐为主要临床症状,若不积极治疗,可引发心律失常,增加猝死风险.临床上再灌注治疗是AMI治疗的主要手段,再灌注治疗通过溶栓药物、介入治疗或手术治疗,将完全闭塞的血管重新开通,使缺血组织获得再灌注.及时的血运重建治疗能够在短时间内恢复血液供应,但同时亦会导致不同程度的缺血再灌注损伤(IRI),损害心肌的结构和功能,被认为是影响冠心病患者再灌注治疗效果的主要事件.目前研究发现心肌缺血再灌注损伤(MIRI)与氧化应激、Ca2+超载、能量代谢障碍、炎症反应等机制相关.药物治疗着眼于相关机制从而保护心肌缺血再灌注损伤,如抗氧自由基、抑制钙超载、改善炎症浸润及细胞凋亡、减轻线粒体损伤.目前西医治疗再灌注损伤已处于瓶颈,笔者尝试引入中医药理论.根据中医观点,AMI可归于"心痛""胸痹"范畴,病位在心,牵连肝、脾、肾等诸多脏器,病机见于气虚血瘀,宜采用养气除痹、活血化瘀之法.因而从中西医结合理论深入探索再灌注损伤的发病机制,系统总结再灌注损伤的中西医可能的主要机制,对于防治缺血再灌注损伤具有重要价值.
Abstract
Myocardial ischemia is an important pathological change in coronary heart disease.A decrease in blood flow perfusion puts the myocardium in a state of ischemia and hypoxia,leading to abnormal energy metabolism and varying degrees of decreased cardiac function.In severe cases,it can induce adverse events such as myocardial infarction and sudden death.The most severe type of myocardial ischemia after acute myocardial infarction(AMI)is coronary heart disease,with chest pain,breathing difficulties,chest tightness,and vomiting as the main clinical symptoms.If not actively treated,it can cause arrhythmias and increase the risk of sudden death.In clinical practice,reperfusion therapy is the main method of treating AMI.Through thrombolytic drugs,interventional therapy,or surgical treatment,reperfusion therapy reopens completely occluded blood vessels,allowing ischemic tissue to achieve reperfusion.Timely revascularization therapy can restore blood supply in a short period of time,but it can also lead to varying degrees of ischemia-reperfusion injury(IRI),damaging the structure and function of the myocardium,and is considered a major event that affects the effectiveness of reperfusion therapy in patients with coronary heart disease.At present,research has found that myocardial ischemia-reperfusion injury(MIRI)is related to mechanisms such as oxidative stress,Ca2+ overload,energy metabolism disorders,and inflammatory reactions.Drug therapy focuses on relevant mechanisms to protect MIRI,such as combating oxygen free radicals,inhibiting calcium overload,improving inflammatory infiltration and cell apoptosis,and alleviating mitochondrial damage.At present,the treatment of reperfusion injury with Western medicine is at a bottleneck,and the author attempts to introduce the theory of traditional Chinese medicine.According to the perspective of traditional Chinese medicine,AMI can be classified into the categories of"heartache"and"chest obstruction".The disease is located in the heart,involving many organs such as the liver,spleen,and kidney.The pathogenesis is seen in qi deficiency and blood stasis,and it is recommended to use the methods of nourishing qi to remove obstruction and promoting blood circulation to remove stasis.Therefore,exploring the pathogenesis of reperfusion injury from the perspective of integrated traditional Chinese and Western medicine theory and systematically summarizing the possible main mechanisms of reperfusion injury in traditional Chinese and Western medicine is of great clinical significance for the prevention and treatment of IRI.
关键词
急性心肌梗死/心肌缺血/再灌注损伤/中西医结合疗法Key words
Acute myocardial infarction/Myocardial ischemia/Reperfusion injury/Chinese and Western Medicine引用本文复制引用
基金项目
济宁市重点研发计划项目(2022YXNS131)
济宁市重点研发计划项目(2019MNS021)
山东省中医药科技发展计划项目(2019-0454)
出版年
2024
NETL
NSTL
万方数据