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心肌炎的治疗
目录
一、心肌炎
1急性心肌炎(频发早搏)··········································································································
2急性心肌炎(心肌缺血)··········································································································
3急性心肌炎(儿童)··················································································································
4迁延性心肌炎·······························································································································
5慢性心肌炎(心律失常、房颤、不完全性传导阻滞、心肌缺血)··································
6心肌炎后遗症···························································································································
二、扩张型心肌病
1扩张型心肌病(心肌炎后)·······································································································
2扩张型心肌病(病因不明)·······································································································
3扩张型心肌病(病因不明)········································································································
4扩张型心肌病(病因不明)·······································································································
5扩张型心肌病(酒精性)············································································································
三、肺源性心脏病
1肺源性心脏病··································································································································
2肺源性心脏病···································································································································
3肺源性心脏病···································································································································
四、冠心病
1冠心病(缺血性心肌病)············································································································
2冠心病(支架手术后)················································································································
3冠心病(变异性心绞痛)············································································································
4冠心病(病窦综合症)·················································································································
5冠心病(慢性心衰)·····················································································································
6冠心病(小冠状动脉病变)········································································
7冠心病(心律失常、心衰)·····································································································
五、高血压心脏病················································································································
六、肥厚型心肌病················································································································
1肥厚型非梗阻性心肌病·················································································································
2肥厚型梗阻性心肌病·····················································································································
七、风湿性心脏病
1风湿性心脏病(未手术)·············································································································
2风湿性心脏病(未手术)··············································································································
3风湿性心脏病(手术前)··············································································································
八、心律失常
1频发早搏(病因不明)···················································································································
2窦性心动过缓(心肌损伤)···········································································································
九、先天性心脏病
1先天性心脏病(手术后)·············································································································
2先天性心脏病(手术前)·············································································································
十、二尖瓣脱垂综合症······································································································
十一、脑梗塞····························································································································
1冠心病并脑梗··································································································································
2风湿性心脏病并脑梗······················································································································
以下病例分析均参考《心脑血管疾病中医诊治》(主编李七一方祝元)2001年8月第一版人民卫生出版社
一、心肌炎病例分析
1急性心肌炎(频发早搏)一例
例1:
患者宋某某,女性,34岁,山西长治市人。
因感冒后自感胸闷,无力1月,2007年10月就诊于当地医院,门诊查动态心电图提示频发室性早搏,9800次/24小时,64排螺旋CT提示心尖部心肌缺血,心肌酶正常。
入院查体:
体温35.8℃,脉搏66次/分,呼吸16次/分,血压100/80mmHg。
双肺呼吸音清,未闻及干湿性啰音。
心率66次/分,心律不齐,可闻及早搏约每分钟6次,各瓣膜听诊区未闻及病理性杂音。
当地医院诊断为“急性心肌炎”,给予常规西药治疗一个月后,患者症状无明显减轻,于2007年10月开始服用玉丹®荣心丸治疗,一次8丸,一日3次,同时口服药物辅酶Q10,维生素C。
2周后胸闷,无力症状明显改善,连续服药治疗6个月,后于2008年4月在长治市中医研究所附属医院复查动态心电图完全正常,玉丹®荣心丸用量调整为6丸/次。
1年后即2008年9月在城区第二人民医院复查心电图正常,心脏彩超:
左室假腱索,停服玉丹®荣心丸。
分析虚
心肌炎系指各种原因引起心肌的局灶性或弥漫性炎症病变,临床上又分为急性期、恢复期、迁延期、慢性期和后遗症期,各年龄段均可发病。
常见致病源为病毒,另外药物、毒物反应或中毒、放射线照射、某些全身性疾病在心肌的反应,如皮肌炎,结节病等也可以导致心肌炎症性病变。
发病机理:
目前发现包括发病早期病毒或毒素代谢产物等直接侵犯心肌引起的心肌细胞损害和功能障碍,另一个是病毒感染后、引发的免疫反应所造成的心肌损害。
由于病情轻重不同,患者表现差异很大,常见症状为胸闷、心前区隐痛、心悸、乏力、恶心、头晕等,婴幼儿病情多较重,成年人多较轻。
轻者可无明显病状,重者可并发严重心律失常,心功能不全甚至猝死。
西医治疗心肌炎目前以对症治疗为主,尚缺乏有效药物,弊端是有些西药本身也可以直接造成心肌免疫损伤和感冒症状,副作用明显,价格昂贵。
玉丹®荣心丸填补了心肌炎治疗药物的空白,本例就是刚开始经西医西药治疗效果欠佳的患者、通过按疗程服用玉丹®荣心丸治愈心肌炎的实例。
上海玉丹药业有限公司(以下简称:
玉丹药业)生产的玉丹®荣心丸是目前国家基本药物目录(2004版)指定的治疗病毒性心肌炎的唯一用药。
通过研究证实,该药组方中苦参、蓼大青叶中的活性成分能抵抗病毒直接的损伤;苦参、蓼大青叶、辽五味子、玉竹、丹参和降香中的活性成分能调节自身免疫造成的心肌损伤;玉竹、丹参和降香中的活性成分能够清除病毒心肌炎产生的过多自由基;而丹参和辽五味子中的有效成分可以有效抑制心肌细胞的凋亡,治疗心肌细胞损伤。
所以玉丹®荣心丸针对各类病因引发的心肌炎,心肌损伤都有治疗作用,对病毒性心肌炎作用更优。
从西医角度分析,心肌炎无论何种病因,病灶心肌细胞总伴有不同程度的炎症,心肌内小血管损伤或冠脉小分支病变、心脏神经病变和心脏收缩过度状态甚至出现心室小动脉阻塞。
因此局部心肌供血不足情况普遍存在,同时可出现心肌收缩力减弱,心输出量下降。
玉丹®荣心丸具有直接阻断病毒复制,减少病毒及毒素对心肌的直接损伤作用,同时该药还具有改善心肌代谢,促进心肌功能修复,调节免疫,减少心肌自身免疫损伤作用,从而改善心肌供血不足,调节心律,消除心律失常,对各种病因所致的心肌损伤都有直接治疗作用。
从中医角度分析,心肌炎多为“温病外袭内舍于心”,属外邪发病,血瘀滞脉,气阴两虚。
若患者在长期“气阴两虚”病损的基础上就可能导致心阳虚弱,血瘀痰闭,患者自感胸闷、心悸等,还可能出现水肿、气喘、畏寒肢冷、脉结代、厥逆等症状。
玉丹®荣心丸功效:
益气养阴、活血理气调脉,能预防心肌炎的严重并发症,并使急性期心肌炎逐步转归到恢复期,从而使心肌炎在根本上得到控制和治疗,并对延缓、逆转心肌炎向扩张型心肌病转变有利。
药理实验证明:
玉丹®荣心丸在治疗病毒性心肌炎的同时,能作用于原发病毒感染和调节机体免疫,消除了心肌炎反复发病的潜在因素。
从整体来说,中药对心肌炎的治疗注重辨证施治和验方治疗,优势独特。
但若病情表现为严重的心律失常,急性心衰,心源性休克等危急重症,必须以西医抢救为主,辅以中药;待病情趋缓,重心可转为中药治疗。
附:
1.宋某某2008年4月动态心电图(用药后半年复查)
2.宋某某2008年9月9月心脏彩超和心电图(用药后1年复查)
2急性心肌炎(心肌缺血)一例
例2:
患者卿某某,男性,20岁,湖南邵阳人。
2006年2月因感冒致胸闷憋气,心前区疼痛,背部隐痛,失眠,当地做心电图检查提示T波改变,心肌缺血,诊断为急性心肌炎。
由于患者已经通过服兵役体检,故非常担心不能顺利完成即将开始的高强度兵役训练,参军的梦想即将破灭。
患者于2006年4月服用玉丹®荣心丸治疗,每日3次,每次8丸。
2个月后胸闷憋气症状明确改善,感冒次数减少,患者如期参加军训,继续坚持用药1年后复查心电图正常。
分析虚
急性心肌炎病程多在新发病6个月以内,临床症状和检查明显而多变。
由于病灶心肌细胞有不同程度的炎症、心肌内小血管损伤或冠脉小分支病变、心脏神经病变和心脏收缩过度状态甚至出现心室小动脉阻塞的原因,容易出现局部心肌供血不足。
玉丹®荣心丸能有效阻断受病毒感染心肌细胞的凋亡,提高心肌细胞耐氧能力,维持心肌细胞基本结构,清除病毒和细胞代谢产物,保护和修复受损心肌细胞,改善心肌代谢,清除氧自由基损伤,调节免疫,减少心肌自身免疫损伤,从而改善心肌供血不足。
该病例是典型急性心肌炎患者,服用玉丹®荣心丸治疗后,及时控制了症状,稳定了病情,而且显著改善了心肌缺血的心电图,防止向心肌炎后遗症转化。
附:
卿某某2006年反馈信
3.急性心肌炎(儿童)病例分析
例3:
患者董某某,男,5岁,山东济宁人。
患儿在2008年1月份感冒后引发心肌炎,心肌酶升高伴有早搏,在当地多次住院治疗半年,心肌酶恢复正常但仍有早搏消除不掉,一分钟3--4次。
患者一直服用“心律平”控制早搏,用药初期效果很好,可是一停服心律平、早搏就反复出现,甚至比原来更多,入院查体:
体温36.0℃,脉搏96次/分,呼吸20/分,血压90/60mmHg。
双肺呼吸音清,未闻及干湿性啰音。
心尖搏动位于左侧第五肋间锁骨中线内0.5cm,心率96次/分,心律不齐,可闻及早搏约每分钟5次。
于2008年6月开始服用玉丹®荣心丸,每次3丸,每日3次。
2周后复查心电图,早搏减少为每分钟1次。
该患者继续服用该药半年,复查心电图正常,巩固2周后停药。
分析虚
早搏是心肌炎急性期比较常见的心律失常,如果没有及时消除很容易顽固发作,形成心肌炎后遗症。
玉丹®荣心丸具有调节心肌代谢,促进心肌功能修复,调节免疫,减少心肌自身免疫损伤,从而改善心肌供血不足,调节心律,消除心律失常的作用。
和西药抗心律失常药物相比,具有标本兼治,停药后心律失常不反复的优点,临床用药安全可靠。
另外,由于儿童患者自我防护意识薄弱,休息不足,机体自我调节以及免疫水平等均低于成人等原因,往往使病程延长,病情反复而成为迁延性或慢性过程。
因此需要彻底修复损伤心肌,才能逐渐停服玉丹®荣心丸,过早停药有可能使早搏再现。
附:
董某某母亲2008年7月反馈信
4.迁延性心肌炎
例4:
患者李某某,男性,10岁,河南省平顶山市人。
因长叹气3年入院。
该患者在2002年感冒后出现长叹气症状,当地医院门诊检查心肌酶五项全部升高,在当地医院治疗半年,心肌酶复查仍有一项升高,长叹气现象仍存在。
由于患者平时经常感冒,运动量没有控制好,2004年3月心电图出现ST-T改变,患者于2005年初感到胸口疼痛明显,憋气,5月和7月分别两次在当地住院,诊断为“迁延性心肌炎”,检查心电图ST-T改变,动态心电图:
窦性心律不齐,窦性心动过速,T波改变;心肌酶谱:
LDH334.8u/l、HBDH190.70u/l,心彩超正常。
患者于2005年8月开始服用玉丹®荣心丸治疗,每次6丸,每日3次。
经过两年的连续治疗,患者的不适症状消失,各项检查全部正常。
2007年8月停药,停药一年后无复发症状,感冒的次数也明显减少,生长发育均未受到任何影响。
2008年9月其父再次写信感激上海玉丹药业。
分析虚
迁延性心肌炎是指患者心肌酶谱反复升高,病程超过一年以上。
这种疾病的患者多是由于急性期治疗不及时、不彻底,或不注意限制剧烈运动,不能有效避免感冒和劳累等,导致病情反复发作,心肌反复受累,导致病程较长,并有可能出现心脏扩大或心衰等严重后果。
迁延性心肌炎患者治疗时间通常要一年以上,治疗期间应注意休息、避免任何劳累、情绪激动等诱因。
症状控制好转后仍需要巩固治疗一段时间,本例患者在两年的治疗中未有间断,停药后一年内未复发。
附:
李某某2004年心电图
李某某2005年心电图、动态心电图、各项生化检查报告单、心脏彩超
李某某2005年患者父亲来信(病情说明)
李某某2008年患者父亲来信(反馈信)
5慢性心肌炎(心律失常、房颤、不完全性传导阻滞、心肌缺血)一例
例5:
患者陈某,男性,38岁,上海人,主诉:
反复胸闷、憋气、早搏6年。
患者在1999年初突感心脏不适,立即到黄浦区中心医院检查,心电图显示心率不齐、频发早搏、T波改变、房颤、不完全房室传导阻滞,诊断为心肌炎,经住院1个月输液、口服心律平等治疗,心律失常控制,但心律平一减量便重新出现心律失常,经常感到心慌,虚汗,失眠。
患者从2006年3月开始服用玉丹®荣心丸治疗,每日3次,每次6丸,一周后早搏明显减少,心慌减轻,巩固治疗一个疗程(3个月)后早搏彻底消失,停服心律平没有出现心律失常。
复查心电图仍有T波改变,继续治疗1年至2007年7月复查心电图完全恢复正常。
分析虚
慢性心肌炎病程多在1年以上,病人症状、各项检查呈反复变化或迁延不愈。
玉丹®荣心丸具有益气养阴,活血理气调脉的功效,促使慢性期心肌炎逐步转归到恢复期,修复受损心肌及传导系统,从而使心肌炎在根本上得到控制和治疗,并对延缓、逆转心肌炎向扩张型心肌病转变有利。
从中医上分析,玉丹®荣心丸用于治疗“温病外袭内舍于心”的各种症状,包括心肌炎、心律失常、房颤等一系列现代医学中的疾病和症候群,效果显著,可益气养阴、活血解毒,用于气阴两虚兼脉瘀阻所致的胸闷、心悸、气短、乏力、虚汗、心前区不适。
由于标本兼治,所以不容易出现抗心律失常西药停药后心律失常反复的缺点。
本例患者经过正规疗程治疗,摆脱了心律平的困扰,心电图也彻底恢复正常。
附:
陈某某2007年10月7日反馈信
6心肌炎后遗症一例
例6:
患者张某,男,9岁,黑龙江牡丹江市。
2002年患急性心肌炎,经过治疗症状消失,但心电图遗留II°II型房室传导阻滞,交界性逸搏心率。
平时无异常,感冒后或运动量稍大就出现疲乏无力,脸色发白的情况,没有晕厥史。
1周前感冒后症状再现,复查心电图II°I型房室传导阻滞,II°II型房室传导阻滞,偶发房早,可见成对伴差传,交界性逸搏。
当地诊断“心肌炎后遗症”,并向家长提出警告,如果病情继续加重,将可能需要安装起搏器。
入院查体:
体温36.2℃,脉搏70次/分,呼吸16次/分,血压98/60mmHg。
双肺呼吸音清,未闻及及干湿性啰音。
心率70次/分,律不齐,偶可闻及提前搏动。
第一心音强弱不等,各瓣膜听诊区未闻及病理性杂音。
双下肢无浮肿。
患者于2006年9月开始服用玉丹®荣心丸治疗,4丸/次,3次/天。
1年后复查动态心电图提示为偶发II°I型房室传导阻滞,故瞩患儿玉丹®荣心丸减量为4丸/次,2次/天。
继续半年后即2008年4月复查动态心电图提示为间歇性I°房室传导阻滞,II°I型房室传导阻滞。
至2009年3月,患儿心电图一直比较稳定,无不适症状。
分析虚
根据心肌炎病情变化和病程长短可分为5期:
急性期、恢复期、迁延期、慢性期、后
遗症期。
玉丹®荣心丸适用于心肌炎的各个发病阶段均有显著疗效。
药物启动了修复心肌机制,改善病灶血氧供应,不但促使急性期的心肌炎逐步转归到稳定期和恢复期,而且对慢性期、后遗症期出现的顽固性早搏、传导阻滞等心律失常亦有明显疗效,其相关的抗心律失常作用目前已经成为国际学术领域研究的热点。
玉丹®荣心丸组方中的苦参、蓼大青叶中的活性成分能抵抗病毒直接的损伤;苦参、蓼大青叶、辽五味子、玉竹、丹参和降香中的活性成分能调节自身免疫造成的心肌损伤;玉竹、丹参和降香中的活性成分能够清除病毒心肌炎产生的过多自由基;而丹参和辽五味子中的有效成分可以有效抑制心肌细胞的凋亡,治疗心肌细胞损伤;苦参在药理上也被证实有抗早搏作用。
通过长期补气,养阴,活血,清热解毒等多重治疗,使受损心肌及传导系统得以修复并改善供血、强心复脉,纠正心律失常。
本例心肌炎后遗症患者正是通过长期按疗程服用玉丹®荣心丸,传导阻滞得以逐步减轻,解除了安装起搏器的困扰。
但是心肌炎患者需要较长时间服药治疗,这是本病心气虚的病理和邪毒特点决定,不能过早停药,以免复发或变生他病。
急性期患者需服至症状、体征消失或基本消失,各项检查恢复正常后继续用药1-2个月巩固,慢性期、后遗症期则应常年服药治疗。
一般而言,各期均可