试述病毒性心肌炎的诊治

【摘  要】病毒性心肌炎属中医“心悸”、“胸痹”、“水肿”、“虚劳”等范畴，根据前驱呼吸道和消化道病毒感染病史、感染症状及心脏受累症状、心律失常等体征、心肌酶心电图等辅查进行诊断和必要的鉴别诊断给予确诊，治疗方法包括⑴卧床休息等一般治疗;⑵α-干扰素抗病毒治疗，经中医辨证为毒瘀虚的给予宣肺解表清热解毒的桑菊银翘散化裁广谱抗病毒抗菌治疗、丹参等活血化瘀即改善冠脉及微循环治疗、黄芪生脉饮补益气阴抗病毒兼保护心肌治疗;⑶西药的维生素C、辅酶Q10、曲美他嗪等心肌保护治疗;⑷必要时的糖皮质激素免疫抑制剂治疗;⑸小剂量洋地黄和血管紧张素转换酶抑制剂抗心衰治疗，安装临时起搏器对抗完全性房室传导阻滞、病态窦房结综合征者，以及短期使用地塞米松抑制免疫反应引起的心律失常等的对症治疗。对于病毒性心肌炎，西医西药辨病治疗，结合中医中药辨证施治的诊治方法，可优势互补，疗效显著。

【关键词】病毒性心肌炎;心悸;胸痹;虛劳;中医中药辨证施治;毒、瘀、虚;清热解毒、活血化瘀、补益气阴

【中图分类号】R198      【文献标识码】A      【文章编号】1004-7484（2019）07-0319-02

【Abstract】Viral myocarditis belongs to the description of “heart palpitations”， “chest blocking”， “edema” and “weak fatigue” in Traditional Chinese Medicine. It can be diagnosed based on the history of precursor respiratory tract and digestive tract viral infections，signs of infection and symptoms of cardiac involvement， the signs of arrhythmia， and myocardial enzyme electrocardiogram etc. The treatment methods can consist of ⑴General treatment （like let the patient rest in bed），⑵A-interferon antiviral treatment （for the patient diagnosed as Poison， Stasis and Faintness by Traditional Chinese Medicine， using Sangju Yinqiao San to disperse lung qi， clearing heat and detoxification， using Radix Salviae Miltiorrhizae to promote blood circulation and remove blood stasis to improve coronary and microcirculation， and using Astragalus Membranaceus Pulse-activating Decoction to improve Qi and Yin to protect myocardium），⑶ Using Western Medicine to protect myocardium like Vitamin C， Coenzyme Q10， and Trimetazidine etc，⑷ Glucocorticoid immunosuppressive therapy when necessary， ⑸Heart treatment （using little Digitalis and Angiotensin Converting Enzyme Inhibitor for anti-heart failure， installing a temporary pacemaker to resist Complete Atrioventricular Block and Sick Sinus Node， and using Dexamethasone for short time to inhibit arrhythmia caused by immune response）. For viral myocarditis， Western Medicine treatment， combined with Traditional Chinese Medicine syndrome differentiation， can complement each other and the effect is significant.

【Keywords】Viral myocarditis; Heart palpitations; Chest blocking; Weak fatigue; Traditional Chinese Medicine syndrome differentiation; Poison， Stasis， Faintness; Clearing heat and detoxification， Promoting blood circulation for removing blood stasis， improving Qi and Yin

推荐访问:心肌炎 诊治