摘要
扩张型心肌病(Dilated Cardiomyopathy,DCM)是以心室扩大和心肌收缩功能降低为特征的异质性心肌病,易引发心力衰竭、心律失常甚至猝死,国内≥35岁成人患病人数约177万,病死率高。指南的制订遵循中华中医药学会指南制定规范,整合中西医结合治疗本病的循证证据,并初步拟定推荐方药,经多轮专家名义组会议投票最终确定是否推荐及其推荐方向和强度。中医病名上,将本病统一为“心胀病”,病机本虚标实,本虚以气虚为主,标实以血瘀为主,兼夹水饮。中医辨证包括气虚血瘀、气阴两虚及阳虚水停证3种主要证型,可兼血瘀、水停证。治疗目标以控制症状、改善预后为主。治疗方案上,西医治疗方案主要参考现行DCM相关指南。中医辨证论治按照证型不同推荐相应的中药汤剂、中成药及中药静脉制剂。此外,伴低血压者推荐递增益气升陷药物剂量。
Dilated cardiomyopathy(DCM)is a heterogeneous cardiomyopathy characterized by ventricular enlargement and reduced myocardial contractile function,which easily leads to heart failure,arrhythmiaand even sudden cardiac death.The number of adults aged more than 35 years old with this disease in China is approximately 1.77 million,and the case-fatality rate is high.This guideline was formulated in accordance with the guideline development specifications of the Chinese Association of Chinese Medicine,integrating evidence-based evidence for the treatment of this disease with integrated traditional Chinese and Western medicine,and preliminarily formulating recommended prescriptions.After multiple rounds of voting by the expert nominal group meeting,the recommendation,recommendation directionand intensity were finally determined.In terms of traditional Chinese medicine(TCM)disease names,this disease is uniformly referredas“heart distension disease”.The pathogenesis is deficiency of the root and excess of the tip.The root deficiency is mainly Qi deficiency,and the tip excess is mainly blood stasis,accompanied by water retention.TCM syndrome differentiation includes three main syndrome types:Qi deficiency and blood stasissyndrome,Qi and Yin deficiencysyndrome,Yang deficiency with water retention syndrome,which can be accompanied by blood stasis syndromeand water retention syndrome.The treatment goals are mainly to control symptoms and improve prognosis.For the treatment plan,the western medicine treatment plan mainly refers to the current DCM-related guidelines.TCM syndrome differentiation and treatment recommends the corresponding TCM decoctions,proprietary Chinese medicinesand TCM intravenous prep-arations according to different syndrome types.In addition,for those with hypotension,increasing the dosage of Qi-tonifying and sink-raising drugs is recommended.
作者
王振涛
王佑华
陆曙
何丽云
徐惠梅
《扩张型心肌病中西医结合诊疗指南》项目组
WANG Zhentao;WANG Youhua;LU Shu;HE Liyun;XU Huimei;Project Group of Guideline for Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Dilated Cardiomyopathy(Henan Provincial Hospital of Traditional Chinese Medicine(The Second Affiliated Hospital of Henan University of Chinese Medicine),Zhengzhou 450011,Henan,China;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214071,Jiangsu,China;China Academy of Chinese Medical Sciences,Beijing 100700,China;Heilongjiang Academy of Traditional Chinese Medical Sciences,Harbin 150080,Heilongjiang,China;不详)
出处
《中华中医药学刊》
北大核心
2025年第9期248-258,共11页
Chinese Archives of Traditional Chinese Medicine
基金
河南省中医学“双一流”创建科学研究专项(HSRP-DFCTCM-2023-2-04)。
关键词
扩张型心肌病
中西医结合
指南
气虚血瘀证
气阴两虚证
阳虚水停证
dilated cardiomyopathy
integrated traditional Chinese and western medicine
guideline
Qi deficiency and blood stasis syndrome
Qi and Yin deficiency syndrome
Yang deficiency with water retention syndrome
