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新冠感染后长期心血管症状的病理、病因及中医药疗法
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Abstract:
伴随着后疫情时代的来临，新冠感染后长期症状患者人群广、数量众多，其中以新冠感染后长期心血管症状患者居多，该类患者表现多以神疲、乏力，气短、懒言，稍动则心慌、心悸、汗出为主，伴见咽干、口燥、潮热、盗汗。心肌损伤以及冠状动脉灌注受限或严重缺氧可能是主要原因，心肌损伤标志物、超声心动图及心电图及多元化评估能帮助早期识别筛查。中医辩证属“心悸、胸痹心痛、心瘅”范畴，分气阴亏虚证、痰瘀互结证及痰阻气滞、肝脾失调三证辩证治疗，核心病机是余邪未清、气阴亏虚，临床坚持“辩证”与“辨病”结合各种中医药物疗法补气养阴、调和阴阳，以促进患者早日康复。
With the advent of the post-pandemic era, there is a wide and numerous population of long COVID symptom patients, with a majority suffering from Post-Acute Sequelae of SARS-CoV-2 Infection Cardiovascular Disease/Syndrome (PASC-CVD/CVS). These patients often present with fatigue, weakness, shortness of breath, lethargy, palpitations upon slight exertion, accompanied by dry throat, thirstiness, hot flashes, night sweats. This severely affects their quality of life and imposes significant economic burden and mental stress. Western medicine attributes this to myocardial injury as well as restricted coronary artery perfusion or severe hypoxia. Early identification can be achieved through biomarkers for myocardial damage (BNP, cTnI, LDH, CK-MB), UCG, and ECG which are crucial for diagnosing and screening PASC-CVD/CVS. Traditional Chinese Medicine categorizes it under “heart palpitations” “chest obstruction and heartache” “heart depression” etc., with a complex pathogenesis involving residual pathogens and deficiency in qi-yin being the core etiology- mechanism. It is divided into three patterns: deficiency in qi-yin pattern; phlegm-stasis mutual constraint pattern; phlegm stagnation obstructing qi pattern combined with liver-spleen disharmony pattern. In clinical practice, it adheres to the principle of combining syndrome differentiation with disease diagnosis while employing various non-pharmacological therapies to tonify qi, nourish yin, and harmonize yin-yang, to achieve overall regulation, rehabilitation, and promote early recovery for patients.
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