目的 探讨行不停跳冠状动脉旁路移植术的冠心病患者围术期中医证型变化的规律.方法 选择北京安贞医院心脏外科2012年1月至2013年5月拟行不停跳冠状动脉旁路移植术386例患者,围术期分为心血瘀阻证组、痰阻心脉证组、气阴两虚证组和心肾阴虚证组,术前,术后3 d、7 d、3个月和6个月分析中医证型并分析变化规律.结果 386例患者术前分型结果心血瘀阻证者占67.9%(262/386),痰阻心脉证者占13.2%(51/386),气阴两虚证者占12.2%(47/386),心肾阴虚证者占6.7%(26/386),痰阻心脉证患者三支病变比例较高[92.2%(47/51)],与其他3组比较,差异有统计学意义(P=0.011).术后第3天,心血瘀阻证为5.4%(21/386),痰阻心脉证为90.7%(350/386),较术前明显增加,差异有统计学意义(P=0.021).气阴两虚证为2.1%(8/386),痰阻心脉证为1.5%(6/386),另有0.3%(1/386)演变为阳气虚衰证;术后7 d,痰阻心脉为80.8%(312/386);术后3～6个月痰阻心脉证为20.3%(78/386)和15.3%(56/386),较术后7 d比较,差异有统计学意义(P=0.011,P=0.006).结论 拟行不停跳冠状动脉旁路移植术的冠心病患者术前中医证型以心血瘀阻为主;痰阻心脉病变相对重且术后比例大幅增加.临床上应该高度重视这一证型的患者,并根据证型变化应用中西医联合治疗.%Objective To explore the alternation of TCM syndrome before and after coronary bypass graft surgery in patients with coronary heart disease. Methods A total of 386 patients were divided into four clinical types of TCM syndrome: heart blood stasis syndrome group(262 cases,67.9%), phlegm blocking heart vessel syndrome group(51 cases, 13.2%), dual deficiency of qi and yin syndrome group(47 cases,12.2%) and yin deficiency of heart and kidney syndrome group(26 cases,6.7%). The 3 days, 7days and 6 months postoperative TCM syndrome were collected and analyzed. Results Phlegm blocking heart vessel syndrome group had a higher rate of three vessel lesion[92.2%(47/51)] than the other three groups(P<0.05). Three days postoperative, the ratio of heart blood stasis syndrome decreased to 5.4%(21/386)(P<0.05)while the ratio of phlegm blocking heart vessel syndrome increased to 0.7%(350/386)(P<0.05). Seven days postoperative, the ratio of phlegm blocking heart vessel syndrome slightly decreased to 80.8%(312/386). At 3 to 6 months follow-up, the ratio of phlegm blocking heart vessel syndrome still decreased to 20.3%(78/386)(P<0.05)and 15.3%(56/386)(P<0.05), respectively. Conclusion Heart blood stasis syndrome is the main type of coronary heart disease patients who undergo coronary bypass graft surgery. Phlegm blocking heart vessel syndrome may increase postoperative and have relative severe lesion.
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