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1、现代中医学填补动脉瘤药物治疗空白Modern Chinese medicine to fill the gaps in the treatment of aneurysms作者：江兴利Author: Jiang Xingli四川阆中：川北中医糖尿病专科Langzhong: College of traditional Chinese Medicine Diabetes Sichuan Sichuan联系方式：电话15528851920 电子邮箱：内容摘要：动脉瘤属于由遗传缺陷、感染、代谢障碍、循环障碍、外伤等因素，主要是由营养代谢障碍导致循环系统动脉血管形态损伤，导致人体循环系统功能障碍和血管
2、组织结构与形态损伤，发生在颅内、外周或腹主动脉各段膨隆突起或血管壁组织分层的一类致死率高达95%的一类危重病症。世界医学体系只能等到动脉瘤突发，动脉壁突然大幅度膨胀或破裂急救时被检出进行外科干预来延缓患者13年生存期。医学界至今还没有动脉瘤的内科治疗技术和药物。传统中医学里是找不到与动脉瘤相对应的疾病，只有笼统的“癥瘕、积聚、痞块”等针对人体病理性组织结构异常的辨证模式，不适用于动脉瘤病因辨证而难以准确指导动脉瘤的处方用药。笔者根据代谢障碍、循环器官损害、动脉膨出扩张乃至破裂的病理特征，研究出本病在传统中医临床诊断当中的特殊辩证规律，确立了本病以“湿、痰、气滞、血瘀为疾病演变进展规律的辨证模式
3、，拟定出以“利湿排酯、清障逐瘀、行气减压、补气运血、再生修复”为治疗原则指导临床用药。实施临床紧急治疗时要把握以下两个要点：1.及时有效调控血压和腹腔压力，配备合理临床监护和适应性体位，严防瘤体破裂出血，避免意外发生。2.通过实施中药进行活血、祛风、解痉、降压的有效治疗，切实保护受害器官，缓解痛苦程度。根据动脉瘤患者的相应病理阶段的不同特点确立与之相适应的4项基本治疗法则：1“行气化水、活血祛瘀、导滞减压”是急救期的治疗宗旨2“除湿降脂清理障碍，修复血液循环”是治疗的基本措施3中药治疗动脉瘤“补肝肾促修复”是维持疗效稳定的用药方针4补肾中元气、益肝肾精血、促细胞修复贯穿治疗全过程Content
4、 summary:Belong to the aneurysm by genetic defect, infection, metabolic disorders, circulatory disorder, trauma factors, mainly circulatory system morphology of arteries injury caused by nutritional and metabolic disorder, resulting in human circulatory system dysfunction and vascular tissue structu
5、re and morphology of injury, occurred in the intracranial, peripheral or abdominal aorta segments of bentonite long protrusions or the walls of blood vessels are hierarchically organized a mortality rate of up to 95% for a class of critical illness. The world medical system can only wait until the s
6、udden burst of the arterial wall, the sudden expansion of the arterial wall, or rupture of the first aid to be detected when surgical intervention to delay the patient 1 - 3 years of survival. The medical profession has not yet been treated in the Department of internal medicine, the treatment techn
7、ology and medicine.Traditional Chinese medicine science is to find corresponding to the aneurysm disease, only general Zhengjia, accumulation, lump in the abdomen in human pathology organization structural abnormalities of the syndrome differentiation model, does not apply to aneurysm etiology to co
8、rrectly guide the aneurysm of prescription medication. The according to pathological features of metabolic disorders, circulatory organ damage, artery bulging expansion and rupture, the disease in the clinical diagnosis of traditional Chinese medicine special law of dialectical, established the dise
9、ase by the wet, phlegm, qi stagnation, blood stasis disease evolution law of development of the dialectical mode, draw up a Lishi row ester, the wrecker by stasis, gas decompression, Qi blood circulation, regeneration and repair for the treatment of the principle to guide clinical medication.Two key
10、 points should be grasped in the implementation of clinical emergency treatment:1. Timely and effective regulation of blood pressure and abdominal pressure, with reasonable clinical care and posture adaptability, prevent aneurysm rupture and bleeding, avoid accidents.2. through the implementation of
11、 traditional Chinese medicine for promoting blood circulation, effective therapy of expelling wind and spasmolysis, step-down, effectively protect the organ damage, relieve the degree of pain.According to the different characteristics of the patients with the corresponding pathological stage, 4 basi
12、c treatment rules were established:1：water, blood stasis, qi stagnation is the treatment of emergency relief purpose2：to clean up the blood and blood circulation is the basic measure of treatment.3：Chinese herbal medicine treatment of arterial tumor repair and liver and kidney promoting repair is to
13、 maintain the efficacy of the drug policy4： kidney qi and tonifying the liver and kidney, promoting blood cell repair throughout the entire treatment process主题词： 腹主动脉瘤， 动脉夹层， 湿痰， 气滞， 血瘀， 除湿降脂， 清障减压， 修复循环Key words: abdominal aortic aneurysm, aortic dissection, phlegm, qi stagnation, blood stasis, deh
14、umidification lipid-lowering, clear the obstacle, repair cycle现代中医学填补动脉瘤药物治疗空白一 动脉瘤医学概念和临床现状动脉瘤属于由遗传缺陷、感染、代谢障碍、循环障碍、外伤等因素，主要是由营养代谢障碍导致循环系统动脉血管形态损伤的疾病领域。中医内科属“湿、痰、气滞、血瘀”病因引起的人体循环系统功能障碍和血管组织结构与形态损伤所发生在颅内、外周或腹主动脉各段膨隆突起及血管壁组织分层的一类致死率达高95%的一类危重病症。动脉瘤临床病理特征是由于各种病理因素，特别是由代谢障碍、脂质过氧化和自由基损伤促使动脉系的大血管内膜受损，同时构成血
15、管肌层的由弹力蛋白构成的弹力纤维束断裂，加上血管组织病理特征和血液的物理特性发生改变，再加之持续性血压升高，致使动脉血管内压力突破了血管壁的张力极限，所导致的局部性血管逐渐或迅速向外或向血管壁内膜夹层扩张、膨隆和突出的一类疾病。其病理基础不属通常所说的肿瘤，而是血管自身的组织结构形态所发生改变所引起的病变。由于社会经济日益发达物质丰富，人们的营养过剩和运动减少的生活方式，造成大量因代谢障碍而导致循环系统障碍,进而使身体健康受到严重危害的人群。据世界卫生组织统计资料显示，40岁以上人群发生动脉瘤的比例达到0.2%,60岁以上人群发生动脉瘤的比例达到8%。众所周知，动脉瘤是一种致死率极高的病种。但
16、世界医学体系至今还没有研究出任何内科治疗动脉瘤的相关技术和药物。患者和家属一般都要等到动脉瘤突发，动脉壁突然大幅度膨胀或破裂急救时被检出。此时就只有进行外科干预和姑息、物理支撑来延缓患者13年生存期。由于动脉瘤的复杂性和发病位置解剖特点，有70%动脉瘤患者不具备手术条件，只有30%患者才具备外科手术治疗的可能性，而手术抢救成功的比例小于20%。5cm以上直径的未破裂动脉瘤患者一般生存期为3个月-3年。那些已破裂动脉瘤患者能活下来的机会仅有5%，50%动脉瘤破裂患者生命终结于发病以后第一个24小时。1955年4月18日，历史留给全世界人民的沉痛记忆，人类历史上最伟大的科学家，阿尔伯特爱因斯坦因主动脉瘤破裂而逝于美国普林斯顿。2001年，中国男排一代名将朱刚,还有上世纪八十年代当时排坛上和我国女排名将郎平齐名的美国女排著名的主攻手海曼都是死于动脉瘤这一生命
