肺心病失代偿期合并房性早搏的中西医结合治疗策略

Treatment Strategy of Integrated Traditional Chinese and Western Medicine for Decompensated Cor Pulmonale Complicated with Atrial Premature Beats

摘要: 房性早搏是肺心病失代偿期最常见的并发症，在治疗心律失常方面，指南推荐心脏选择性β1受体阻滞剂(如比索洛尔)，但比索洛尔会随着使用剂量的增加出现β2受体阻断的现象，从而诱发支气管痉挛，导致肺功能恶化，尤其在重度气道阻塞的肺心病患者中表现尤为明显，同时比索洛尔在抑制交感神经兴奋的同时，具有负性肌力作用可能会加重右心衰竭，故指南建议起始剂量要小。温阳利水定悸方是由《伤寒论》中真武汤、桂枝甘草汤加猪苓、泽泻、葶苈子、丹参、大枣化裁而成，具有温阳利水，宁心定悸之功，既可治疗房性早搏，又可治疗肺心病失代偿期出现的右心衰竭。该文就低剂量比索洛尔联合温阳利水定悸方治疗肺心病失代偿期合并房性早搏阳虚水泛证疗效的安全性及有效性作一论述。

Abstract: Atrial premature beat is the most common complication in the decompensated stage of cor pul-monale. The guidelines recommend cardiac selectivity in the treatment of arrhythmias β 1 receptor blockers (such as bisoprolol), but bisoprolol will appear with the increase of dosage β 2 receptor blocking, which induces bronchospasm and leads to the deterioration of pulmonary function, espe-cially in patients with cor pulmonale with severe airway obstruction. At the same time, bisoprolol has negative muscle strength effect while inhibiting sympathetic nerve excitation, which may ag-gravate right heart failure. Therefore, the guidelines suggest that the initial dose should be small. Wenyang Lishui Dingji recipe is made from Zhenwu Decoction, Guizhi licorice decoction, Polyporus umbellatus, Alisma orientalis, Salvia miltiorrhiza and jujube in Treatise on febrile diseases. It has the function of Warming Yang Lishui and calming the heart. It can not only treat atrial premature beats, but also treat right heart failure in the decompensated period of cor pulmonale. This paper discusses the safety and effectiveness of low-dose bisoprolol combined with Wenyang Lishui Dingji formula in the treatment of decompensated cor pulmonale complicated with atrial premature beats with Yang deficiency and water flooding syndrome.