沃爾夫—巴金森—懷特氏症候群（WPW syndrome）的中醫診療病例報告

A Case Report of Traditional Chinese Medicine in Treating the Pediatric Patient with WPW syndrome

許晉嘉(Chin-Chia Hsu) ； 許堯欽(Yao-Chin Hsu)

《北台灣中醫醫學雜誌》 13卷1期 (2021/03) Pp. 17-33

摘要

14歲男性，陣發性心悸胸悶感多年，但10歲前因症狀輕微而未在意，然自102年11月時因激烈運動後發作較嚴重之心悸胸悶，心電圖診斷為沃爾夫-巴金森-懷特氏症候群（Wolff－Parkinson－White syndrome），後續2～3年間持續有間斷小發作，均能以Valsalva maneuver以及口服Verapamil緩解症狀。然自105年3月開始症狀逐漸不易控制，4月症狀嚴重發作，且無法以前法緩解，醫師懷疑為陣發心室上心搏過速（Paroxysmal supraventricular tachycardia）而建議電燒，然患者母親暫不考慮，至本院中醫尋求協助。初診時患者心悸胸悶述皆為劇烈運動後發作，過勞、或熬夜後更易發。平時容易手腳冰冷，運動時容易大汗出，發病前兩個月每日晨起作噴嚏流鼻水。本次發病時症狀發作時心跳加速至180beats／min以上，伴大汗出、全身虛弱、冒冷汗，無法步行，且無法藉由Valsalva maneuver或Verapamil緩解。中醫辨證主證為平時為心肺氣虛，發作期為心腎陽虛、心陽暴脫。治則採補益心肺腎為主，疏肝解鬱為輔。處方為生脈散合八味地黃丸與加味逍遙散加減。病人在服藥一周後，運動後誘發的胸悶心悸已逐漸減輕；三周後晨起作噴嚏鼻水大幅度改善；五周後胸悶心悸大幅改善；而兩個月後運動後已未再發胸悶心悸；五個月後病情穩定，開始減量服藥；八個月後停止服藥。至今已兩年半，病人正常運動與作息，胸悶心悸未再發作。我們運用中醫辨證論治順利控制此WPW症候群病人之臨床症狀。

關鍵字

WPW症候群 ； 心律不整 ； 心肺氣陰兩虛 ； 肝鬱氣滯

並列摘要

A 14-year-old male patient had suffered from palpitation and chest tightness for many years. However, the symptoms were relatively mild so he did not seek medical attention. In November of 2013, the patient experienced a severe episode of palpitation and chest tightness. Electrocardiographic finding confirmed the diagnosis of WPW syndrome. In the following 2-3 years after the diagnosis, he had experienced several minor episodes that can be alleviated by Valsalva maneuver and Verapamil. However, the symptoms worsened in March of 2016. In April, he experienced a severe episode with persistent palpitation and chest tightness which can not be relieved by former maneuver. PSVT was suspected and catheter ablation was recommended by the cardiologist. The mother of the patient refused the recommended treatment and came to our outpatient clinic for help. During his first visit, the patient stated that palpitation and chest tightness always presented after severe exercise. Over-loading work, or lack of sleep would worsen the symptoms. The patient suffered from cold sensation of extremities and heavy sweating after exercise. 2 months before the onset of the severe episode, he suffered from sneezing after wake-up. In the latest episode, he suffered from a heat rate over 180 beats per minute accompanied by excessive sweating, general weakness, cold sweat and inability to walk. The symptoms could not be alleviated by Valsalva maneuver and Verapamil. The major Traditional Chinese Medicine (TCM) pattern during his daily life was Qi-Yin deficiency of the Heart and Lung, while the pattern during acute episode was Yang deficiency of Heart and Kidney and sudden collapse of Heart Yang. Our prime treatment principle was to increase the supply of Heart, Lung, and Kidney, and disperse stagnated Liver-Qi. The prescription was the combination of Sheng Mai San, Ba Wei Di Huang Wan, and Jia Wei Xiao Yao San. After 1 week of treatment, the discomfort of palpitation and chest tightness triggered by exercise was alleviated. After 3 weeks, the symptom of sneezing was significantly relieved. 5 weeks later the occurrence and discomfort of palpitation and chest tightness massively decreased. After 2 months the discomfort did not pop-out even when he did his regular exercise. 5 months late the condition was stable so we decided to lower down the dose. 8 months after the first prescription, he withdrew all the Chinese Medicine medication. Since then, our patient can live normally and does not suffer from palpitation and chest tightness anymore. With application of TCM pattern differentiation and the treatment of Chinese herbal medicine, the presenting symptoms in this pediatric patient with WPW syndrome showed well-control.

並列關鍵字

WPW syndrome ； Arrhythmia ； Qi-Yin deficiency of the Heart and Lung ； Liver-Qi stagnation

參考文獻

Bradley P Knight, MD, FACC. Anatomy, pathophysiology, and localization of accessory pathways in the preexcitation syndrome. UpToDate 2019.

Luigi Di Biase, MD, PhD, FHRS, FACCEdward P Walsh, MD. Wolff-Parkinson-White syndrome: Anatomy, epidemiology, clinical manifestations, and diagnosis. UpToDate 2019.

Luigi Di Biase, MD, PhD, FHRS, FACCEdward P Walsh, MD. Treatment of symptomatic arrhythmias associated with the Wolff-Parkinson-White syndrome. UpToDate 2019.

Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2016; 133:e506.

Mehta D, Wafa S, Ward DE, Camm AJ. Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia. Lancet 1988; 1:1181.