心臟房室早期收縮合併陣發性心房顫動與多發性心室頻脈之中醫藥治療病例報告

An AtriaVentricular Premature Constraction Combined with Paroxysmal Atrial Fibrillation and Multiformi Ventricular Tachycardia Patient Treated by Traditional Chinese Medicine

許堯欽(Yao-Chin Hsu) ； 謝元凱(Yuan-Kai Hsieh) ； 王宏銘(Hung-Ming Wang) ； 廖啟卉(Chi-Hui Liao) ； 徐尉芳(Wei-Fang Hsu)

《中醫藥雜誌》 31卷1期 (2020/06) Pp. 100-109

https://doi.org/10.6940/JCM.202006_31(1).08

摘要

本案例為一位47歲男性病人，罹患心律不整多年，初期因症狀輕微未積極就醫診療，直至半年前因胸悶心悸嚴重影響工作與睡眠，乃求診於某區域教學醫院，經24小時心電圖檢查發現一日內有834次心室早期收縮（PVC）與4,179次心房早期收縮（PAC），合併陣發性心房顫動（PAF）與多發性心室頻脈（VT）。因規律服用西藥一個月後症狀仍反覆發作，乃求助於中醫。經診察，中醫辨證屬心脾兩虛，痰瘀阻脈。初診處方以歸脾湯合溫膽湯加減。服藥二週後自覺心悸症狀明顯減少八成。前後經中藥調理半年後，病人自覺心悸症狀幾乎已消失，再回原醫院接受24小時心電圖檢查，結果顯示陣發性心房顫動與多發性心室頻脈消失，一日內的心室早期收縮（PVC）僅剩7次，心房早期收縮（PAC）僅剩2次。因病情穩定，停服中西醫藥物，至今已一年半未再發生胸悶心悸等症狀。中醫辨證論治有效地控制心律不整的案例，提供臨床醫師一個值得參考的診療模式。

關鍵字

心律不整 ； 房室早期收縮 ； 陣發性心房顫動 ； 多發性心室頻脈 ； 歸脾湯 ； 溫膽湯

並列摘要

A case of a 47-year-old male patient suffered from arrhythmia for ten years. The illness had aggravated until half an year ago. Chest tightness and palpitation recurred and lead to insomnia. The patient came to the outpatient department of Cardiology for help. 24 hours Holter ECG revealed: 834 Premature ventricular contractions / 4,179 Premature atrial contractions, Short-run Ventricular tachycardia and Paroxysmal atrial Fibrillation with RVR. As the illness did not subsided after treatment, the man came to our Chinese medical department for help. According to the Chinese Medical Syndrome Differentiation, the pattern of identification was Deficiency of the Heart and the Spleen, combined with Phlegm lodged in the channels of the Heart. Guipi decoction and Wendan decoction were prescribed. Two weeks after, the patient came back and declared that the palpitation had decreased 80%. So we ordered the same prescription in the following six months. As the illness improved apparently, the patient came to the original hospital for further examination, and the 24 hours Holter EKG revealed: No Short-run VT and neither PAf were noted, and only 7 Premature ventricular contractions and 2 Premature atrial contractions were recorded. Chinese Medical Syndrome Differentiation and Treatment had work as an effective treatment for arrhythemia in this case, We hoped this experience can provide useful opinion for doctors.

並列關鍵字

Arrhythmia ； Atria-Ventricular premature constraction ； Paroxysmal atrial fibrillation ； Multiformi Ventricular Tachycardia ； Guipi decoction ； Wendan decoction

參考文獻

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