風濕性心臟瓣膜疾病併發心房顫動的中醫診療病例報告

Rheumatic Heart Valvular Disease with Atrial Fibrillation: Case Report of Chinese Medical Diagnosis and Treatment

本案例是一位罹患風濕性心臟病合併二尖瓣狹窄的中年女性，於2001年接受經皮二尖瓣氣球擴張術。術後隨即發生陣發性心房顫動，經以鹽酸銨碘酮（amiodaron）控制穩定。而後曾有二次因急性肝炎發作住院，因懷疑是Amiodaron副作用，改用Sotalol控制心房顫動。後續分別於2004年12月、2005年4月、2005年5月分別再因眩暈心律不整急診住院，其中有一次藥物失效，需以心臟電氣轉換術才順利讓病人恢復正常心率。最近2週心率不整頻頻發作，胸悶心悸頭暈持續終日。病患遂求助於本院中醫部。來診時病患面色黃白少華，疲憊無精神，說話聲低無力。心律不整發作時主要症狀為明顯的胸悶、氣喘、心悸、頭暈持續終日，合併疲倦嗜睡、與蹲起眩暈。脈見沉細濇數無力，至數不齊。再加上平素畏冷、手足不溫、低血壓等陽虛體質的考量。整體辨證為：「心陽不振，氣血虧虛」。治則是急則溫陽補氣固攝以治房顫，緩則以益氣養血以強心復脈。處方以炙甘草湯合參附湯加減。二診時反應服一帖後自覺心律不整發作次數已減少許多，精神體力明顯改善。三診時濇數脈律不整之象已無。後續處方轉為以補益心氣心血為主，滋養肝腎為輔以鞏固療效。由此經驗我們認為適當的運用中醫藥確能有效迅速的控制風濕性心臟瓣膜疾病的心房顫動。但如何進行後續之調理，以根除房顫病因，則還需更進一步的努力。 The female suffered from mitral valve stenosis-accompanied rheumatic heart disease had received Percutaneous Transvenous Mitral Commissurotomy (PTMC) in 2001. Right after operation, the paroxysmal atrial fibrillation (PAF) occurred and was amiodarone-controlled steadily. Afterwards, the acute hepatitis led to the hospitalization twice. Attributed to the amiodarone side effects suspected, sotalol was for moderating AF. Sequently, the pressing hospitaliation happened in December 2004 and in April and May 2005 due to dizziness and cardiac arrhythmia: the diagnosis remained PAF. the medication failed once, so no normal heart rates were restored before synchronized electrical cardioversion exerted. The cardiac arrhythmia was frequent in these two weeks. The chest tightness, palpitation, and dizziness lasted whole day. Concomitantly, the patient came for help. When first visit, she was: with the pale yellow based complexion which was less glowing, tired, slack, in a feeble low voice. Additionally, the cardiac arrhythmia symptoms the whole day were: chest tightness, pants, palpitation, and dizziness, primarily, fatigued, sleepy and postural hypotension accompanied. The thin, deep, astringent, rapid, weak and irregular pulse was averred, so were cold intolerance, cold extremities, and low blood pressure for yang deficiency constitution. The holistic differential diagnosis is Heart Yang-deficiency syndrome combined Deficiency of Qi and Blood. Acutely, warming Yang and invigorating Qi for replenishing were to treat Atrial fibrillation. Chronically, augmenting Qi and nourishing Blood were to strengthen the Heart and reinstate the Pulse. The Roasted Liquorice Decoction with Ginseng and Aconiti Praeparatae Decoction was prescribed. According to her statement at the 2nd visit, the 1st pack of medicine reduced cardiac arrhythmia frequency tremendously and amended mind and strength saliently. At the 3rd visit, no astringent, rapid, and irregular pulse was indicated. Consecutively, the prescription was: principally for benefiting cardiac Qi and Blood; supplementarily for nourishing the liver and kidney to consolidate a curative effect. Consequently, appropriately applying Chinese medicine quickly and effectively controlled rheumatic heart valve disease-induced AF certainly. Otherwise, succeeding adaptation for eliminating both etiological factors of AF and rheumatic fever damaging cardiovascular tissues should be further explored.