2021年胸痹心痛中医诊疗规范.pdf

胸痹心痛【定义】胸痹心痛指因胸阳不足，阴寒、痰浊留踞胸廓，或心气不足，鼓动乏力，使气血痹阻，心失血养所致。以胸闷及发作性心胸疼痛为主要表现的内脏痹病类疾病。【诊断要点】1 膻中及左胸膺部突发憋闷而痛，疼痛性质有闷痛，灼痛，绞痛，刺痛，隐痛等不同。疼痛可涉及肩背，前臂，咽喉，胃脘部等，甚至可沿手少阴，手厥阴经循行部位至中指或小指，呈发作性或持续不解常伴心悸气短，自汗，甚至喘息不得卧。2 突然发作，时作时止，反复发作，轻者几秒至数十分钟，经休息或服用芳香温通药物可迅速缓解。3 多见于中年以上，常因情绪波动，寒冷刺激，饱餐之后，劳累过度而诱发。4 静息 ECG,Holter,运动试验，冠脉造影可明确诊断，血脂，血糖，心肌酶谱测定检查可有助于诊断。【类病鉴别】1 真心痛：为胸痹心痛重症，由于心脉闭塞。猝然大痛，四肢不温，面白唇紫，大汗淋漓，脉微欲绝，经芳香温通药物不能缓解，疼痛可持续几小时至几天不能缓解。2 胃脘痛：二者疼痛部位可相近，但胃脘痛多伴嗳气，精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 1 页，共 11 页呃逆，呕吐，泛酸，腹胀等胃系症状。【辨证论治】1寒凝心脉症候：猝然胸痛如绞，形寒，四肢不温，冷汗自出，心悸气短，或心痛彻背，背痛彻心，感寒痛甚。舌象：淡红，苔白。脉象：沉紧或促。治法：祛寒活血、宣痹通阳方药：当归四逆汤加减：桂枝、红花、当归、芍药、通草、甘草、大枣、丹参、檀香。针灸：主穴选厥阴腧、膻中，备穴选百会、涌泉、足三里，平补平泻。中药穴位敷贴：心绞痛膏（肉桂、檀香、川芎）敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、肝。2 气滞心胸主症：心胸满闷，隐痛陈发，痛无定处，时欲太息，遇情志不遂时容易诱发或加重，或兼有脘胀闷，得嗳气或矢气则舒。舌象：苔薄或薄腻。脉象：细弦。治法：疏调气机，和血舒脉。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 2 页，共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4方药：柴胡疏肝散加减：柴胡、枳壳、香附、川芎、陈皮、白芍、郁金、元胡、丹参、甘草。针灸：主穴选厥阴腧、膻中、内关，备穴选百会、合谷、足三里，平补平泻。中药穴位敷贴：心绞痛膏敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、肝。3 痰浊闭阻证候：胸闷重而心痛轻微，肥胖体沉，痰多气短，遇阴雨天而易发作或加重，伴倦怠乏力，纳呆便溏，口粘，恶心，咯吐痰涎。舌象：舌质淡，或紫暗，苔白腻或白滑。脉象：滑。治法：通阳泄浊、豁痰开结方药：瓜萎薤白半夏汤加减：栝蒌、薤白、半夏。针灸：主穴选厥阴腧、膻中，备穴选百会、涌泉、足三里，平补平泻。中药穴位敷贴：心绞痛膏敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、脾。4 心血瘀阻证候：心胸疼痛剧烈，如剌如绞，痛有定处，甚则心痛彻背，背痛彻心，或痛引肩背，伴有胸闷，日久不愈，可因暴怒而加重。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 3 页，共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4舌象：舌质暗红，或紫暗，有瘀斑，舌下瘀筋，苔薄脉象：弦涩或结、代、促治法：活血化瘀、通脉止痛方药：血府逐瘀汤加减:当归、川芎、赤芍、桃仁、红花、生地、牛膝、桔梗、柴胡、枳壳、甘草。针灸：主穴选厥阴腧、膻中，备穴选百会、涌泉、足三里，平补平泻。中药穴位敷贴：心绞痛膏（肉桂、檀香、川芎）敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、神门、胸。5 气虚血瘀证候：胸闷，心痛如刺，心悸，气短神疲，活动后加重。舌象：暗淡或有斑点。脉象：弱或涩。治法：补益心气，活血化瘀方药：生脉散合丹参饮加减：人参、麦冬、五味子、丹参、檀香、砂仁。针灸：主穴选厥阴腧、膻中、内关，备穴选百会、合谷、足三里，平补平泻。中药穴位敷贴：心绞痛膏敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、脾、肝。6 气阴两虚精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 4 页，共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4证候：胸闷，心痛，心悸，气短，神疲乏力，失眠多梦或汗出，便结。舌象：舌红少苔。脉象：脉细数无力或促或代。治法：益气养阴方药：生脉散加减：人参、麦冬、五味子。针灸：主穴选厥阴腧、膻中、内关，备穴选百会、合谷、足三里，平补平泻。中药穴位敷贴：心绞痛膏敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、脾、肝、肾。7 心阳不振证候：心悸而痛，胸闷气短，自汗，动则更甚，神倦怯寒，面色晄白，四肢欠温或肿胀。舌象：舌质淡胖，苔白或腻脉象：脉沉细迟。治法：补益阳气、温振心阳方药：参附汤合桂枝甘草汤加减：人参、制附子、桂枝、甘草针灸：主穴选厥阴腧、膻中、内关，备穴选百会、合谷、足三里，平补平泻。中药穴位敷贴：心绞痛膏敷心腧、足三里、膻中。耳针：心、小肠、皮质下、交感、肾上腺、肾。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 5 页，共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4【难点分析】胸痹心痛治疗，当急则治标，缓则治本，治标，当分秒必争，若出现厥脱，治疗较难，预后较差，缓则治本，进行辨证论治。【疗效判定】1.治愈：症状消失，心电图及有关实验室检查恢复正常。2.好转：症状减轻，发作次数减少，间歇期延长，实验室检查有改善。3.未愈：主要症状及心电图无改善。心绞痛【定义】心绞痛是冠状动脉供血不足，心肌急剧的、暂时缺血与缺氧所引起的以发作性胸痛或胸部不适为主要表现的临床综合症。有稳定型心绞痛、不稳定性心绞痛、变异性心绞痛之分。【临床表现】1.症状：典型心绞痛具有以下5 个特点：部位：胸骨体上段或中段之后，可能波及大部分心前区，界限不清楚，可放射至左肩、左上肢前内侧，达无名指和小指，或至颈、咽和下颌部。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 6 页，共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4性质：阵发性、突然发生的胸痛，常为压榨性、闷胀性或窒息性疼痛，亦可有烧灼感，偶可伴有濒死的恐惧感觉。诱因：常在体力劳累、情绪激动（发怒、焦急、过度兴奋）、受寒、饱食、吸烟时发生。贫血、心动过速或休克亦可诱发。持续时间：疼痛历时35 分钟，很少超过15 分钟。可数天或数星期发作1 次，亦可一日内多次发作。缓解方式：休息或含有硝酸甘油片。2.体征：平常一般无异常体征。发作时常见心率加快、血压升高、表情焦虑、皮肤冷或汗出，有时可有第四、第三心音奔马律，心尖区可有收缩期杂音，第二心音可有逆分裂，交替脉。【实验室及其他检查】1入院常规实验室检查：血象、尿、便常规、血型、凝血功能、血离子、血糖、血脂、CRP、ESR、肝肾功能、心肌酶学、肌钙蛋白、肝炎病毒系列等检查。出院前应复查血常规、血糖、血脂四项、肝功能，根据病情适当增加其他的实验室检查。2常规心电图检查：前3 天每天 1 次，病情有变化随时检查，心绞痛发作及缓解时，出院前1 次。3.常规动态心电图，有异常要复查。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 7 页，共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T44.必要时做运动负荷试验。5.病情允许时，应做心脏彩超(心功能)，必要时行心脏核素检查、冠状动脉CT。6.冠状动脉造影检查(1)病情稳定后 2