［摘要］目的：运用中医时间医学理论阐释病毒性心肌炎患者室性早搏24 h的分布规律，为确定合理的给药时间提供科学的依据。方法：240例病毒性心肌炎患者行24 h动态心电图监测，运用中医五脏主时节律等理论对患者室性早搏分布的节律性变化进行研究。结果：病毒性心肌炎患者室性早搏普遍高发于寅、卯、辰、巳四个时辰，尤以卯时为甚；酉、戌、亥三个时辰为室性早搏发生的低谷时段。随着年龄的增长，病毒性心肌炎患者室性早搏夜半时段的'发生频度增加。不同证型的病毒性心肌炎患者其室性早搏发作的高峰时段不同。邪热犯心证患者，室性早搏多高发于日中时段；阴虚火旺证患者，室性早搏多高发于白天，日中时段加重；心气阳虚证患者，室性早搏多高发于平旦和夜半时段。结论：病毒性心肌炎患者室性早搏日分布具有明显的中医病理节律，不同证型的室性早搏，其日分布的节律亦不相同，可指导临床辨证施治。
［关键词］昼夜节律; 心肌炎; 室性早搏复合征
Study on pathological rhythm of traditional Chinese medicine about circadian distribution of premature ventricular contractions in 240 patients with viral myocarditis
ABSTRACT Objective: To explore the circadian distribution of premature ventricular contractions (PVCs) in patients with viral myocarditis (VM) according to the theory of chronomedicine in traditional Chinese medicine (TCM) in order to find out the scientific evidence for a reasonable administration time. Methods: Two hundred and forty patients with VM were enrolled and electrocardiograms were examined for all by Holter monitor. The circadian distribution of PVCs was evaluated according to the theory of chronomedicine of TCM about time periods corresponding to five zang viscera. Results: PVCs mostly happened in periods of 3∶005∶00, 5∶007∶00, 7∶009∶00 and 9∶0011∶00, in which 5∶007∶00 was the most serious time. Less PVCs happened in periods of 17∶0019∶00, 19∶0021∶00 and 21∶0023∶00. The frequency of PVCs in midnight also increased with aging. The time periods of the frequency peak of PVCs in patients with different syndromes were also different. In patients with syndrome of pathogenic heat invading heart (PHIH), the PVCs mostly appeared in midday. In patients with syndrome of flaring of fire due to yindeficiency (FFYD), the PVCs were most serious in daytime and aggravated at noon. And in patients with syndrome of insufficiency of heartqi and yang (IHQY), the PVCs mostly happened in early morning or midnight. Conclusion: There was a manifest regulation of the pathological circadian rhythm of PVCs in patients with VM. The circadian distributions of PVCs were variable in patients with different syndromes. Therefore the theory of chronomedicine of TCM may be used to guide the treatment based on syndrome differentiation.
KEY WORDS circadian rhythm; myocarditis; ventricular premature complexs
各种心律失常是病毒性心肌炎的主要表现，尤以室性早搏最为常见。有报道指出：频发室性早搏可使冠状循环血流减少25%，脑循环血流减少25%，肾血流减少8%～10%。因此，抗心律失常是治疗病毒性心肌炎的一个重要方面。但由于其潜在的致心律失常作用，致使其在临床的使用受到了一定的限制。采用中医药辨证治疗病毒性心肌炎室性早搏，具有独特的优势，尤其是对于那些室性早搏集中分布型的患者，辨时与辨证相结合的治疗方法已成为提高疗效的重要途径。