张伯礼教授中西医结合救治高龄急性脑卒中伴心源性休克经验

Professor ZHANG Boli’s experience in the integrated Western and traditional Chinese medicine for the treatment of an elderly patient with acute stroke complicated by cardiogenic shock

关键词:  卒中-心脏综合征  心脑同治  心虚髓亏  益气复脉注射液  扶正合剂

Key words:  stroke-heart syndrome  simultaneous treatment of heart and brain  heart deficiency and marrow depletion  Yiqi Fumai Injection  Fuzheng Mixture

摘要:

卒中-心脏综合征（SHS）是指急性缺血性脑卒中后早期发生的新发心脏损伤或心功能障碍，或脑卒中后相关心功能恶化。其临床表现主要包括急性心肌损伤、心力衰竭和心律失常等，心脏损害常在发病72 h内达到高峰。文章报道1例急性脑卒中后24 h内突发心力衰竭的高龄患者，临床上面临“保脑灌注、减心负荷”的治疗矛盾，经西医常规对症治疗后虽病情趋于稳定，但仍存在升压药物难以撤除的困境。张伯礼教授基于中医心脑关系认识和高龄患者“心虚髓亏”的中医病机特点，指导合并应用静脉输注益气复脉注射液、口服扶正合剂，成功实现血管活性药物的减量和撤除，为高龄危重症患者的中西医结合救治和心脑同治提供有效治疗策略。

Abstract:

Strokeheart syndrome（SHS）refers to newonset cardiac injury or dysfunction，or the worsening of preexisting cardiac conditions，occurring early after acute ischemic stroke. Its clinical manifestations primarily include acute myocardial injury，heart failure，and arrhythmias，with cardiac damage often peaking within 72 hours of onset. This article reports the case of an elderly patient who developed acute heart failure within 24 hours after an acute stroke. The clinical challenge lay in balancing the need to“preserve cerebral perfusion”while“reducing cardiac load.”Although the patient’s condition stabilized after conventional symptomatic Western medical treatment，the dilemma of unable to withdraw vasopressors persisted. Based on traditional Chinese medicine heart-brain interconnection and the pathogenesis characteristics of“heart deficiency and marrow depletion”in elderly patients，Professor ZHANG Boli guided the combined application of intravenous Yiqi Fumai Injection and oral Fuzheng Mixture was administered. This approach successfully facilitated the reduction and withdrawal of vasoactive agents，offering an effective combined therapeutic strategy for managing critically ill elderly patients under the“heart-brain simultaneous treatment”principle.