Expert introduction:
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Wei Yingna
Master of Medicine, Deputy Chief Physician.
He has been to study in the General Hospital of the PLA Army, and has rich clinical experience in various complex cardiovascular diseases such as coronary heart disease, hypertension, arrhythmia, and heart failure. It is particularly good at the treatment of complex arrhythmia. Frequent tachycardia and frequent ecstasy radio frequency fusion. Published more than ten papers and published two monographs.
At present, people’s living standards have gradually increased, and the incidence of various diseases has gradually increased, and the incidence of coronary heart disease is particularly obvious. Coronary heart disease is the abbreviation of coronary atherosclerosis heart disease. It refers to the clogging of the coronary atherosclerosis and the changes in the functionality of the coronary arteries, which cause heart disease caused by myocardial ischemia and hypoxia, also known as Ischemic heart disease. The main clinical manifestations are seizureal angina pectoris or squeezing pain. Resting or serving nitroglycerin can be relieved. However, there can be a variety of complications with the progress of the disease, which endangers patient life. Therefore, the prevention and treatment of coronary heart disease is very critical. In order to evaluate the incidence of atherosclerosis in different ages, regions and CVD risk factors, investigations on 10 regions in my country, and the survey found that 31%of Chinese adults have cervical plaques. Cervical plaques are the manifestation of carotid atherosclerosis, which can indicate the formation of systemic atherosclerosis, thereby increasing the risk of coronary heart disease. Coronary heart disease is called “the first killer of humans” due to the high incidence and high mortality rate, which is seriously endangered. In patients with hypertension, diabetes, abnormal blood lipids, or smokers, the incidence of coronary heart disease is very high. Among them, diabetes is called critical illness of coronary heart disease. If there is diabetes without intervention, not timely treatment, blood glucose is not controlled to the normal range, and its ten -year incidence generally exceeds 20%. If the patient possesses the above risk factors, early discovery and proper treatment in time, the incidence of coronary heart disease will be reduced.
Therefore, in order to prevent the occurrence of coronary heart disease and improve the quality of life of coronary heart disease, we should actively treat coronary heart disease. The treatment of coronary heart disease includes drug treatment, internal medicine stent treatment, and surgery treatment. Different treatments have their own advantages and disadvantages. Schiure treatment methods have small trauma and almost no pain. The advantage of the bracket is that the operation is convenient and the trauma is small, and it can be repeated to a certain extent, but it needs to take anti -platelet drugs for a long time after surgery. In addition, the recurrence of angina pectoris requires relatively many interventional treatment. After bridge surgery, the symptoms have less recurrence, but the surgical trauma is large, the surgical risk is high, and the surgery is almost feasible. Most patients have a low degree of acceptance of it. Some doctors do not know the treatment of surgery, and they will induce patients to choose surgery and some oral medications for treatment. According to the survey, the number of heart brackets and bridges in my country increased at a rate of 40%and 28%per year. A large number of abuse of stent intervention surgery made patients fear. Although the bracket and bridge surgery can save a lot of life in emergency situations, the mortality rate has increased significantly within five years after the operation, which is not optimistic. Because stent and bridge surgery did not solve the continuous deposition of garbage such as blood lipids, and at the same time, due to the side effects and complications of the surgery itself, the mortality rate increased significantly. Many patients with heart disease choose brackets and bridge surgery, but they still cannot keep their lives. Therefore, after surgery, oral drug treatment is still needed to prevent recurrence. It can be seen that drug treatment plays a very important role in the treatment of coronary heart disease.
Before the 1990s, most of the views of the treatment of coronary heart disease were just that the patient did not develop a disease. Now the concept of treating coronary heart disease has changed. Coronary heart disease should be given more drug treatment in the early stages of coronary heart disease. Due to the abnormal factors of lipid metabolism and blood flow change, it is the main factors of coronary heart disease, but conventional cardiovascular drugs such as nitroglycerin and aspirin have no significant lower blood lipids. Therefore, blood lipids should be given. Medicine combined treatment. Patients have been in a long -term hyperlipidemia in the patient, causing lipids to deposit on the vascular wall, causing coronary atherosclerosis, reduced elasticity of the vascular wall, and thus inducing coronary heart disease. Therefore, reasonable control of blood lipid levels will reduce the malignant progress of coronary heart disease. With the advancement and development of science, various types of lipid -lowering drugs have also been studied in in -depth research. Some studies have shown that for patients with coronary heart disease, regardless of whether the blood lipid level is high, long -term use of “statin” drugs will help treatment for treatment Coronary heart disease, reduce the mortality of patients with coronary heart disease. This is because of the “Biting” drug: 1. By reducing cholesterol, reducing the deposition of cholesterol on the vessel wall, reducing the progress of vascular sclerosis, narrowing, and reducing the content of cholesterol fat in plaques; 2. It can improve the function of vascular endothelial cells , Make blood vessel endothelial cells secrete the material to protect blood vessels, delay blood vessel aging; 3. It can play a combat effect on chronic inflammation of the blood vessel wall, which can stabilize the plaque of the coronary vein and reduce the probability of rupture, just like reducing the “volcanic” eruption The same; 4. It can combat the oxidation stress reaction in the body, reduce the role of free radicals, thereby stabilizing arterial plaques and reducing acute events; 5. Change platelet membrane cholesterol content, and then change the liquidity of the membrane, exert the platelet aggregation The inhibitory effect, and inhibit the formation of thrombosis, reduce the activation of the coagulation at different stages, improve the heart function of patients, and delay the occurrence and development of heart failure. In 2013, the “Guidelines for the treatment of stability ischemia heart disease” released by Europe and the United States recommend all patients with stable coronary heart disease that need to intervene, dietary guidance, and give Hewuting drug treatment. Hisatin treatment should be adhered to for a long time. If there is no contraindications for lifelong treatment, whether the total cholesterol and LDL-C increase in patients at the time of admission should be started and have been used for a long time. Some doctors have doubts that patients’ blood lipids have reached normal levels. Do you still need to continue to take statins again? My answer is yes, and I must continue to take statins, unless there is obvious side effects to stop. Because the “Bittin” drug is the purpose of reducing lipids by inhibiting the synthesis of cholesterol. If it is discontinued, the enzyme activity of synthetic cholesterol will increase again, and the cholesterol will slowly rise and continue to break the blood vessel wall. Development, the condition will become heavier. Other doctors asked me that the blood lipids of coronary heart patients remained at normal levels. Do you need to eat it? The answer is obviously not. Because the cause of coronary heart disease is not only high blood lipids, but a variety of factors coexist. Therefore, lipid -lowering therapy for coronary heart disease is critical. In addition, the safety of statin drugs is high, and the vast majority of patients will not have adverse reactions. Only a few patients will have different degrees of intolerance when taking such drugs, causing adverse reactions. These adverse reactions are usually mild or short -term and can be recovered after stopping the drug. Studies have pointed out that Atropine is currently safer and effective clinical prescription medication. For most patients, regardless of age, gender, history of coronary heart disease, and in patients with diabetes and hypertension, his category drugs have to prevent myocardial infarction, prevent ischemic stroke, and reduce most of the causes of cardiovascular disease. The role of rate is reduced, and the total mortality is reduced. In most patients, the benefit of his class is far more than its adverse reactions. Hisatin drugs have become the first choice of drugs in blood lipids and prevention and treatment of coronary heart disease in clinical practice. In addition to lipid -lowering effects, he can also play many other functions. Through their multi -effect, they can effectively prevent accidental atherosclerotic coronary heart disease, cholesterol levels of coronary heart disease, and the prevention of stroke, dementia, re -narrowing of vascular forming, and new blood vessels. It can also be used for prevention and auxiliary treatment of nephritis, cancer, orthopedic diseases and organ rejection after transplantation. At the same time, we should pay attention to the adverse reactions of Hisine drugs and the interaction with other drugs. If there is hypertension and diabetes, treatment together has synergistic effects, that is, the control of blood sugar is controlled, and blood lipids will decrease.
Coronary heart disease is also important in addition to treatment. The early prevention of coronary heart disease is reflected in various stages. The occurrence of coronary heart disease without coronary heart disease is called “first -level prevention”; Interheart research released in 2004 Studies have shown that smoking, hypertension, abnormal blood lipids, diabetes, abdominal obesity, psychological and social pressure, less fruits and vegetables, drinking and lack of physical activity are the main risk factors of coronary heart disease, and individuals who coexist with multiple risk factors Increased. Therefore, coronary heart disease prevention should comprehensively control the multiple risks of cardiovascular disease. Improvement, lowering blood pressure, fat regulation, and controlling blood glucose are important measures to prevent coronary heart disease. Those who have already obtained coronary heart disease must prevent the aggravation of coronary heart disease and the occurrence of complications. This is “secondary prevention”. “Two -level prevention” is more important for patients with coronary heart disease. Patients with coronary heart disease are evaluated by risk factors, and patients are encouraged to quit smoking, receive health education, rehabilitate exercise, and give daily guidance. Comprehensively control the multiple risk factors of coronary heart disease, on the basis of fully improving the lifestyle, use standardized drug treatment to perform blood pressure, blood sugar, blood lipids, emotion, and sleep management, effectively reduce the disease rate of coronary heart disease, prevent cardiovascular incidents, significantly significantly Reduce the incidence and mortality of myocardial infarction, and increase the survival rate of patients with coronary heart disease. The reasonable diet of patients with coronary heart disease is very important, because both drugs, internal medicine stents and surgery treatment, they are possibly recurred, which can further affect the scientific and reasonable dietary health care for patients’ life. , Prevent further deterioration. The recommendation of the World Health Organization should follow the principle of “five lows and two highs”. Five low refers to: low calories, low fat, low sugar, low protein, low salt, two high refers to: high vitamin, high cellulose. Therefore, in the prevention and control of patients with coronary heart disease, no matter what the patient’s blood lipids level, the treatment of Jeating drugs should be initiated early, which can effectively improve the prognosis of patients with coronary heart disease and reduce the occurrence of acute events. Coronary heart disease patients should not reduce or stop medicine without authorization. If there is no clear adverse reaction, patients with coronary heart disease should take medicine for life, and adhere to good eating habits while taking drugs. It is easy to come out of the haze of coronary heart disease.
references
[1] Kou Wenyu. Relations of Basic and Clinical Studies of Blood Lipidation [J]. Chinese Medicine Magazine, 1998, 37: 364-367
[2] Zhao Fei, Kun Bijuan, Zeng Liyin, Wang Xiangzheng. Research on the intervention mode of coronary heart disease secondary prevention mode [J]. Nursing Magazine 2004 Issue 15
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[3] Yao Guilian, the role of health education in patients with elderly coronary heart disease [J]. Chinese Chinese Medicine Modern Exormpic Education, 2010, 8 (10): 121
[4] Cardiovascular Disease Branch of the Chinese Medical Association, Cardiovascular Diseases on Cardiovascular Diseases of the China Rehabilitation Medicine Society, the Professional Committee of Cardiovascular and Cerebral Vascular Diseases in China. Magazine, 2013, 41 (4): 267-275.
[5] The impact of Wang Detine drugs on the blood lipid level and inflammatory state of patients with coronary heart disease [J]. Hebei Medicine, 2014, 20 (2): 344-346.
