基于HIS真实世界的温阳养血活血法早期干预糖尿病足的疗效评价

发布时间：2018-01-13 08:09

  本文关键词：基于HIS真实世界的温阳养血活血法早期干预糖尿病足的疗效评价　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 糖尿病足 中医辨证分型 疗效分析 真实世界研究 温阳养血活血

【摘要】：糖尿病足(Diabetic Foot,简称DF)又称糖尿病性肢端坏疽,是糖尿病(Diabetes Mellitus,简称DM)血管病变和周围神经病变的严重并发症之一,而早期糖尿病足则常表现肢端供血不足、皮肤凉、颜色苍白或紫绀、麻木、感觉丧失或迟钝。肢端灼痛或刺痛,常兼有足或足趾畸形等表现,又称高危足。而早期识别和防治糖尿病足能减轻患者的经济负担,降低致残致死率,提高患者生活质量。目的:基于真实世界研究方法,以早期糖尿病足为研究对象,分析早期DF中医证型分布特点、我院内分泌科治疗早期DF发病现状及温阳活血法早期干预DF的近远期疗效,为糖尿病足的早期预防和治疗提供参考。方法:从广州市中医医院电子信息系统(HIS)数据库提取2009年1月1日至2016年12月31日诊断为0级糖尿病足或糖尿病下肢血管病变的内分泌科住院病人。依据纳入排除标准筛选病人数据,建立基础数据库(主要包括一般情况、糖尿病病程、糖化血红蛋白、中西医诊断、证型诊断等),对基础数据库数据进行一般情况分析和证型分布及演变规律分析。从基础数据库中提取症状、体征等病史记录详细病例填写《病例数据收集表》(见附录5)。根据《病例数据收集表》中数据原始记录辨证分型,当《病例数据收集表》中中医证候诊断与原始数据记录中医症状及舌脉象不符时,则参照广州市中医医院内分泌科"十一五"重点专科建设中消渴病痹症辨证分型,对《病例数据收集表》中证型不符者进行修正。修正证型诊断后进行证型分布分析,以及对阳虚血瘀证与非阳虚血瘀证之间进行疗效分析,并对长期在我院就诊的病人通过其就诊信息和住院病历进行终点事件随访,其余病人采取电话随访。采用SPSS20.0软件包进行统计学分析。结果:本研究纳入病例共233例。其中男38例,女195例,随访64例,其中截肢1例,截肢率1.56%。年龄平均(70.43± 10.14)岁,糖尿病病程平均(10.52±6.99)年,体重指数平均(24.2±4.06)Kg/m2,糖化血红蛋白水平平均(8.66±2.33)%。并发症方面以并发血脂异常为主,占67.81%,其余并发症发病频率从高到低依次为糖尿病周围神经病变、高血压病、糖尿病肾病、冠心病和糖尿病视网膜病变,分别占56.22%、39.91%、28.76%、25.32%和9.01%。证型分布以"气阴两虚证"与"阳虚血瘀证"和"痰热瘀结证"为主。各证型之间在年龄、糖尿病病程、体重指数、糖化血红蛋白上的差异均无统计学意义(P0.05)。从233例中提取症状、体征等病史记录完善者进行疗效分析,共113例。证型分布主要有肝肾亏虚证、痰瘀阻络证、气虚血瘀证、阳虚血瘀证、阴虚血瘀证和湿热毒盛证。早期糖尿病足患者的临床证型以阳虚血瘀证多见,代表方归龙汤加减,以达到温阳养血活血之效。治疗前后中医症状积分和临床症状积分对照,阳虚血瘀证组与非阳虚血瘀证组治疗后中医症状积分和临床症状积分均较治疗前均显著降低,差异有统计学意义(P0.05)。与阳虚血瘀证组比较,非阳虚血瘀证组治疗前后差值显著降低,差异有统计学意义(P0.05)。疗效方面,阳虚血癖证组疗效较非阳虚血癖证组好,统计结果有显著性差异(P0.01)。结论:通过本研究得出早期糖尿病足好发于老年女性,其发病与糖尿病病程、血糖水平成正相关,与体重指数无明显相关性。中医药早期干预糖尿病足治疗可降低糖尿病足患者的截肢率。早期糖尿病足患者大多有血管病变和神经病变的病理基础,较易并发血脂异常。其证型分布主要有主要以"气阴两虚证"、"阳虚血瘀证"和"痰热瘀结证"为主。各个证型之间的演变与年龄、DM病程、体重指数和糖化血红蛋白无明显相关性。疗效方面,阳虚血瘀证组与非阳虚血瘀证组组根据中医辨证施治后,均能明显改善早期糖尿病足中医症状和临床症状,说明中医辨证施治疗效肯定。此外研究结果显示阳虚血瘀证组在中医症状改善和疗效方面均优于非阳虚血瘀证组,说明在早期糖尿病足发生发展的过程中,阳虚血瘀为其主要病因病机,而辨明正邪虚实后,予以温阳养血活血法能在一定程度上改善患者症状,提高临床疗效。
[Abstract]:Diabetic foot (Diabetic Foot, referred to as DF) also known as diabetic gangrene, diabetes (Diabetes Mellitus, referred to as DM) is one of the serious complications of vascular disease and peripheral neuropathy, and early diabetic foot is usually acral insufficiency, cold skin, pale or cyanosis, numbness, loss of sensation or slow burning acral. Or tingling, often with foot or toe deformities, also called high-risk foot. Early recognition and prevention of diabetic foot can reduce the economic burden of the patients, reduce the mortality and improve the quality of life of patients. Objective: To study the method based on the real world, in the early stage of diabetic foot as the research object, analyzing the characteristics of the DF TCM Syndrome Distribution early, short term and long term effect of Department of endocrinology in our hospital for treatment of early onset DF status and warming yang and promoting blood circulation in early intervention of DF, to provide reference for early prevention and treatment of diabetic foot. Methods: from Guangzhou City Chinese medicine hospital electronic information system (HIS) database from January 1, 2009 to December 31, 2016 for the diagnosis of grade 0 diabetic foot or diabetic lower extremity vascular disease in Department of Endocrinology patients. According to inclusion and exclusion criteria, screening of patient data, established a basic database (including the general condition, duration of diabetes, HbA1c, western medicine diagnosis, syndrome diagnosis, etc.) on the basis of the general situation of the data analysis and the syndrome distribution and evolution analysis. The extraction of symptoms from the underlying database, signs and other records with case case data collection form fill the < > (see Appendix 5). According to the case data collection form > data in original records of syndrome differentiation, when the data collection form > < case TCM syndrome diagnosis and the record of original data of TCM symptoms and tongue and pulse is inconsistent, with reference to the Guangzhou Municipal Hospital of traditional Chinese Medicine Department of Endocrinology "11th Five-Year" special focus Department of construction of XiaoKeBing arthralgia syndrome differentiation, the case data collection form < > type inconsistent correction. To analyze the distribution of syndrome type modified syndrome diagnosis, as well as between the Yang deficiency and blood stasis syndrome and non Yang deficiency and blood stasis syndrome curative effect analysis, and for a long time in our hospital by the doctor patient information and medical records were followed up all the patients by end point events, telephone follow-up. The data were analyzed by SPSS20.0 software. Results: the study included 233 cases. 38 cases were male, 195 were female, 64 cases were followed up, including 1 cases of amputation, the amputation rate was 1.56%. The average age (70.43 + 10.14) years old. The average duration of diabetes (10.52 + 6.99) years, the average body mass index (24.2 + 4.06) Kg/m2, mean glycated hemoglobin level (8.66 + 2.33)%. The complications with abnormal blood lipids, accounted for 67.81%, the remaining complication frequency from high to low. Disease, peripheral neuropathy, hypertension and coronary heart disease, diabetic nephropathy, diabetic retinopathy, respectively 56.22%, 39.91%, 28.76%, 25.32% and 9.01%. syndrome with "two Qi and yin deficiency syndrome and yang deficiency and blood stasis and phlegm heat stasis". The distribution of the various syndromes in age, duration of diabetes. The difference on body mass index, glycosylated hemoglobin were not statistically significant (P0.05). The extraction from the symptoms in 233 cases, signs and other medical records were perfect efficacy analysis, a total of 113 cases. The syndrome distribution mainly in liver and kidney deficiency, phlegm and blood stasis syndrome, Qi deficiency and blood stasis syndrome, Yang Deficiency and blood stasis, yin deficiency and blood stasis syndrome dampness heat. The clinical syndromes of diabetic foot in patients with Yang deficiency and blood stasis syndrome, on behalf of the side to the Dragon Decoction, in order to achieve the effect of Warming Yang and nourishing blood. The control of TCM symptom score and clinical symptoms before and after treatment, Yang deficiency and blood stasis syndrome group and non blood stasis syndrome of Yang Deficiency After treatment, TCM symptoms score and clinical symptom score were significantly lower than before treatment, the difference was statistically significant (P0.05). Compared with Yang deficiency and blood stasis syndrome group, non treatment group before and after the Yang deficiency and blood stasis syndrome difference decreased significantly, the difference was statistically significant (P0.05). The curative effect, the curative effect of Yang deficiency and blood stasis syndrome group than non Yang deficiency blood stasis syndrome group, the difference was statistically significant (P0.01). Conclusion: the study of early diabetic foot occurred in elderly women, the incidence and duration of diabetes, blood glucose level is positively correlated with body mass index had no significant correlation of traditional Chinese medicine. Early intervention treatment of diabetic foot can reduce amputation in patients with diabetic foot the rate of early diabetic foot. Most patients have the pathological basis of vascular disease and neuropathy, easily complicated with abnormal blood fat. The distribution of syndromes are mainly "two Qi and yin deficiency syndrome, Yang Deficiency Blood Stasis and phlegm heat and blood stasis Card. "Evolution and age, between various syndromes in the course of DM, there was no significant correlation between BMI and HbA1c. The curative effect, Yang deficiency and blood stasis syndrome group and non Yang deficiency and blood stasis group according to TCM syndrome differentiation, can significantly improve the clinical symptoms and symptoms of early diabetic foot, shows that the TCM treatment effect in the Yang deficiency and blood stasis syndrome in TCM symptoms and curative effect were better than non Yang deficiency and blood stasis syndrome group results showed that in the early process of occurrence and development of diabetic foot, Yang deficiency and blood stasis is the main pathogenesis, and identify the actual situation after the failed, to warming Yang nourishing and activating blood can improve the symptoms of patients in a certain extent and improve the curative effect.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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本文编号：1418164