基于聚类分析探讨心脏直视手术术后“汗证”的中医证型

发布时间：2018-01-18 12:04

本文关键词：基于聚类分析探讨心脏直视手术术后“汗证”的中医证型　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：本研究主要采用收集病例的方法,对心脏直视手术术后"汗证"病人的中医四诊信息的相关数据进行统计学分析,进而探讨心脏直视手术术后"汗证"的中医辨证分型规律,为术后"汗证"提供中医辨证依据,指导临床诊疗。目的:探讨心脏直视手术术后"汗证,"的中医辨证分型规律,用以提供术后"汗证"中医辨证依据,更好的指导临床辨证及治疗。方法:收集2016年6月—2017年2月期间在江苏省中医院心胸外科,以及南京市第一医院心胸外科行心脏直视手术治疗的患者的病例共256例,采用因子分析及聚类分析,初步探讨心脏直视手术术后"汗证"的中医证候特点,进一步了解心脏直视手术术后"汗证"的分型规律。结果:心脏直视手术术后"汗证"的中医证型分4类,分别为气虚证,痰湿证,湿热证,阴虚火旺证。共同症为:术后汗出。气虚证主症为:舌质淡,体倦乏力,神疲,气短,痰多色黄,身重困倦,周身酸楚,便秘,盗汗,背部汗,午后潮热,脉弦,口苦。痰湿证主症为:汗出恶风,蒸蒸汗出,舌质淡,苔白腻,稍劳汗出尤甚,多梦,烦躁,脉弦数,尿黄。湿热证主症:体倦乏力,身重困倦,全身汗出,面色晦暗,周身酸楚,烦躁,热汗,五心烦热,心悸,苔黄腻,面色不华,口苦。阴虚火旺证主症:稍劳汗出尤甚,神疲,气短,发热,身重困倦,烦躁,半身汗出,五心烦热,面赤烘热,少苔乏津,背部汗,心悸,尿黄,午后潮热,失眠少寐,口苦。结论:1.心脏直视手术术后"汗证"发病率高达78.4%,术后汗出跟手术时间,输血量及呼吸机支持时间无关。2.中医辨证术后"汗证"分为4类证型,依次为气虚证,痰湿证,湿热证,阴虚火旺证。3.体外循环与非体外循环两种手术方式对于术后的汗出影响无统计学差异。4.4类证型患者性别无统计学差异;年龄主要分布在61-70岁,以气虚证为主。痰湿证与阴虚火旺证患者年龄有统计学差异,阴虚火旺证患者的年龄较痰湿证大。5、阴虚火旺证和气虚证两类证型患者输血量存在统计学差异,阴虚火旺证秩均值大于气虚证,因此,大量输血更易导致或者加重阴虚火旺的症候。6、湿热证与气虚证、阴虚火旺证患者呼吸机支持时间存在统计学差异,湿热证患者呼吸机支持时间较气虚证、阴虚火旺证长,因此,长时间使用呼吸机可能导致湿热证。
[Abstract]:This study mainly adopts the method of collecting cases, carries on the statistical analysis to the related data of TCM four diagnosis information of the patients with "sweating syndrome" after open heart surgery. And then to explore the TCM syndrome differentiation and classification rule of "sweat syndrome" after open heart surgery, to provide TCM differentiation basis for "sweat syndrome", and to guide clinical diagnosis and treatment. Objective: to explore the "sweat syndrome" after open heart surgery. "the law of TCM syndrome differentiation and classification, to provide postoperative" Khan syndrome "TCM syndrome differentiation basis. Methods: from June 2016 to February 2017, we collected cardiothoracic surgery in Jiangsu Provincial traditional Chinese Medicine Hospital. A total of 256 cases were treated with open heart surgery in the Department of Cardiothoracic surgery in the first Hospital of Nanjing. Factor analysis and cluster analysis were used to explore the characteristics of TCM syndromes of "sweating syndrome" after open heart surgery. Results: the TCM syndromes of "sweating syndrome" after open heart surgery were divided into 4 types: Qi deficiency syndrome, phlegm dampness syndrome and damp-heat syndrome. The common symptoms are: sweating after operation. The main symptoms of Qi deficiency syndrome are: light tongue, tired body, tired spirit, short breath, polychromatic phlegm, heavy sleepiness, body acerbity, constipation, night sweat, back sweat, hot tide in the afternoon. The main symptoms of phlegm dampness syndrome are: sweating out bad wind, steam sweating out, tongue light, fur white and greasy, slightly overworked sweat especially, many dreams, fidgety, pulse string number, urine yellow. Damp-heat syndrome main symptom: body fatigue, body heavy sleepiness. The whole body sweats out, the complexion is dark, the whole body is sour, fidgety, hot sweat, five upset heat, palpitation, moss yellow greasy, the complexion is not Hua, the mouth is bitter. Yin deficiency fire prosperous syndrome main symptom: slightly laboriously sweats out especially, the spirit is tired, the breath is short, the fever, the body heavy sleepiness. Fidgety, half body sweats out, five upset heat, the face is red baked heat, little moss is spent, back sweat, palpitation, urine yellow, afternoon hot flashes, insomnia less sleep. Conclusion 1. The incidence of "sweating syndrome" after open heart surgery is as high as 78.4%, and the operative time after operation is as high as 78.4%. The amount of blood transfusion and the time of ventilator support are not. 2.The syndrome of "sweat syndrome" after TCM syndrome differentiation can be divided into 4 types: Qi deficiency syndrome, phlegm dampness syndrome and damp-heat syndrome. There was no significant difference in the effect of cardiopulmonary bypass (CPB) and non-cardiopulmonary bypass (CPB) on postoperative sweating. The main age distribution in 61-70 years old, mainly qi deficiency syndrome. Phlegm-dampness syndrome and Yin deficiency of fire syndrome patients with age difference, Yin deficiency of fire and the age of the syndrome is larger than the phlegm dampness syndrome. There is a statistical difference in blood transfusion volume between the two types of syndrome, and the mean value of the rank of yin deficiency fire is greater than that of qi deficiency. Therefore, a large amount of blood transfusion is more likely to lead to or aggravate the syndrome of yin deficiency fire. 6. There was statistical difference in the time of ventilator support between damp-heat syndrome and qi deficiency syndrome and Yin deficiency fire syndrome. The time of ventilator support in damp and heat syndrome was longer than that in qi deficiency syndrome and Yin deficiency fire syndrome. Prolonged use of ventilators may lead to dampness and heat syndrome.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】