国医大师邓铁涛论治冠心病气虚痰阻诊断标准研究

发布时间：2018-05-29 13:37

本文选题：邓铁涛 + 冠心病　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:在国医大师邓铁涛论治冠心病气虚痰阻证证型诊断的标准化、规范化的研究课题领域中,目前暂未建立公认程度较高、实用性较强的辨证诊断标准。建立冠心病气虚痰阻证的辨证标准,是深入研究冠心病气虚痰阻证的必要前提,也是保证以后气虚痰阻证研结果具备科学性和准确性的必要条件。因此本研究对该问题进行初步探讨。主要通过总结整理邓铁涛教授论治冠心病气虚痰阻证的学术思想,围绕以病证结合为主要研究单元进行统计分析,初步探讨与拟定国医大师邓铁涛对于冠心病气虚痰阻证的诊断标准草案,为名老中医专病诊治的学术思想传承工作作出一定的贡献。方法:1.文献研究及问卷研究部分1.1对文献进行研究整理:筛选相关的证候要素,冠心病气虚痰阻证的宏观表征。筛选的主要内容包括:邓老及其主要学术传承人、合作学术传承人的学术论文、医案、论著;1.2对邓老主要学术传承人进行调查问卷,并对问卷结果进行相关的频数统计分析,采用百分权重法对结果的相关条目进行筛选;2.临床研究部分:根据前面第一部分的研究结果,初步拟定病例观察表,进行临床研究部分的病例数据调查分析。方法:回顾性分析2015年1月1日至2017年1月1日我院住院期间符合该研究临床观察试验研究标准的患者。统计分析:对临床部分研究结果进行Logstic回归分析得出相关的结论。结果:根据Logistic回归分析结果,国医大师邓铁涛论治冠心病气虚痰阻证的主要相关因素有:胸痛(以闷痛、隐痛为主)(OR=2.63)、四肢乏力(OR=3.51)、神疲、咳嗽、痰多(OR=1.98)、苔腻(OR=1.79)、脉沉滑或沉细(OR=1.9)、纳呆(OR=1.53)、吸烟(OR=3.33)、BMI(OR=1.24)、高尿酸血症(OR=1.14)、TG(OR=1.29)、LDL-C(OR=1.49)、HCY(OR=1.15)、EF 值(OR=1.07)、E/A(OR=2.07)、高血压(OR=1.62)。结论:根据各变量OR值分别对应各个变量因素对结果的贡献度,对主、次证进行筛选。结合相关证候诊断标准的文献报道,以临床"实用性"、"科学性"、"重要性"三大原则为主要遵循原则。充分结合国医大师邓铁涛的主要传承人相关建议,以临床研究部分回归分析中OR值的大小为主要依据,并且与临床实际紧密联系,初步探讨与拟定国医大师邓铁涛论治冠心病气虚痰阻证的辨证诊断标准如下:注:诊断条件①主症A中一项+主症B中一项;脉象指标供临床辨证参考;②主症A中一项+次证B中至少2项;脉象指标供临床辨证参考;③主症B中一项+次证A中2项;脉象指标供临床辨证参考;④次证A中2项+次证B中至少2项;脉象指标供临床辨证参考;⑤冠心病气虚痰阻证的诊断必须包含主症或次证中的至少一项宏观指标,单纯危险因素指标不能诊断冠心病气虚痰阻证。
[Abstract]:Objective: in the field of standardization and standardization of diagnosis of syndrome of Qi deficiency and phlegm obstruction syndrome in the treatment of coronary heart disease by Deng Tietao, a master of Chinese medicine, there is currently no established diagnostic standard of syndrome differentiation, which has a higher degree of recognition and stronger practicability. To establish the syndrome differentiation standard of qi deficiency and phlegm obstruction in coronary heart disease is the necessary prerequisite for further research on qi deficiency and phlegm obstruction syndrome of coronary heart disease, and is also the necessary condition to ensure that the research results of qi deficiency and phlegm obstruction syndrome are scientific and accurate in the future. Therefore, this study is a preliminary study of the problem. Mainly through summing up Professor Deng Tietao's academic thoughts on treating Qi deficiency and phlegm obstruction syndrome of coronary heart disease, and focusing on the combination of disease and syndrome as the main research unit, to carry out statistical analysis. To discuss and draw up the draft diagnostic standard of Qi-deficiency and phlegm-blocking syndrome of coronary heart disease by Deng Tietao, a master of Chinese medicine, and to contribute to the inheriting of academic thoughts on the diagnosis and treatment of old Chinese medicine. Method 1: 1. Literature research and questionnaire study part 1.1 to study the literature: screening the relevant syndromes elements, coronary heart disease Qi deficiency phlegm obstruction of the macro representation. The main contents of the selection include: Deng Lao and his main academic inheritors, academic papers of cooperative academic inheritors, medical records, a questionnaire to the main academic inheritors of Deng Lao, and statistical analysis of the frequency of the results of the questionnaires. The percentage weight method was used to screen the relevant items of the result. Clinical study part: according to the results of the first part of the previous study, a preliminary case observation table is drawn up, and the case data of the clinical research part are investigated and analyzed. Methods: the patients who met the criteria of clinical observation trial in our hospital from January 1, 2015 to January 1, 2017 were retrospectively analyzed. Statistical analysis: the results of clinical studies were analyzed by Logstic regression analysis. Results: according to the results of Logistic regression analysis, the main factors related to the treatment of Qi-deficiency and phlegm obstruction syndrome of coronary heart disease by Deng Tietao, a great master of Chinese medicine, were as follows: chest pain (mainly suffocating pain, latent pain), fatigue of limbs and orgnia 3.51, fatigue and cough. The sputum was more than OR1.98, the moss was greasy with OR1. 79, the veins were slippery or fine, the OR1. 9 and 1. 53, smoking was 3. 33 and BMIOR1. 24, and hyperuricemia was OR1. 14 and TGG OR1. 29 LDL-COR1.49. The EF value OR1.07EP / A / O 2.07, and hypertension OR1. 622 / 0. Conclusion: according to the contribution degree of each variable factor to the result, the main and secondary syndromes were screened. In combination with the literature reports on the diagnostic criteria of syndromes, the three principles of clinical practicability, scientificalness and importance are the main principles to be followed. In full combination with the relevant suggestions of Deng Tietao, the master of national medicine, and taking the OR value in the partial regression analysis of clinical research as the main basis, and closely related to the clinical practice, The diagnostic criteria for treating Qi-deficiency and phlegm obstruction in coronary heart disease by Deng Tietao, a master of Chinese medicine, were discussed and drawn up as follows: note: one of main symptom B of main symptom A, one of main symptom B, one of pulse index for clinical syndrome differentiation; (2) at least 2 items in one sub-syndrome B of main symptom A, 2 in one sub-syndrome A of main syndrome B for clinical syndrome differentiation, at least two in 2 out of 4 syndromes B for clinical syndrome differentiation. The diagnosis of Qi-deficiency and phlegm obstruction syndrome in coronary heart disease must include at least one macroscopic index in the main or secondary syndromes. The pure risk factor index can not diagnose Qi-deficiency phlegm obstruction syndrome of coronary heart disease.
【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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