126例老年体位性低血压中医证型分布规律和相关因素分析

发布时间：2018-08-31 19:35

【摘要】：目的:通过对本课题的研究,探索老年体位性低血压的中医证型分布及其规律,探索该病主要证型的中医特点及临床表现,了解相关因素对本病的发生发展及中医各证型分布的关系,为规范该病中医证型辨证提供客观依据,为该病进一步的流行病学研究提供一定的基础资料。方法:拟定《老年体位性低血压临床调查表》,通过对中日友好医院和东直门医院两家医院门诊及住院的老年体位性低血压患者进行现场调查及进行相关检查,观察老年体位性低血压中医症候特点、寻找中医辨证分型规律,统计、分析该病与年龄、高血压、动态血压及各种合并疾病等的相关性。结果老年体位性低血压发病隐匿,以卧立位时头晕、乏力、活动能力下降等症候为特点。对126例该病患者进行分析研究:①对中医证型进行分析:主要的中医证型有4个,分别为气阴两虚(63.5%)脾肾两虚(12.7%)痰瘀互阻(9.5%)阴阳两虚(7.1%),气阴两虚证型中,亚型瘀血阻络型占到近一半,尚有阴虚阳亢、湿热内蕴、心肾不交等证型,所占比重较小。②对发病年龄进行分析:老年体位性低血压患病率随年龄增长而增加,其中 60-69 岁 26 例(20.6%),70-79 岁 35 例(27.8%),80-90 岁 54 例(42.9%),90岁以上11例(8.7%)。③对患者病史进行分析:其中无体位性低血压病史46例(36.5%),3年以内(含3年)63例(50.0%),3年以上]7例(13.5%)。④对患者的职业进行分析:脑力劳动者90例(71.4%),体力劳动者24例(19.0%),不确定者12例(9.5%)。⑤对合并症统计分析:大多数合并有3种及以上基础疾病,其中合并高血压(82例,65.1%)和合并脑梗(80例,63.5%)的超过半数;78例患者完成了 24小时动态血压监测,其中非勺型血压占绝大多数(72例,92.3%)。⑥对中医证型与相关因素分析:70岁以上各证型分布差异较大(P0.05),以气阴两虚和亚型瘀血阻络为主;在职业上各证型分布无明显差异(P0.05),亚型瘀血阻络在合并高血压分布中有显著性差异(P0.05),其他证型无差异;气阴两虚和亚型瘀血阻络在合并脑梗塞的分布上有显著性差异(P0.05),其他证型无差异。结论气阴两虚、脾肾两虚、痰瘀互阻、阴阳两虚是老年体位性低血压的四个主要基本证型,其中气阴两虚型占绝大多数,亚型瘀血阻络占到气阴两虚型近一半,血瘀是最重要的病理因素。老年体位性低血压的中医发病特点为:起病隐匿,患者不能正确估算发病时间,常伴有头痛、头胀、气短乏力、口干舌燥、大便干结、小便频数等临床症状。老年体位性低血压随年龄的增加其患病率增加,与职业(脑力劳动)有一定的相关性。老年体位性低血压常合并3种以上的合并症,其中以高血压、脑梗塞较多见(50%),而糖尿病、冠心病、肾功能不全等常见基础疾病似与老年体位性低血压没有很强的相关性,高血压、24h动态血压异常与体位性低血压密切相关,分析可能是同一种疾病在不同发展时期的阶段性突出表现相互参杂、相互影响。脑梗塞和体位性低血压高度相关并相互影响,共同促进了脑损伤发展,影响大脑认知功能。年龄越大,气阴两虚和亚型瘀血阻络分布越明显。
[Abstract]:Objective:To explore the distribution and regularity of TCM syndromes of orthostatic hypotension in the elderly, explore the characteristics and clinical manifestations of the main syndromes of the disease, understand the relationship between the occurrence and development of the disease and the distribution of TCM syndromes, and provide an objective basis for standardizing the syndrome differentiation of the disease in TCM, so as to promote the progress of the disease. Methods: To draw up the clinical questionnaire of orthostatic hypotension in the elderly, and to observe the characteristics of TCM symptoms of orthostatic hypotension in the elderly through on-the-spot investigation and related examinations on the outpatients and inpatients of both Sino-Japanese Friendship Hospital and Dongzhimen Hospital. Results The incidence of orthostatic hypotension in the elderly was concealed, characterized by dizziness, fatigue and decreased activity in the supine position. 126 cases of this disease were analyzed and studied: 1. Analysis: There are four main TCM syndromes: deficiency of both qi and Yin (63.5%) and deficiency of spleen and kidney (12.7%) and mutual obstruction of phlegm and blood stasis (9.5%) and deficiency of both yin and Yang (7.1%). The prevalence of hypertension increased with age, including 26 cases (20.6%) aged 60-69, 35 cases (27.8%) aged 70-79, 54 cases (42.9%) aged 80-90 and 11 cases (8.7%) aged over 90. Analysis: 90 cases (71.4%) of mental workers, 24 cases (19.0%) of manual workers, 12 cases (9.5%) of uncertainties. _Statistical analysis of complications: most of the patients with three or more basic diseases, including hypertension (82 cases, 65.1%) and cerebral infarction (80 cases, 63.5%) more than half of them; 78 patients completed 24-hour ambulatory blood pressure monitoring, including non- Spoon blood pressure accounted for the vast majority (72 cases, 92.3%)._Analysis of TCM syndrome types and related factors: the distribution of syndrome types over 70 years old was significantly different (P 0.05), mainly deficiency of both Qi and Yin and blood stasis blocking collaterals of subtypes; occupational distribution of each syndrome type was not significantly different (P 0.05), subtype of blood stasis blocking collaterals in the distribution of combined hypertension was significantly different (P 0.05), others (P 0.05). Conclusion Qi-yin deficiency, spleen and kidney deficiency, phlegm and blood stasis obstruction, yin-yang deficiency are the four main basic syndromes of senile orthostatic hypotension, of which Qi-Yin Deficiency and blood stasis obstruction are the overwhelming majority. Blood stasis is the most important pathological factor in nearly half of the deficiency of both Qi and Yin. The onset of orthostatic hypotension in the elderly is characterized by concealed onset, incorrect estimation of onset time, headache, head distension, shortness of breath, dry mouth, dry stool, and frequent urination. Postural hypotension in the elderly is often associated with more than three complications, including hypertension and cerebral infarction (50%), while diabetes, coronary heart disease, renal insufficiency and other common basic diseases seem to have no strong correlation with postural hypotension in the elderly, hypertension, 24h ambulatory blood pressure is different. Often closely related to orthostatic hypotension, analysis may be the same disease in different stages of development, the prominent manifestations of each other, mutual influence. The more obvious the distribution.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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