婴儿痉挛症中医证型分布特点及与脑电图、预后的关系研究

发布时间：2018-08-24 14:36

【摘要】：目的：研究婴儿痉挛症中医证型分布特点及与视频脑电图、预后的关系。方法：按照一定的诊断、纳入标准、排除标准,采用问卷调查的方式,收集婴儿痉挛症患儿病例100例,问卷设计了中医辩证诊断所需的所有症状的证候调查内容。对婴儿痉挛症患儿进行正确的中医辩证分型,同时使用美国BMSI6000128通道全数字化视频脑电图仪,按照国际10-20系统标准,安放19导联记录电极,双侧耳电极为参考电极,并附加心电及肌电。所有纳入试验的患儿均未使用催眠药物,采用自然睡眠或剥夺睡眠的方法,进行2-3h清醒和睡眠期的视频脑电图监测。治疗上采用2007欧洲专家的共识方案,并进行1-2年跟踪随访。结果：婴儿痉挛症的中医证型的分布情况,结果由多到少依次为：肝肾亏虚型、痰痫、瘀血痫、惊痫。100例IS患儿中,治疗前脑电图典型的高峰节律紊乱53例,变异型高峰节律紊乱23例,局灶性异常的尖棘波24例。各证型与脑电图间有一定的关系,但关联度不强(rp=0.372)。经治疗后1个月短期的痉挛发作控制情况显示：4种证型IS患儿疗效有显著性差异(P0.01),肝肾亏虚型VS痰痫有显著性差异(P0.01)；肝肾亏虚型VS惊痫有显著性差异(P0.01)；瘀血痫VS痰痫有显著性差异(P0.05)；其它各证型之间的疗效无显著性差异(P0.05)。结论：通过对婴儿痉挛症的流行病学调查研究,发现婴儿痉挛症中医证型主要以肝肾亏虚型为主,其次为痰痫、瘀血痫、惊痫。婴儿痉挛症的中医证型与视频脑电图的异常有一定的相关性,肝肾亏虚型与瘀血痫患儿视频脑电图多见变异型高峰节律紊乱和局灶性尖棘波。而痰痫及惊痫患儿其视频脑电图多为典型高峰节律紊乱。IS患儿预后差,大多数患儿伴有不同程度的精神运动发育落后。IS各中医证型中,肝肾亏虚型、瘀血痫患儿预后差,痰痫、惊痫患儿预后优于肝肾亏虚型、瘀血痫。
[Abstract]:Objective: to study the distribution of TCM syndromes of infantile spasm and its relationship with video EEG and prognosis. Methods: 100 cases of infantile spasticity were collected by questionnaire according to certain diagnosis, inclusion standard and exclusion standard. The questionnaire designed the content of syndrome investigation of all the symptoms needed for dialectical diagnosis of TCM. The correct Chinese medicine dialectical classification of infantile spasms was carried out. At the same time, according to the international 10-20 system standard, 19 lead recording electrodes and double lateral ear electrodes were placed as reference electrodes using the BMSI6000128 channel full digital video EEG instrument in the United States, according to the international standard of 10-20 system. The electrocardiogram and myoelectricity were added. No hypnotic drugs were used in all the children who participated in the study. The visual electroencephalogram (VEEG) was monitored by natural sleep or sleep deprivation during 2 to 3 hours of waking and sleeping. The treatment was followed by a consensus protocol of 2007 European experts and followed up for 1-2 years. Results: the distribution of TCM syndromes of infantile spasticity was as follows: deficiency of liver and kidney, phlegm epilepsy, eclampsia and convulsion. Among the 100 cases of IS, 53 cases had typical peak rhythm disorder of EEG before treatment. There were 23 cases with abnormal peak rhythm and 24 cases with focal abnormal spikes. There is a certain relationship between each syndrome type and EEG, but the correlation degree is not strong (rp=0.372). One month after treatment, the control of spasmodic seizure showed that there were significant differences in the curative effect among the four types of IS (P0.01), the phlegm epilepsy of VS with deficiency of liver and kidney (P0.01), the type of VS with deficiency of liver and kidney (P0.01), the type of VS with deficiency of liver and kidney (P0.01), and the control of sputum epilepsy with VS with deficiency of liver and kidney (P0.01). There was significant difference in phlegm epilepsy of VS with blood stasis (P0.05), but there was no significant difference among other syndromes (P0.05). Conclusion: based on the epidemiological investigation of infantile spasticity, it is found that the main types of TCM syndrome of infantile spasm are deficiency of liver and kidney, followed by phlegm epilepsy, blood stasis epilepsy and convulsion epilepsy. There is a certain correlation between TCM syndrome type of infantile spasm and abnormal video-EEG. In children with deficiency of liver and kidney and ecchymosis, the abnormal peak rhythm disorder and focal sharp spike were found in the video-EEG of children with liver and kidney deficiency and ecchymosis. Most of the children with sputum epilepsy and convulsion had poor prognosis of the typical peak rhythm disorder. The majority of the children had different degrees of mental and motor retardation. Among the syndrome types of different TCM syndromes, deficiency of liver and kidney, poor prognosis of children with blood stasis epilepsy, phlegm epilepsy, etc. The prognosis of children with epilepsy was better than that of deficiency of liver and kidney and ecchymosis.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272

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