基于医案回顾的中风病急性期气虚血瘀证临床特点及演变趋势研究

发布时间：2018-01-12 11:18

  本文关键词：基于医案回顾的中风病急性期气虚血瘀证临床特点及演变趋势研究　出处：《北京中医药大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 中风病 气虚血瘀证 临床特点 演变

【摘要】：目的：通过病例回顾分析中风病始发态气虚血瘀证临床特点,探讨阳(气)虚化风病机的临床内涵,并根据病例分析得出的中风病始发态气虚血瘀证临床特点,总结前人辨识始发态气虚血瘀证的临床依据；同时通过病例回顾观察始发态气虚血瘀证在中风病急性期不同时点的演变,分析中风病急性期气虚血瘀证演变趋势。方法：收集发病3天以内的中风病住院病例1049例,其中中医证候诊断符合气虚血瘀证的病例85例,使用统一的调查量表《中风病医案信息调查表》,采集患者发病1-3天、5-7天、10-14天三个时点的信息。采集内容主要包括患者的基本信息、发病诱因、起病形式、中医四诊信息、既往史、个人史、家族史、诊断、方药等资料。将采集内容进行整理并建立中风病医案数据库,首先对中风病医案信息进行描述性统计分析,并对比分析气虚血瘀证和非气虚血瘀证临床表征的不同,寻找对气虚血瘀证有特异性诊断价值的临床表征,然后回顾分析以气虚血瘀证为首发证候的中风病在不同年代、发病不同时点的呈现规律和演变趋势。结果：1、以气虚血瘀证为首发证候的中风病患者共计85例,占同期住院中风病总人数的8.10%,在所有中风病始发态中医证候中位居第四位；平均发病年龄为66.76±10.393岁,其中60-70岁和70-80岁是发病的两个高峰,与非气虚血瘀证相比在年龄上无明显差异(P0.05)；气虚血瘀证患者多发于秋冬季节,尤以冬季发病率最高,与非气虚血瘀证相比在季节上无明显差异(P0.05)：在有明确发病诱因的患者中气虚血瘀证以劳累最为多见,与非气虚血瘀证相比在发病诱因上无明显差异(P0.05)；气虚血瘀证最常见的既往史由高到低依次为高血压、中风、冠心病,占比分别为56.47%、51.76%、32.94%,气虚血瘀证组存在既往中风病史、冠心病史、房颤病史患者百分率均高于非气虚血瘀证组(P0.05)。2、中风病急性期气虚血瘀证患者临床常见症状按出现频率由高到低依次为神疲乏力或倦怠嗜卧或少气懒言(57.65%)、头晕(48.24%)、便干(32.94%)、饮水呛咳(25.88%)、心悸(25.88%)、肢痛不移(24.71%)、胸闷(24.71%)、大便三日或数日未解(23.53%)、不寐(20.00%)、头痛(20.00%)、咳嗽(16.47%)、步履不稳(16.47%)、纳差(14.12%)、口干(11.76%)、恶呕(10.59%)、小便频数(10.59%)、小便失禁(10.59%)、憋气(10.59%)；在神疲乏力或倦怠嗜卧或少气懒言、便干、肢痛不移、胸闷、面色萎黄、憋气、四末不温、短气、余尿不尽或不畅、便溏、手足肿胀、大便黏腻不爽等症状较非气虚血瘀证组比例升高(P0.05)；从舌象来看,气虚血瘀证组患者中出现舌淡、舌暗、舌体胖大、舌边有齿痕、白苔、薄苔的百分率高于非气虚血瘀证组(P0.05)；从脉象来看,气虚血瘀证组患者中出现缓脉、沉脉、细脉、弱脉、涩脉、结代脉的百分率高于非气虚血瘀证组(P0.05)。3、以气虚血瘀证为首发证候的中风病在90年代以前、1990-1994、1995-1999、2000年以后四个时间段中发病率呈现下降中转升,总体趋势为逐渐升高,2000年以后发病率最高,为13.68%。4、气虚血瘀证在中风病发病1-3天、5-7天、10-14天出现频率分别为8.10%、14.68%、24.69%,随发病时间的推移,气虚血瘀证所占比例逐渐增大。首发证候为气虚血瘀证的85例中风病患者在发病5-7天时有60例保持原有证候不变,而在发病10-14天时有50例保持原有证候不变,以痰湿蒙塞心神、痰热瘀血、阴虚风动为始发态证候的中风病患者在发病5-7天时最容易演变为气虚血瘀证,演变率分别为28.57%、23.53%、16.67%。5、以气虚血瘀证为首发证候的中风病,中药治疗大法为益气活血,基本方药为补阳还五汤的组成即赤芍、当归、黄芪、川芎、地龙、桃仁、红花。同时根据患者临床症状的不同,随证加减。结论：1、中风病始发态气虚血瘀证患者临床特异性症状包括：面色萎黄、神疲乏力或倦怠嗜卧或少气懒言、胸闷、憋气、短气、肢痛不移、手足肿胀、四末不温、余尿不尽或不畅、便溏、大便黏腻不爽,舌象为舌淡、舌暗、舌体胖大、舌边有齿痕、白苔、薄苔,脉象为缓脉、沉脉、细脉、弱脉、涩脉、结代脉；始发态为气虚血瘀证与中风病史、冠心病史、房颤病史相关。上述临床表现可作为辨识中风病始发态气虚血瘀证的临床依据。2、中风病从始发态到发病14天,气虚血瘀证比重不断增加,与既往中风病恢复期气虚血瘀证较为多见相吻合；中风病始发态气虚血瘀证者,约60%在中风病发病14天以内不发生变化,其余40%中有一半以上向风痰瘀血痹阻脉络证演变。3、中风是气机逆乱所致,阳亢化风,风痰瘀血痹阻脉络已经成为公认的中风病发病病机,阳(气)虚化风,气虚血瘀所致中风,也应引起高度重视,始发态为气虚血瘀证者属阳(气)虚化风,治疗大法为益气活血。
[Abstract]:Objective: through the retrospective analysis of clinical features of stroke originating state of qi deficiency and blood stasis syndrome, to explore the clinical meaning of Yang (gas) virtual wind disease machine, and according to the clinical characteristics of stroke with Qi deficiency and blood stasis syndrome cases originating state analysis, summarize the clinical basis of previous identification of starting states of qi deficiency and blood stasis; at the same time by retrospective observation of origin the state of qi deficiency and blood stasis syndrome evolution in the acute stage of stroke and analysis of acute stroke with Qi deficiency and blood stasis syndrome evolution trend. Methods: 1049 cases were collected within 3 days of onset of stroke patients, the diagnosis of TCM syndrome with Qi deficiency and blood stasis syndrome 85 cases, questionnaire < apoplexy medical record information questionnaire the use of a unified collection >, patients 1-3 days, 5-7 days, 10-14 days and three point information. The acquisition includes basic information, patients with predisposing factors, mode of onset, four diagnostic information of TCM, not only The diagnosis of history, personal history, family history, medicine and so on. The content of the collection sorting and the establishment of apoplexy medical record database, first carries on the descriptive statistical analysis on the apoplexy medical record information, and the comparative analysis of qi deficiency and blood stasis and Qi deficiency and blood stasis syndrome clinical characterization of different clinical characterization for a specific diagnostic value for Qi deficiency and blood stasis, and then analyzed retrospectively with Qi deficiency and blood stasis syndrome as the first stroke in different ages, and the evolution trend of incidence trend at different time points. Results: 1, with Qi deficiency and blood stasis syndrome as the first stroke patients with 85 cases, accounting for the total number of hospitalized stroke 8.10%. Ranked fourth in all stroke syndromes in the state of origin; the average age was 66.76 + 10.393 years, 60-70 years and 70-80 years old is the peak incidence of two, compared with the non Qi deficiency and blood stasis in the age of no significant difference ISO (P0.05); patients with Qi deficiency and blood stasis syndrome is more common in autumn and winter, especially in winter, the highest incidence rate, compared with Qi deficiency and blood stasis syndrome has no obvious difference in the season (P0.05): when there is a clear predisposing factors in patients with Qi deficiency and blood stasis with fatigue is the most common, compared with Qi deficiency and blood stasis syndrome without obvious the difference in incidence incentives (P0.05); the most common syndrome of qi deficiency and blood stasis history from high to low were hypertension, stroke, coronary heart disease, accounted for 56.47%, 51.76%, 32.94%, Qi deficiency and blood stasis group had previous history of stroke, coronary heart disease history, history of atrial fibrillation patients were all higher than that of qi deficiency and blood stasis group (non.2, P0.05) in acute stroke patients with Qi deficiency and blood stasis of common clinical symptoms according to the frequency from high to low is fatigue or lethargy lying or less lazy (57.65%), dizziness (48.24%), dry stool (32.94%), hydroposia (25.88%), (25.88%), limb palpitations 鐥涗笉绉，

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