缺血性脑卒中中医证型、证候积分与NIHSS评分的相关性分析

发布时间：2018-03-11 21:02

  本文选题：缺血性脑卒中　切入点：中医证型　出处：《辽宁中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:观察首次发病的缺血性脑卒中(Cerebral ischemic stroke,CIS)患者急性期(72小时内)中医证型的特点、证候总积分与NIHSS评分的差异,以探索其间的内在联系。材料与方法:1.通过望问闻切四诊合参采集缺血性脑卒中患者急性期(72小时内)的所有症状和体征,根据《中风病辨证诊断标准》中各项目内容分值进行相应的赋分值处理,分别计算患者风证、火热证、痰证、瘀证、气虚证、阴虚阳亢证六个基础证的证候分值,然后根据该分值进行证型诊断,计算证型的证候总积分;同时采用NIHSS评分量表对患者神经功能缺损程度进行评分,记录总评分。2.数据统计处理:(1)计量资料采用均数±标准差表示;(2)证型间证候总积分、神经功能缺损评分比较符合正态采用t检验,不符合正态采用秩和检验;(3)证候积分与NIHSS评分的关系采用相关性分析。结果:1.缺血性脑卒中急性期(72小时内)不同主证证型分布以风证为主证的证型所占比例最大,阴虚阳亢为主证者次之。2.相兼证型分布以二证相兼证型所占比例最大(约58.0%),三证相兼次之,单一证型、四证、五证相兼证型比例相对较小,无六证相兼病例。3.不同主证证型间比较:(1)证候总积分比较:以风、火热、痰为主证的证型与气虚为主证者比较差异有统计学意义(ρ0.05),而以风为主证者与以阴虚阳亢为主证者比较差异亦有统计学意义(ρ0.05);(2)NIHSS评分比较:差异无统计学意义(ρ0.05);(3)相关性分析:各组间证候总积分与其NIHSS评分(除以气虚为主证者外)呈显著正相关(ρ0.01),尤以痰证为主者相关程度最密切。4.虚实侧重证型间比较:(1)证候总积分与NIHSS评分比较:差异均有统计学意义(ρ0.01),且以标实为主者较以本虚为主者证候总积分与NIHSS评分更高;(2)相关性分析:虚实侧重不同证型的证候总积分与NIHSS评分呈正相关(ρ0.01)。5.相兼证型间比较:(1)证候总积分与NIHSS评分比较:单一证型、两证相兼证型与其他各组比较差异均有统计学意义(ρ0.05),三证、四证、五证相兼的证型间差异无统计学意义(ρ0.05);(2)相关性分析:除单一证型外,余各组证候总积分与神经功能缺损评分均呈正相关(ρ0.05),且随证候总积分越高,NIHSS评分也越高。结论:1、首次缺血性脑卒中72小时内中医证型相对简单,以二证相兼证型涵盖比例最大。2、缺血性卒中急性期内以风、火热、痰为主证的证型其证候程度重于气虚为主证者。3、侧重于实证的证型其证候程度与神经功能缺损程度均重于以虚证为主的证型。4、三证、四证、五证相兼的证型其证候与神经功能缺损程度均较以单证、二证相兼者更加严重。5、证候总积分(证候程度达中度以上)与NIHSS评分呈正相关。
[Abstract]:Objective: to observe the characteristics of TCM syndromes, the difference between the total score of syndromes and NIHSS score in patients with ischemic stroke within 72 hours of acute phase. Materials and methods: 1. To collect all symptoms and signs of ischemic stroke patients within 72 hours of acute phase. According to the "criteria for diagnosis of apoplexy Syndrome differentiation", the corresponding score was assigned to each item, and the syndromes of six basic syndromes, namely, wind syndrome, fire and heat syndrome, phlegm syndrome, blood stasis syndrome, qi deficiency syndrome, yin deficiency and yang hyperactivity syndrome, were calculated respectively. According to the score, the syndrome type was diagnosed, and the total syndromes integral of the syndrome type was calculated. At the same time, the NIHSS scale was used to evaluate the degree of neurological impairment of the patients. Record total score .2.Data-statistical processing: 1) the measurement data were measured by mean 卤standard deviation to represent the total integral of syndromes and syndromes between syndromes, and the scores of neurological impairment were in accordance with normal state and t test. The relationship between syndromes score and NIHSS score was analyzed by correlation analysis. Results: 1. Within 72 hours of acute phase of ischemic stroke, the distribution of different main syndromes was the largest with wind syndrome as the main syndrome type. The distribution of two syndromes and syndromes was the largest (about 58.0%, three syndromes and two syndromes were second, single syndrome type, four syndrome type, five syndromes phase and syndromes type) were relatively small. Comparison between different types of principal syndromes: comparison of the total score of syndromes: wind, fire, heat, There was a significant difference between the syndrome type of phlegm and qi deficiency (蟻 0.05), and the difference between wind syndrome and yin deficiency and yang hyperactivity (蟻 0.05). The difference was not statistically significant (蟻 0.05). Sex analysis: there was a significant positive correlation between the total score of syndromes and their NIHSS score (except those with deficiency of qi) (蟻 0.01, especially phlegm syndrome). Comparison: there was significant difference (蟻 0.01g, and the total integral of syndrome and NIHSS score were higher than those with deficiency): the total integral of syndromes with different syndromes was positively correlated with the NIHSS score (蟻 0.01g. 5. both syndromes and syndromes). Comparison of total score of syndromes and NIHSS score: single syndrome type, There were significant differences between the two syndromes and the other groups (蟻 0.05, three, four and five syndromes, respectively). There was no significant correlation analysis between the two syndromes (蟻 0.05) and the other groups (蟻 0.05): except the single syndrome type, there was no significant difference between the two syndromes (蟻 0.05). There was a positive correlation between the total score of syndromes and the score of neurological deficit (蟻 0.05), and the higher the total score of syndromes was, the higher the score of NIHSS was. Conclusion: 1, the TCM syndrome type is relatively simple within 72 hours after the first ischemic stroke. The proportion of two syndromes and syndromes was the largest. 2. The acute phase of ischemic stroke was characterized by wind and heat. The degree of syndromes of phlegm-predominant syndrome is more serious than that of qi deficiency syndrome. The degree of syndromes and nerve function defect of syndrome type with emphasis on empirical evidence is more serious than that of syndrome type .4 with deficiency syndrome, with three syndrome types and four syndromes with deficiency syndrome. The syndromes of the five syndromes and the degree of neurological impairment were more serious than those of the two syndromes. The total score of syndromes was positively correlated with the NIHSS score.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7
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本文编号：1599884