缺血性卒中合并SAHS的证候特点研究

发布时间：2018-03-25 01:17

  本文选题：缺血性卒中　切入点：睡眠呼吸暂停低通气综合征　出处：《广州中医药大学》2017年硕士论文

【摘要】：研究目的:课题通过研究缺血性卒中合并与不合并SAHS的患者在证候分布上的差异,寻找缺血性卒中合并SAHS患者的证候分布特点。为进一步分析缺血性卒中合并SAHS的中医病机及中药治疗方法提供依据,并有助于进一步挖掘SAHS的中医病机内涵,拓宽中医药在现代医学领域的研究范围。研究方法:1.收集广州中医药大学第一附属医院脑病科住院的缺血性卒中患者33例,其中男性26例,女性7例,所有患者均已完成头颅CT或MRI检查(CT或MRI)并发现明确的脑缺血灶,其中有24为前循环梗死,2例为后循环梗死,7例前后循环均有梗死。全部缺血性卒中患者中有6例为无症状性梗死。有显著神经系统功能缺损的病史缺血性卒中患者,根据梗塞发生时间分为急性期13例,恢复期20例,卒中发生两周以后后为恢复期;根据梗塞发生次数分为首发缺血性卒中14例及再发缺血性卒中13例。其中再发缺血性卒中患者包括有两次及两次以上明确卒中病史的患者以及首次出现明确卒中症状但在影像学检查时发现有陈旧性梗死病灶的患者。2.所有缺血性卒中患者进行多导睡眠监测,检测通道主要包括脑电图(Electroencephalogram,EEG),鼻气流,胸腹运动,血氧饱和度,双眼眼动电极、下颌肌电、肢体运动以及视频检测。通过EEG配合R0C、下颌肌电、肢体运动以及视频检测分析患者睡眠及觉醒情况,在结合鼻气流及血氧饱和度检测分析计算患者的呼吸暂停低通气指数(apnea-hypopneaindex,AHI),AHI指数≥5或夜间7小时睡眠呼吸暂停低通气总数大于30者诊断为SAHS。所有患者在在监测前一天内不能饮酒、浓茶及咖啡,不能临时使用安眠药物或神经精神类药物,长期服用上述药物的患者按照日常剂量继续服用。3.在完成PSG检查分析后,根据是否合并SAHS将缺血性卒中患者分为两组,分别是缺血性卒中不合并SAHS组和缺血性卒中合并SAHS组。收集两组患者患者性别、年龄、体重指数等一般情况。对两组患者进行美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NISHH)评分和中风病辨证诊断标准评分。中医辨证标准根据1994年《中风病辨证诊断辨证诊断标准》,分为风、火、痰、瘀血、气虚及阴虚阳亢6种基本证候要素。凡某一项证候要素评分大于或等于7分者认为存在这一证候。研究结果:1.多导睡眠监测结果在监测的所有33名患者中有17名(51%)存在SAHS,23名(70%)存在夜间低氧血症。其中轻度的SAHS 11名,中度SAHS 3名,重度SAHS 3名;轻度低氧血症17名,中度低氧血症4名,重度低氧血症2名,SAHS及夜间低氧血症均以轻度为主。将患者根据有无SAHS分为缺血性卒中伴SAHS组及缺血性卒中不伴SAHS组,两组人数分别为16人和17人。2.两组患者性别、年龄分布情况比较两组患者在性别构成上无明显差异。收集患者中最年轻的为39岁,最年长者为78岁。缺血性卒中合并SAHS的人数随年龄增长而逐渐增多,对于大于49岁的患者而言,两者之间存在有显著的线性关系(Y=0.3x-12.7,v=1,R=1),缺血性卒中不合并SAHS组则未见显著相关性。两组患者年龄均值无显著差异。3.两组患者卒中相关情况比较合并SAHS者所占无症状卒中、首发卒中和再发卒中比例分别为33.3%、50%及61.5%,两组患者在无症状卒中与有症状卒中、首发卒中与再发卒中的分布情况均无显著差异。卒中分期方面,合并SAHS的患者占急性期患者总数的46.2%,恢复期患者总数55%,两组在急性期及恢复期卒中患者人数分布上无显著差异。卒中部位方面,两组患者均分别有12人为前循环,1人为后循环,合并SAHS组与不合并SAHS组前+后循环人数分别为4人及3人,两组患者人数在各卒中部位中均分布平均。卒中严重程度方面,缺血性卒中合并SAHS组NHISS评分均值为2.8±3.49,缺血性卒中不合并SAHS组NHISS评分均值为1.8 ±1.87,两组未见显著差异。4.两组患者各中医证素分布情况比较受检者中排名前五的证候类型依次为气虚夹痰证(7例)、风证(5例)、风痰证(4例)、痰证(3例)、痰浊瘀血证(3例)。缺血性卒中合并SAHS组主要分布在气虚夹痰证(85.7%),风痰证(75.0%)以及痰证(66.7%)中;缺血性卒中不合并SAHS组主要分布在风证(100%)及痰证瘀血证(100%)中。各证候要素的分布方面,两组患者在风证(P=1.00)、火证(P=0.65)、血瘀证(P=0.69)以及阴虚阳亢证(P=0.48)上没有发现显著差异,在气虚证(P=0.03)及痰证(P=0.00)的分布上具有显著差异。所有(100%)合并SAHS的患者均有痰证,而不合并SAHS组患者中仅44.0%的患者有痰证。52.9%的合并SAHS患者存在气虚证,而仅12.5%的缺血性卒中不合并SAHS患者存在气虚证。缺血性卒中合并SAHS的患者气虚证及痰湿证的发病率明显高于不合并SAHS的患者。5.缺血性卒中合并SAHS的组内分析不同的缺血性卒中严重程度(轻微、轻度、中度)中均以轻度SAHS为主,NHISS与卒中程度间无明显线性关系。急性期与恢复期患者均以轻度SAHS为主,别为66.7%和58.3%。两者AHI值无显著差异。无症状性卒中、首发卒中及再发卒中患者均以轻度SAHS为主,AHI值无明显差异。前循环及前+后循环患者均以轻度SAHS为主,构成比分别为9 0%与5 0%,两者AHI值无显著差异。痰证不兼气虚的患者中轻度SAHS占87.5%,重度SAHS占12.5%,无中度SAHS;痰证兼有气虚证的患者中轻度SAHS占44.4%,中度SAHS占33.3%,重度SAHS占22.2%。两类患者的AHI均值分别为13.56土4.83与21.20±14.62,两者间不具有显著差异(P=0.28)。研究结论:1.研究未发现性别与缺血性卒中患者是否合并SAHS的相关性。对大于49岁的患者而言,缺血性卒中患者合并SAHS的患者人数患病年龄见存在显著线性关系,提示缺血性卒中患者发生SAHS的概率会随着年龄增长而增加。2.研究未发现缺血性卒中是否合并SAHS以及SAHS严重程度与卒中次数、部位、分析及NHISS评分的相关性。3.缺血性卒中合并SAHS患者痰证及气虚证明显增多。兼有气虚证的痰证患者可能不兼有气虚证的痰证患者SAHS更加严重。研究中合并SAHS患者均具有痰证,过半患者(52.9%)有气虚证,以及气虚兼有痰证的患者其中重度SAHS比例及AHI均值高于痰证不兼有气虚的患者。从这一结果来看,痰证或许可视为SAHS发生普遍的病理基础,而气虚则可被视作痰邪内伏日久,损伤阳气所致。
[Abstract]:Objective: by study of ischemic stroke patients with and without SAHS in the syndrome distribution of the differences for the characteristics of syndrome distribution of patients with ischemic stroke complicated with SAHS. To provide the basis for Chinese medicine treatment machine and method for further analysis of ischemic stroke in patients with SAHS, and contribute to the pathogenesis of the connotation of further mining SAHS, to broaden the scope of study of traditional Chinese medicine in the field of modern medicine. Methods: 1. patients with ischemic stroke were collected in Guangzhou University of Chinese Medicine Department of the First Affiliated Hospital of encephalopathy in 33 cases, including 26 cases of male, female 7 cases, all patients were completed by CT or MRI (CT or MRI) and found that the focal ischemic brain clear. Of which 24 were anterior circulation infarction and 2 patients with posterior circulation infarction, 7 cases of anterior and posterior circulation infarction. All patients had ischemic stroke in 6 cases of asymptomatic infarction. Significant neurological function The defect of ischemic stroke patients, according to the time of occurrence of infarction was acute in 13 cases, 20 cases of convalescent stroke, two weeks after the recovery period; according to the number of infarction divided into initial ischemic stroke and 14 cases of recurrent ischemic stroke in 13 cases. The patients with recurrent ischemic stroke include two times and more than two patients with clear history of stroke and stroke symptoms first appeared clear but in radiographic inspection found that chronic infarction lesions in patients with.2. all ischemic stroke patients underwent polysomnography, including EEG detection channels (Electroencephalogram, EEG), nasal airflow, abdominal movement, oxygen saturation, binocular eye electrode. Mandibular muscle, limb movement and video detection. By EEG with R0C, mandibular muscle, limb movement and video detection and analysis of patients with sleep and awakening, in combination of nasal airflow and blood Analysis of patients with apnea hypopnea index oxygen saturation detection (apnea-hypopneaindex, AHI), AHI index is more than 5 or 7 hours a night sleep apnea hypopnea total more than 30 of all patients diagnosed with SAHS. in drinking not in a day before the monitoring, tea and coffee, not the temporary use of hypnotic drugs or psychotropic drug and nerve long-term use of the drug, the patients according to daily dose continued to take.3. in the examination of PSG analysis, with SAHS in patients with ischemic stroke were divided into two groups, respectively, ischemic stroke and ischemic stroke patients without SAHS group with SAHS group. The two groups were collected in patients with gender, age, body mass index of the general case. Two groups of the National Institutes of Health Stroke Scale (National Institute of Health stroke scale, NISHH) score and the diagnostic standard of TCM score. According to the 1994 differentiation standard < diagnostic diagnosis criteria >, divided into the wind, fire, phlegm, blood stasis, Qi deficiency and yin deficiency and yang hyperactivity syndrome. 6 basic elements where a syndrome factor score greater than or equal to 7 points that the existence of this syndrome. Results: 1. polysomnography the monitoring results in all 33 patients monitored in 17 patients (51%) SAHS, 23 (70%) of nocturnal hypoxemia. Among them 11 mild SAHS, moderate SAHS 3, SAHS 3 were severe; mild hypoxemia 17, moderate hypoxemia 4, severe hypoxemia in 2 SAHS, and nocturnal hypoxemia were mainly mild. The patients according to whether the SAHS is divided into SAHS group and ischemic stroke patients with ischemic stroke without SAHS group, the number of the two groups were 16 and 17.2. patients in the two groups of gender, age distribution were compared between the two groups in gender has no significant difference. Most patients were collected Young is 39 years old, the oldest is 78 years old. The number of ischemic stroke patients with SAHS with age gradually increased, for more than 49 year old patients, there is a significant linear relationship exists between the two (Y=0.3x-12.7, v=1, R=1), ischemic stroke patients without SAHS group did not see significant correlation with comparison. There was no significant difference between the two groups of patients with mean age of.3. patients in the two groups of SAHS stroke related accounts for no symptoms of stroke, stroke and initial stroke rates were 33.3%, 50% and 61.5%, two patients without symptoms of stroke and stroke symptoms, there were no significant differences between the first stroke and the stroke of the distribution. Stroke staging in patients with SAHS, accounting for 46.2% of the patients with acute period, recovery period a total of 55% patients, two groups in the acute period and recovery period no significant difference in the distribution of the number of patients with stroke. Stroke, two groups of patients respectively. 鏈，

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