后循环缺血性眩晕临床证候分布规律研究

发布时间：2018-04-25 21:24

本文选题：后循环缺血 + 眩晕　；参考：《河南中医药大学》2016年硕士论文

【摘要】：目的:通过观察不同证型后循环缺血性眩晕患者的临床表现及发病原因等,探索后循环缺血性眩晕独特的临床特点以及其中医辨证规律,提高后循环缺血性眩晕的临床诊疗水平,并为其诊疗研究的新思路奠定临床试验基础。方法:结合前期已经完成的文献研究、专家问卷,采用临床流行病学调查,编制PCIV中医证候分布特征研究调查量表,建立数据库。在此基础上,应用聚类分析和因子分析等统计方法,以探索PCIV中医证候分布规律。结果:1.后循环缺血性眩晕的男女发病比例约为1.2:1,男性整体发病率稍高于女性。350例PCIV患者平均发病年龄为(60.22±10.37)岁,PCIV高发年龄段在41-80岁。体重超标人群发病率高于体重正常人群,肥胖作为脑血管病的危险因素,亦影响着PCIV的发病。脑力劳动者发病率稍高于体力劳动者。PCIV的发病就其既往史而言,PCIV与高血压、糖尿病、高脂血症、动脉硬化等关系最为密切。2.本研究中医症状除眩晕/头晕外共48项,出现频率最高的是恶心呕吐(53.1%),出现频率超过20%的症状有:恶心呕吐、站立不稳、胸闷、乏力懒言、健忘、耳鸣、视物模糊、纳呆、大便干、肢体头面麻木、烦躁易怒、口干、失眠、头部沉重、双目干涩、口苦、四肢困重、口粘、多梦、腰膝酸软、头晕、眩晕遇劳甚、头胀痛、大便溏、畏寒、视物旋转、目胀、面色赤等共28项,且累计出现频率超过70%。经专家辨证以痰浊中阻证、气血亏虚证、肝阳上亢证、痰瘀阻络证最为多见,四类证型所占比例分别是22%、18.3%、14.9%、14%。3.经聚类分析和因子分析得出,虚证含心脾两虚、肾精不足、脾肾不足、肝肾亏虚;实证含痰湿中阻、肝阳上亢、痰瘀阻滞,聚类分析和因子分析结果有较高的一致性。4.因子分析有脉浮、舌淡红等作为公因子出现,脉浮作为外感表证的特征性脉象,虽然亦可见与气血大虚之人,外感眩晕做为PCIV的病机仍值得我们进一步探讨。结论:PCIV中医证素以痰、瘀、阴虚、阳亢、气血虚等最为常见,病变以肝、脾、肾为主,涉及心、脑等。通过运用因子分析和聚类分析等统计方法,初步总结出了PCIV的证型及其主症、舌脉等,为规范的诊断PCIV做了一定的基础工作,但整体样本量有限,且仅局限在郑州一地,统计方法尚有一定局限,仍需要多中心、大样本,和更完备的统计方法进行证实。
[Abstract]:Objective: to explore the unique clinical characteristics of posterior circulatory ischemic vertigo and its TCM syndrome differentiation by observing the clinical manifestations and the causes of ischemic vertigo in patients with different syndromes. To improve the clinical diagnosis and treatment level of posterior circulation ischemic vertigo, and to lay the foundation of clinical trial for its new thinking of diagnosis and treatment. Methods: combined with the literature research, expert questionnaire and clinical epidemiology investigation, the PCIV TCM syndrome distribution investigation scale was compiled, and the database was established. On this basis, cluster analysis and factor analysis were used to explore the distribution of TCM syndromes in PCIV. The result is 1: 1. The incidence rate of posterior circulatory ischemic vertigo was about 1.2: 1. The overall morbidity of male was slightly higher than that of female. The average age of onset of PCIV was 60.22 卤10.37) years. The high incidence age was 41-80 years old. The incidence of PCIV in overweight population was higher than that in normal body weight group. Obesity, as a risk factor of cerebrovascular disease, also affected the incidence of PCIV. The incidence of mental workers was slightly higher than that of manual workers. The incidence of PCIV was most closely related to hypertension, diabetes, hyperlipidemia and arteriosclerosis in terms of its previous history. In this study, there were 48 symptoms in Chinese medicine except vertigo / dizziness. The most frequent symptoms were nausea and vomiting (53.1%). The symptoms with frequency of more than 20% were nausea and vomiting, unsteady standing, chest tightness, fatigue and lazy speech, amnesia, tinnitus, blurred vision and incapacity. Dry stool, numbness of the head, irritability, dry mouth, insomnia, heavy head, dry eyes, bitter mouth, heavy limbs, sticky mouth, many dreams, sore waist and knee, dizziness, pain of head, loose stool, cold, rotation of things, Eye expansion, color, and so on 28, and the cumulative frequency of more than 70. According to the experts' differentiation, the syndrome of phlegm turbid and middle obstruction, deficiency of qi and blood, hyperactivity of liver yang, phlegm and stasis of collaterals were the most common, and the proportion of the four types of syndrome were 220.18.3and 14.90.3. respectively. Cluster analysis and factor analysis showed that deficiency syndrome contained deficiency of both heart and spleen, deficiency of kidney essence, deficiency of spleen and kidney, deficiency of liver and kidney, and evidence of phlegm dampness, hyperactivity of liver yang, phlegm and blood stasis block. Factor analysis showed that pulse floating, tongue red and so on appeared as common factors, and pulse floating was the characteristic pulse of external sensory evidence, although it could also be seen in people with deficiency of qi and blood, the pathogenesis of exogenous vertigo as PCIV is still worthy of further study. ConclusionTwain PCIV syndrome is characterized by phlegm, blood stasis, yin deficiency, hyperactivity of yang and deficiency of qi and blood. Liver, spleen and kidney are the main lesions involving heart, brain and so on. By using statistical methods such as factor analysis and cluster analysis, this paper preliminarily summarizes the syndromes of PCIV and its main symptoms, tongue veins and so on. It has done some basic work for the standard diagnosis of PCIV, but the whole sample size is limited, and only in Zhengzhou. There are still some limitations in statistical methods, which still need to be verified by multi-center, large sample, and more complete statistical methods.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R255.3

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