昆明地区冠心病介入术后患者的中医证候研究

发布时间：2018-05-04 07:34

本文选题：冠心病介入术后 + 中医证型　；参考：《云南中医学院》2016年硕士论文

【摘要】：目的研究昆明地区冠心病介入术后患者的证型分布情况及演变规律,探析介入术后再狭窄患者的中医证型特点及危险因素,以期为临床防治冠心病介入术后再狭窄提供一定的参考依据。方法本研究参照《冠心病中医辨证标准》(1990年修订)制作调查问卷,通过调查问卷形式分别采集昆明地区冠心病患者介入术后1周、3月、6月的中医临床四诊等信息,以SPSS 22.0软件进行数据统计,分析术后患者证型分布特点及证型演变规律、术后再狭窄的中医证型特点及再狭窄的危险因素。结果1.本次研究共收集冠心病介入术后有效病例207例,经临床信息采集整理,统计分析后发现:介入术后1周患者出现频数最多的证型为血瘀证114例,占总病例数的55.1%,其次为痰浊证99例(47.8%)和气虚证79例(38.2%),依次为气滞证、阴虚证、寒凝证、阳虚证,提示患者术后一周以血瘀证、痰浊证、气虚证为主要证型;术后3月患者依然以气虚证、血瘀证、痰浊证为主要证型;术后6月患者出现频数前三的证型为气虚证110例(53.1%)、血瘀证93例(44.9%)和阴虚证76例(36.7%),依次为痰浊证、气滞证、阳虚证、寒凝证,提示患者术后6月以气虚证、血瘀证、阴虚证为主要证型。2.术后1周、3月、6月三个时间点的观察期内,血瘀证、痰浊证比例以缓慢趋势持续下降,气虚证、阳虚证、阴虚证持续上升,其中阴虚证变化明显,寒凝证、气滞证无明显变化,血瘀证、气虚证、痰浊证在整个观察周期内一直为主要证型;实证呈减少趋势、虚症呈增多趋势。3.再狭窄组中血瘀证(59.5%)、阴虚证(57.1%)、气虚证(57.1%)最为常见,其次为痰浊证气滞证阳虚证寒凝证,无再狭窄中证型排序为气虚证血瘀证阴虚证痰浊证气滞证阳虚证寒凝证。两组相比较,再狭窄组的血瘀证、痰浊证、阴虚证显著高于无再狭窄组(P0.05),有统计学意义。4.以患者为单位的单因素分析结果显示,再狭窄组与无再狭窄组的男性、吸烟、高血压、糖尿病的分布及BMI具有显著性差异(P0.05)。为进一步验证,以再狭窄为因变量,将单因素结果中P0.05的变量:男性、吸烟、高血压、糖尿病、BMI放入logistic多因素回归模型,结果显示:吸烟、高血压、糖尿病为再狭窄发生的独立危险因素(P0.05),OR依次为:3.287、2.955、4.476。结论1.昆明地区207例冠心病介入术后患者中医证型以血瘀证、气虚证、痰浊证多见。2.昆明地区207例冠心病介入术后患者于术后一周至术后六月血瘀证、痰浊证逐渐减少,气虚证、阴虚证、阳虚证逐渐增多;术后有实证向虚症转化的趋势。3.昆明地区207例冠心病介入术后患者再狭窄组中的血瘀证、痰浊证、阴虚证显著高于无再狭窄组,与介入术后再狭窄的发生有一定的相关性,提示术后应注重化祛痰化瘀、滋阴扶正。4.吸烟、高血压、糖尿病为再狭窄发生的独立危险因素,提示临床中应重视对这些因素的干预措施以降低术后再狭窄的发生概率。
[Abstract]:Objective to study the distribution and evolution of syndrome types in patients with coronary artery disease after coronary intervention in Kunming, and to explore the characteristics and risk factors of TCM syndromes in patients with restenosis after interventional operation. In order to provide a reference for clinical prevention and treatment of restenosis after coronary intervention. Methods according to the criteria of TCM Syndrome differentiation of Coronary Heart Disease (revised in 1990), the questionnaire was made in this study, and the information of four clinical diagnoses of coronary heart disease in Kunming area were collected in 1 week, 3 months and 6 months after intervention, respectively. The data were collected by SPSS 22.0 software, and the distribution and evolution of syndrome types were analyzed. The characteristics of TCM syndromes and risk factors of restenosis after operation were analyzed. Result 1. This study collected 207 effective cases of coronary heart disease after interventional operation. After clinical information collection and statistical analysis, it was found that 114 cases of blood stasis syndrome were the most frequent syndrome in the first week after interventional operation. It accounted for 55.1% of the total cases, followed by phlegm turbid syndrome (99 cases, 47.8 cases) and Qi deficiency syndrome (79 cases, 38.2%), followed by Qi stagnation syndrome, yin deficiency syndrome, cold coagulation syndrome, yang deficiency syndrome, which indicated that the main syndrome types were blood stasis syndrome, phlegm turbid syndrome and qi deficiency syndrome one week after operation. The main syndromes were Qi deficiency syndrome, blood stasis syndrome and phlegm turbidity syndrome in 3 months after operation; Qi-deficiency syndrome in 110 cases of Qi-deficiency syndrome in the first three types of frequency in 6 months after operation, blood stasis syndrome in 93 cases (44.9) and Yin deficiency syndrome in 76 cases (36.7%), followed by phlegm turbid syndrome, Qi stagnation syndrome, Yang deficiency syndrome. Cold coagulation syndrome, suggesting that six months after the operation, Qi deficiency syndrome, blood stasis syndrome, yin deficiency syndrome as the main syndrome type. 2. During the observation period of 1 week, 3 months and 6 months after the operation, the proportion of blood stasis syndrome and phlegm turbid syndrome continued to decrease, qi deficiency syndrome, yang deficiency syndrome and yin deficiency syndrome continued to rise, in which Yin deficiency syndrome changed obviously, cold coagulation syndrome and qi stagnation syndrome did not change significantly. Blood stasis syndrome, qi deficiency syndrome, phlegm turbid syndrome has been the main syndrome type in the whole observation cycle; In the restenosis group, blood stasis syndrome (59.5), yin deficiency syndrome (57.1), Qi deficiency syndrome (57.1), phlegm turbid syndrome, qi stagnation syndrome, yang deficiency syndrome, cold coagulation syndrome, and no restenosis syndrome were ranked as qi deficiency syndrome, blood stasis syndrome, yin deficiency syndrome, phlegm stagnation syndrome, qi stagnation syndrome, cold coagulation syndrome. Compared with the two groups, the blood stasis syndrome, phlegm turbidity syndrome and yin deficiency syndrome in the restenosis group were significantly higher than that in the non-restenosis group (P 0.05), with statistical significance. 4. Univariate analysis showed that there were significant differences in distribution of smoking, hypertension, diabetes and BMI between restenosis group and non-restenosis group (P 0.05). To further verify, taking restenosis as dependent variable, the variables of P05 in univariate results: male, smoking, hypertension, diabetes mellitus were put into logistic multivariate regression model. The results showed that: smoking, hypertension, The independent risk factor for the occurrence of restenosis was: 1: 3.287 / 2.955 / 4.476. Conclusion 1. Blood stasis syndrome, qi deficiency syndrome and phlegm turbidity syndrome were the most common syndromes in 207 patients with coronary heart disease after coronary intervention in Kunming. From one week to six months after intervention, 207 patients with coronary heart disease in Kunming area had blood stasis syndrome, phlegm and turbid syndrome gradually decreased, qi deficiency syndrome, yin deficiency syndrome and yang deficiency syndrome increased gradually, and there was a tendency of positive change to deficiency syndrome after operation. The blood stasis syndrome, phlegm turbid syndrome and yin deficiency syndrome in 207 patients with restenosis after coronary intervention in Kunming area were significantly higher than those without restenosis, which were related to the occurrence of restenosis after interventional operation, which suggested that we should pay attention to expelling phlegm and removing blood stasis after operation. Nourishing yin and nourishing recuperation. Smoking, hypertension and diabetes were independent risk factors for restenosis, which suggested that the intervention measures should be paid more attention to in order to reduce the probability of restenosis after operation.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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