缺血性肠病临床特点及中医证候回顾性分析研究

发布时间：2019-05-08 00:01

【摘要】：目的通过回顾性分析缺血性肠病患者病例资料,探讨本病的临床表现、诊断方法及中医证候特点,提高对本病的认识,为缺血性肠病的防治做出有益探索。方法回顾性分析研究2005年1月至2016年12月北京中医医院、广安门中医医院、北京中医医院延庆医院住院患者,并确诊为缺血性肠病患者病例共50例,通过对病例的阅读,提取患者一般情况、生物学指标、中医四诊信息,并对相关资料进行回顾性的描述分析,总结其西医临床特点、诊治规律、中医证候特点。结果(1)本病发病人群:50例患者中,男性14例(28%),女性36例(72%),男:女=1:2.57,平均年龄:64.40±12.74岁。(2)本病临床表现以腹痛(100%)、便血(58%)、腹泻(14%)为主,且症状与体征多不相符,具有症状重,体重轻的特点。3、患者多具有1种甚至多种基础疾病,高血压病史29例(29/50,58%),冠心病病史15例(15/50,30%),糖尿病病史9例(9/50,18%),高脂血症病史7例(7/50,14%),脑梗塞病史9例(9/50,18%),房颤病史5例(5/50,10%)。(4)23例患者行CTA检查,可见动脉血栓形成、肠系膜动脉或静脉狭窄、栓塞、夹层及肠静脉血栓形成。36例患者行电子肠镜下检查,34例表现为病变处黏膜有不同程度的充血水肿、糜烂、溃疡,部分病例有管腔狭窄。仅2例未见异常。(5):发病季节,50例患者中春季发病共5例(10%),夏季发病共10例(20%),秋季发病共12例(24%),冬季发病共23例(46%)。以冬季发病为主。24节气中以冬至发病最为多见。(6)舌脉信息:舌质多为舌暗26例(52%),舌淡15例(30%),舌红9例(18%);舌苔以苔黄9例(8%),苔白26例(52%),苔厚16例(32%),苔腻18例(36%),苔薄15例(30%)为主。脉象以脉沉18例(36%),脉细22例(44%),脉弦10例(20%),脉滑8例(16%)为主。(7)中医辩证分型:本组50例患者缺血性肠病的中医证型为:气虚血瘀证,湿热蕴肠证,脾肾阳虚证,肝郁脾虚证,脾不摄血型证,以气虚血瘀证、湿热蕴肠证最多,分别为20例(40%),湿热蕴肠证12例(24%)。结论:1、对于老年患者突发腹痛便血腹泻,伴有心脑血管疾病的患者,尽快完善腹部CTA、肠镜以明确诊断。2、本病的中医证型可分为气虚血瘀证、湿热蕴肠证、脾肾阳虚证、肝郁脾虚证、脾不摄血证,舌暗、苔白,脉沉细最为多见。
[Abstract]:Objective to study the clinical manifestations, diagnostic methods and characteristics of TCM syndrome of ischemic bowel disease by retrospectively analyzing the data of patients with ischemic bowel disease, so as to improve the understanding of the disease and make a useful exploration for the prevention and treatment of ischemic bowel disease. Methods from January 2005 to December 2016, 50 cases of ischemic bowel disease were analyzed retrospectively in Beijing traditional Chinese Medicine Hospital, Guanganmen traditional Chinese Medicine Hospital and Yanqing Hospital of Beijing traditional Chinese Medicine Hospital. The general situation, biological indexes, four diagnostic information of traditional Chinese medicine (TCM) were extracted, and the related data were described and analyzed retrospectively. The clinical characteristics, diagnosis and treatment rules and TCM syndrome characteristics of western medicine were summarized. Results (1) among the 50 patients, 14 (28%) were male and 36 (72%) were female. The average age was 64.40 卤12.74 years old. (2) abdominal pain (100%) was the clinical manifestation of the disease, and the mean age was 64.40 卤12.74 years old, the average age was 64.40 卤12.74 years old. Hematochezia (58%), diarrhoea (14%), and symptoms and signs do not match, with symptoms, low weight characteristics. 3, patients with one or more basic diseases, hypertension history in 29 cases (29 / 50, 58%), the patient has a history of hypertension in 29 cases (29 / 50, 58%). The history of coronary heart disease (15 / 50, 30%), diabetes mellitus (9 / 50, 18%), hyperlipidemia (7 / 50, 14%) and cerebral infarction (9 / 50, 18%). CTA examination was performed in 23 patients (5: 50, 10%). (4) with a history of atrial fibrillation. Arterial thrombosis, mesenteric artery or vein stenosis, embolism, dissection and intestinal vein thrombosis were performed in 36 patients. 34 cases showed different degrees of hyperemia, edema, erosion, ulcers, and stenosis of lumen in some cases. (5) there were 5 cases (10%) in spring, 10 cases (20%) in summer, 12 cases (24%) in autumn and 23 cases (46%) in winter in the 50 cases in spring, 10 cases (20%) in summer, 12 cases (24%) in autumn and 23 cases (46%) in winter. 26 cases (52%) with dark tongue, 15 cases (30%) with light tongue and 9 cases (18%) with red tongue were found in 24 solar terms. (6) the information of tongue vein was mostly dark in 26 cases (52%), light tongue in 15 cases (30%) and red tongue in 9 cases (18%). The tongue coating was yellow in 9 cases (8%), white in 26 cases (52%), thick in 16 cases (32%), greasy in 18 cases (36%) and thin in 15 cases (30%). There were 18 cases of pulse sedimentation (36%), 22 cases of pulse fineness (44%), 10 cases of pulse string (20%) and 8 cases of pulse slip (16%). (7) TCM dialectical classification: the TCM syndrome type of 50 patients with ischemic bowel disease was Qi deficiency and blood stasis syndrome. There were 20 cases (40%) with dampness-heat retention syndrome, 12 cases (24%) with dampness-heat syndrome, and 20 cases (40%) with damp-heat syndrome, 12 cases (24%) with dampness-heat syndrome, among which the syndrome of qi deficiency and blood stasis, the syndrome of dampness-heat containing intestines were the most common. Conclusions: 1, for the elderly patients with sudden abdominal pain, stool diarrhea and cardiovascular and cerebrovascular diseases, improve the abdominal CTA, enteroscopy as soon as possible to determine the diagnosis. 2, the TCM syndromes of this disease can be divided into Qi deficiency and blood stasis syndrome, dampness-heat accumulation of intestine syndrome, the disease can be divided into Qi deficiency and blood stasis syndrome, dampness-heat retention bowel syndrome. Spleen and kidney yang deficiency syndrome, liver stagnation spleen deficiency syndrome, spleen does not take blood syndrome, tongue dark, white, pulse thickness is the most common.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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