本文選題：鄧鐵濤 + 冠心病��； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:在國醫(yī)大師鄧鐵濤論治冠心病氣虛痰阻證證型診斷的標準化、規(guī)范化的研究課題領(lǐng)域中,目前暫未建立公認程度較高、實用性較強的辨證診斷標準。建立冠心病氣虛痰阻證的辨證標準,是深入研究冠心病氣虛痰阻證的必要前提,也是保證以后氣虛痰阻證研結(jié)果具備科學性和準確性的必要條件。因此本研究對該問題進行初步探討。主要通過總結(jié)整理鄧鐵濤教授論治冠心病氣虛痰阻證的學術(shù)思想,圍繞以病證結(jié)合為主要研究單元進行統(tǒng)計分析,初步探討與擬定國醫(yī)大師鄧鐵濤對于冠心病氣虛痰阻證的診斷標準草案,為名老中醫(yī)專病診治的學術(shù)思想傳承工作作出一定的貢獻。方法:1.文獻研究及問卷研究部分1.1對文獻進行研究整理:篩選相關(guān)的證候要素,冠心病氣虛痰阻證的宏觀表征。篩選的主要內(nèi)容包括:鄧老及其主要學術(shù)傳承人、合作學術(shù)傳承人的學術(shù)論文、醫(yī)案、論著;1.2對鄧老主要學術(shù)傳承人進行調(diào)查問卷,并對問卷結(jié)果進行相關(guān)的頻數(shù)統(tǒng)計分析,采用百分權(quán)重法對結(jié)果的相關(guān)條目進行篩選;2.臨床研究部分:根據(jù)前面第一部分的研究結(jié)果,初步擬定病例觀察表,進行臨床研究部分的病例數(shù)據(jù)調(diào)查分析。方法:回顧性分析2015年1月1日至2017年1月1日我院住院期間符合該研究臨床觀察試驗研究標準的患者。統(tǒng)計分析:對臨床部分研究結(jié)果進行Logstic回歸分析得出相關(guān)的結(jié)論。結(jié)果:根據(jù)Logistic回歸分析結(jié)果,國醫(yī)大師鄧鐵濤論治冠心病氣虛痰阻證的主要相關(guān)因素有:胸痛(以悶痛、隱痛為主)(OR=2.63)、四肢乏力(OR=3.51)、神疲、咳嗽、痰多(OR=1.98)、苔膩(OR=1.79)、脈沉滑或沉細(OR=1.9)、納呆(OR=1.53)、吸煙(OR=3.33)、BMI(OR=1.24)、高尿酸血癥(OR=1.14)、TG(OR=1.29)、LDL-C(OR=1.49)、HCY(OR=1.15)、EF 值(OR=1.07)、E/A(OR=2.07)、高血壓(OR=1.62)。結(jié)論:根據(jù)各變量OR值分別對應(yīng)各個變量因素對結(jié)果的貢獻度,對主、次證進行篩選。結(jié)合相關(guān)證候診斷標準的文獻報道,以臨床"實用性"、"科學性"、"重要性"三大原則為主要遵循原則。充分結(jié)合國醫(yī)大師鄧鐵濤的主要傳承人相關(guān)建議,以臨床研究部分回歸分析中OR值的大小為主要依據(jù),并且與臨床實際緊密聯(lián)系,初步探討與擬定國醫(yī)大師鄧鐵濤論治冠心病氣虛痰阻證的辨證診斷標準如下:注:診斷條件①主癥A中一項+主癥B中一項;脈象指標供臨床辨證參考;②主癥A中一項+次證B中至少2項;脈象指標供臨床辨證參考;③主癥B中一項+次證A中2項;脈象指標供臨床辨證參考;④次證A中2項+次證B中至少2項;脈象指標供臨床辨證參考;⑤冠心病氣虛痰阻證的診斷必須包含主癥或次證中的至少一項宏觀指標,單純危險因素指標不能診斷冠心病氣虛痰阻證。
[Abstract]:Objective: in the field of standardization and standardization of diagnosis of syndrome of Qi deficiency and phlegm obstruction syndrome in the treatment of coronary heart disease by Deng Tietao, a master of Chinese medicine, there is currently no established diagnostic standard of syndrome differentiation, which has a higher degree of recognition and stronger practicability. To establish the syndrome differentiation standard of qi deficiency and phlegm obstruction in coronary heart disease is the necessary prerequisite for further research on qi deficiency and phlegm obstruction syndrome of coronary heart disease, and is also the necessary condition to ensure that the research results of qi deficiency and phlegm obstruction syndrome are scientific and accurate in the future. Therefore, this study is a preliminary study of the problem. Mainly through summing up Professor Deng Tietao's academic thoughts on treating Qi deficiency and phlegm obstruction syndrome of coronary heart disease, and focusing on the combination of disease and syndrome as the main research unit, to carry out statistical analysis. To discuss and draw up the draft diagnostic standard of Qi-deficiency and phlegm-blocking syndrome of coronary heart disease by Deng Tietao, a master of Chinese medicine, and to contribute to the inheriting of academic thoughts on the diagnosis and treatment of old Chinese medicine. Method 1: 1. Literature research and questionnaire study part 1.1 to study the literature: screening the relevant syndromes elements, coronary heart disease Qi deficiency phlegm obstruction of the macro representation. The main contents of the selection include: Deng Lao and his main academic inheritors, academic papers of cooperative academic inheritors, medical records, a questionnaire to the main academic inheritors of Deng Lao, and statistical analysis of the frequency of the results of the questionnaires. The percentage weight method was used to screen the relevant items of the result. Clinical study part: according to the results of the first part of the previous study, a preliminary case observation table is drawn up, and the case data of the clinical research part are investigated and analyzed. Methods: the patients who met the criteria of clinical observation trial in our hospital from January 1, 2015 to January 1, 2017 were retrospectively analyzed. Statistical analysis: the results of clinical studies were analyzed by Logstic regression analysis. Results: according to the results of Logistic regression analysis, the main factors related to the treatment of Qi-deficiency and phlegm obstruction syndrome of coronary heart disease by Deng Tietao, a great master of Chinese medicine, were as follows: chest pain (mainly suffocating pain, latent pain), fatigue of limbs and orgnia 3.51, fatigue and cough. The sputum was more than OR1.98, the moss was greasy with OR1. 79, the veins were slippery or fine, the OR1. 9 and 1. 53, smoking was 3. 33 and BMIOR1. 24, and hyperuricemia was OR1. 14 and TGG OR1. 29 LDL-COR1.49. The EF value OR1.07EP / A / O 2.07, and hypertension OR1. 622 / 0. Conclusion: according to the contribution degree of each variable factor to the result, the main and secondary syndromes were screened. In combination with the literature reports on the diagnostic criteria of syndromes, the three principles of clinical practicability, scientificalness and importance are the main principles to be followed. In full combination with the relevant suggestions of Deng Tietao, the master of national medicine, and taking the OR value in the partial regression analysis of clinical research as the main basis, and closely related to the clinical practice, The diagnostic criteria for treating Qi-deficiency and phlegm obstruction in coronary heart disease by Deng Tietao, a master of Chinese medicine, were discussed and drawn up as follows: note: one of main symptom B of main symptom A, one of main symptom B, one of pulse index for clinical syndrome differentiation; (2) at least 2 items in one sub-syndrome B of main symptom A, 2 in one sub-syndrome A of main syndrome B for clinical syndrome differentiation, at least two in 2 out of 4 syndromes B for clinical syndrome differentiation. The diagnosis of Qi-deficiency and phlegm obstruction syndrome in coronary heart disease must include at least one macroscopic index in the main or secondary syndromes. The pure risk factor index can not diagnose Qi-deficiency phlegm obstruction syndrome of coronary heart disease.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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