本文選題：制何首烏 + 數(shù)據(jù)挖掘��； 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：研究目的:本文通過對仝小林教授門診應用制何首烏病例數(shù)據(jù)進行回顧性分析,觀察門診應用制何首烏病例患者基本情況(年齡、性別)、疾病情況(糖尿病及并發(fā)癥、高血壓等)、用藥情況(日用劑量、療程、累計劑量等)、四診情況(乏力、脫發(fā)等)、配伍情況以及合并用藥、過敏史對處方中含制何首烏病例出現(xiàn)不良事件類型統(tǒng)計并進行分析。通過基于真實世界的數(shù)據(jù)挖掘,總結仝小林教授臨床應用制何首烏經(jīng)驗。研究方法:收集違反仝小林教授門診病歷系統(tǒng)錄入應用制何首烏的病例,采用回顧性分析,對病歷基本信息采用描述性分析,采用關聯(lián)分析法挖掘癥-藥配伍經(jīng)驗,不良事件采用Karch與Lasagna評定方法評價與制何首烏的相關性。研究結果:(1)基本情況：本研究根據(jù)納入排除標準,從仝小林教授門診2008年7月至2015年3月期間門診病例篩選出143例應用制何首烏病例,共271診次。其中男性患者26例,占比18.18%,女性患者117例,占比81.82%。40歲以上中老年患者居多,共計112例,占比78.61%,其中40～60歲年齡段患者較多,共計90例,占比62.93%。病例診斷主要以糖尿病、代謝性疾病為主。(2)制何首烏用量和療程:何首烏單日劑量主要以30g和15g居多,其15g占比75.81%,30g占比20.95%。少部分病情較輕者小劑量服用水丸,單日劑量0.3～9.6g之間,占比3.24%。總體單日平均劑量(16.55±6.86)g。療程最長為502天,最短14天,平均療程(81.11±82.83)天;累計劑量最大6720g,最小180g,平均累計劑量(1105.26±1015.17)g(3)制何首烏治療主癥及舌脈:刻下癥以失眠、乏力、便秘、四肢麻木疼痛,腰部酸痛,多汗,脫發(fā)較常見;舌象以舌紅、舌底瘀滯、舌胖大、齒痕、舌細顫、苔黃、苔膩較常見;脈象以脈弦、脈沉、脈數(shù)、脈細、脈滑較常見。(4)基于關聯(lián)分析法進行數(shù)據(jù)挖掘:分析對象選取頻次出現(xiàn)較高的刻下癥:失眠、乏力、便秘、烘熱汗出、腰部酸痛、四肢麻木、脫發(fā),臨床應用制何首烏配伍情況分析,結果發(fā)現(xiàn)大部分與臨床實際符合,但也存在偏差。具體結果以網(wǎng)絡圖和關聯(lián)性指數(shù)排列表呈現(xiàn)。(5)不良事件:143例患者中,出現(xiàn)不良事件共17例,以胃腸道反應、皮膚異常較多,胃腸道反應8例,皮膚異常4例,肝功異常2例,腰酸小便頻1例,上火反應2例。根據(jù)Karch與Lasagna評定方法對不良事件進行評價,判斷僅1例不良事件與服用制何首烏相關性強。結論:本研究發(fā)現(xiàn)仝小林教授主要應用制何首烏治療肝腎虧虛、氣血虛弱證型的患者。制何首烏治療常見癥狀主要有失眠、乏力、便秘、脫發(fā)、腰部酸痛等癥狀。不良反應發(fā)生率較低可能與何首烏的炮制以及導師在應用時多隨時關注患者的病史及實驗室指標變化,并相應及時配伍保肝藥物有關;但不良反應事件的發(fā)生影響因素多,個體差異大,醫(yī)生需辨證準確,謹慎用藥,合理配伍減毒預防不良反應的發(fā)生。
[Abstract]:Objective: through retrospective analysis of the data of outpatient application of Polygonum multiflorum by Professor Tong Xiaolin, we observed the basic condition (age, sex, disease (diabetes and complication) of the case of polygonum multiflorum). Hypertension and so on, medication (daily dosage, course of treatment, cumulative dose, etc.), four diagnosis (fatigue, alopecia, compatibility and combination of medication, allergy history of the prescription of polygonum multiflorum) adverse events type statistics and analysis. Based on real-world data mining, Professor Tong Xiaolin's experience in clinical application of Polygonum multiflorum is summarized. Methods: to collect the cases that violated Professor Tong Xiaolin's out-patient medical record system input into the application system of Polygonum multiflorum, to use retrospective analysis, to use descriptive analysis to the basic information of medical records, and to use the correlation analysis method to excavate the experience of symptom-drug compatibility. The adverse events were evaluated by Karch and Lasagna methods. Results: according to the exclusion criteria, 143 cases of Polygonum multiflorum were selected from Professor Tong Xiaolin outpatient between July 2008 and March 2015, with 271 diagnoses. Among them, there were 26 male patients (18.18%), 117 female patients (81.82%), 112 cases (78.61%), and 90 cases (62.93%) in 40 ~ 60 years old patients. The dosage and course of treatment of Radix Polygoni multiflorum were mainly composed of diabetes mellitus and metabolic disease. The daily dose of Radix Polygoni multiflorum was mainly 30g and 15g, and the ratio of 15g / day was 75.81g / 30g and 20.95g / day respectively. A small number of patients with mild illness took water pills at a daily dose of 0.3c9.6g, accounting for 3.24g. The total daily average dose was 16.55 鹵6.86g. The longest course of treatment was 502 days, the shortest 14 days, the average course of treatment was 81.11 鹵82.83 days, the maximum cumulative dose was 6720g, the minimum was 180g, the average cumulative dose was 1105.26 鹵1015.17g / g) the main symptoms and tongue veins of Polygonum multiflorum were treated with insomnia, fatigue, constipation, numb pain in limbs, aching waist, sweating, etc. Alopecia is more common; tongue appearance is red, the base of tongue is stagnant, fat tongue is large, teeth mark, thin tremor of tongue, yellow fur, greasy fur; pulse is more common in string, sink, number and fine vein, Data mining based on correlation analysis: the subjects were selected frequently: insomnia, fatigue, constipation, heat sweating, waist ache, limb numbness, alopecia, etc. According to the analysis of the compatibility of the clinical application of Polygonum multiflorum, it was found that most of them were in accordance with the clinical practice, but there were some deviations. Results among 143 patients with adverse events, 17 had adverse events, including gastrointestinal reactions, gastrointestinal reactions in 8 cases, skin abnormalities in 4 cases and liver dysfunction in 2 cases. Lumbar acid urination frequency in 1 case, fire reaction in 2 cases. According to the Karch and Lasagna evaluation methods, only one case of adverse events was found to be strongly correlated with the use of Radix Polygoni multiflorum. Conclusion: this study found that Professor Tong Xiaolin mainly used Polygonum multiflorum for the treatment of deficiency of liver and kidney, deficiency of qi and blood. The common symptoms of Polygonum multiflorum are insomnia, fatigue, constipation, alopecia, pain in the waist and so on. The low incidence of adverse reactions may be related to the preparation of Radix Polygoni multiflorum and the frequent attention paid by mentors to the changes of patients' history and laboratory indexes, and the corresponding timely compatibility of liver protection drugs, but there are many factors affecting the occurrence of adverse events. The individual difference is big, the doctor needs to differentiate the syndrome accurately, uses the medicine carefully, the reasonable compatibility reduces the poison to prevent the adverse reaction the occurrence.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R249

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