126例老年體位性低血壓中醫(yī)證型分布規(guī)律和相關(guān)因素分析
發(fā)布時(shí)間：2018-08-31 19:35
【摘要】：目的:通過(guò)對(duì)本課題的研究,探索老年體位性低血壓的中醫(yī)證型分布及其規(guī)律,探索該病主要證型的中醫(yī)特點(diǎn)及臨床表現(xiàn),了解相關(guān)因素對(duì)本病的發(fā)生發(fā)展及中醫(yī)各證型分布的關(guān)系,為規(guī)范該病中醫(yī)證型辨證提供客觀依據(jù),為該病進(jìn)一步的流行病學(xué)研究提供一定的基礎(chǔ)資料。方法:擬定《老年體位性低血壓臨床調(diào)查表》,通過(guò)對(duì)中日友好醫(yī)院和東直門(mén)醫(yī)院兩家醫(yī)院門(mén)診及住院的老年體位性低血壓患者進(jìn)行現(xiàn)場(chǎng)調(diào)查及進(jìn)行相關(guān)檢查,觀察老年體位性低血壓中醫(yī)癥候特點(diǎn)、尋找中醫(yī)辨證分型規(guī)律,統(tǒng)計(jì)、分析該病與年齡、高血壓、動(dòng)態(tài)血壓及各種合并疾病等的相關(guān)性。結(jié)果老年體位性低血壓發(fā)病隱匿,以臥立位時(shí)頭暈、乏力、活動(dòng)能力下降等癥候?yàn)樘攸c(diǎn)。對(duì)126例該病患者進(jìn)行分析研究:①對(duì)中醫(yī)證型進(jìn)行分析:主要的中醫(yī)證型有4個(gè),分別為氣陰兩虛(63.5%)脾腎兩虛(12.7%)痰瘀互阻(9.5%)陰陽(yáng)兩虛(7.1%),氣陰兩虛證型中,亞型瘀血阻絡(luò)型占到近一半,尚有陰虛陽(yáng)亢、濕熱內(nèi)蘊(yùn)、心腎不交等證型,所占比重較小。②對(duì)發(fā)病年齡進(jìn)行分析:老年體位性低血壓患病率隨年齡增長(zhǎng)而增加,其中 60-69 歲 26 例(20.6%),70-79 歲 35 例(27.8%),80-90 歲 54 例(42.9%),90歲以上11例(8.7%)。③對(duì)患者病史進(jìn)行分析:其中無(wú)體位性低血壓病史46例(36.5%),3年以內(nèi)(含3年)63例(50.0%),3年以上]7例(13.5%)。④對(duì)患者的職業(yè)進(jìn)行分析:腦力勞動(dòng)者90例(71.4%),體力勞動(dòng)者24例(19.0%),不確定者12例(9.5%)。⑤對(duì)合并癥統(tǒng)計(jì)分析:大多數(shù)合并有3種及以上基礎(chǔ)疾病,其中合并高血壓(82例,65.1%)和合并腦梗(80例,63.5%)的超過(guò)半數(shù);78例患者完成了 24小時(shí)動(dòng)態(tài)血壓監(jiān)測(cè),其中非勺型血壓占絕大多數(shù)(72例,92.3%)。⑥對(duì)中醫(yī)證型與相關(guān)因素分析:70歲以上各證型分布差異較大(P0.05),以氣陰兩虛和亞型瘀血阻絡(luò)為主;在職業(yè)上各證型分布無(wú)明顯差異(P0.05),亞型瘀血阻絡(luò)在合并高血壓分布中有顯著性差異(P0.05),其他證型無(wú)差異;氣陰兩虛和亞型瘀血阻絡(luò)在合并腦梗塞的分布上有顯著性差異(P0.05),其他證型無(wú)差異。結(jié)論氣陰兩虛、脾腎兩虛、痰瘀互阻、陰陽(yáng)兩虛是老年體位性低血壓的四個(gè)主要基本證型,其中氣陰兩虛型占絕大多數(shù),亞型瘀血阻絡(luò)占到氣陰兩虛型近一半,血瘀是最重要的病理因素。老年體位性低血壓的中醫(yī)發(fā)病特點(diǎn)為:起病隱匿,患者不能正確估算發(fā)病時(shí)間,常伴有頭痛、頭脹、氣短乏力、口干舌燥、大便干結(jié)、小便頻數(shù)等臨床癥狀。老年體位性低血壓隨年齡的增加其患病率增加,與職業(yè)(腦力勞動(dòng))有一定的相關(guān)性。老年體位性低血壓常合并3種以上的合并癥,其中以高血壓、腦梗塞較多見(jiàn)(50%),而糖尿病、冠心病、腎功能不全等常見(jiàn)基礎(chǔ)疾病似與老年體位性低血壓沒(méi)有很強(qiáng)的相關(guān)性,高血壓、24h動(dòng)態(tài)血壓異常與體位性低血壓密切相關(guān),分析可能是同一種疾病在不同發(fā)展時(shí)期的階段性突出表現(xiàn)相互參雜、相互影響。腦梗塞和體位性低血壓高度相關(guān)并相互影響,共同促進(jìn)了腦損傷發(fā)展,影響大腦認(rèn)知功能。年齡越大,氣陰兩虛和亞型瘀血阻絡(luò)分布越明顯。
[Abstract]:Objective:To explore the distribution and regularity of TCM syndromes of orthostatic hypotension in the elderly, explore the characteristics and clinical manifestations of the main syndromes of the disease, understand the relationship between the occurrence and development of the disease and the distribution of TCM syndromes, and provide an objective basis for standardizing the syndrome differentiation of the disease in TCM, so as to promote the progress of the disease. Methods: To draw up the clinical questionnaire of orthostatic hypotension in the elderly, and to observe the characteristics of TCM symptoms of orthostatic hypotension in the elderly through on-the-spot investigation and related examinations on the outpatients and inpatients of both Sino-Japanese Friendship Hospital and Dongzhimen Hospital. Results The incidence of orthostatic hypotension in the elderly was concealed, characterized by dizziness, fatigue and decreased activity in the supine position. 126 cases of this disease were analyzed and studied: 1. Analysis: There are four main TCM syndromes: deficiency of both qi and Yin (63.5%) and deficiency of spleen and kidney (12.7%) and mutual obstruction of phlegm and blood stasis (9.5%) and deficiency of both yin and Yang (7.1%). The prevalence of hypertension increased with age, including 26 cases (20.6%) aged 60-69, 35 cases (27.8%) aged 70-79, 54 cases (42.9%) aged 80-90 and 11 cases (8.7%) aged over 90. Analysis: 90 cases (71.4%) of mental workers, 24 cases (19.0%) of manual workers, 12 cases (9.5%) of uncertainties. _Statistical analysis of complications: most of the patients with three or more basic diseases, including hypertension (82 cases, 65.1%) and cerebral infarction (80 cases, 63.5%) more than half of them; 78 patients completed 24-hour ambulatory blood pressure monitoring, including non- Spoon blood pressure accounted for the vast majority (72 cases, 92.3%)._Analysis of TCM syndrome types and related factors: the distribution of syndrome types over 70 years old was significantly different (P 0.05), mainly deficiency of both Qi and Yin and blood stasis blocking collaterals of subtypes; occupational distribution of each syndrome type was not significantly different (P 0.05), subtype of blood stasis blocking collaterals in the distribution of combined hypertension was significantly different (P 0.05), others (P 0.05). Conclusion Qi-yin deficiency, spleen and kidney deficiency, phlegm and blood stasis obstruction, yin-yang deficiency are the four main basic syndromes of senile orthostatic hypotension, of which Qi-Yin Deficiency and blood stasis obstruction are the overwhelming majority. Blood stasis is the most important pathological factor in nearly half of the deficiency of both Qi and Yin. The onset of orthostatic hypotension in the elderly is characterized by concealed onset, incorrect estimation of onset time, headache, head distension, shortness of breath, dry mouth, dry stool, and frequent urination. Postural hypotension in the elderly is often associated with more than three complications, including hypertension and cerebral infarction (50%), while diabetes, coronary heart disease, renal insufficiency and other common basic diseases seem to have no strong correlation with postural hypotension in the elderly, hypertension, 24h ambulatory blood pressure is different. Often closely related to orthostatic hypotension, analysis may be the same disease in different stages of development, the prominent manifestations of each other, mutual influence. The more obvious the distribution.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
本文編號(hào)：2215959
[Abstract]:Objective:To explore the distribution and regularity of TCM syndromes of orthostatic hypotension in the elderly, explore the characteristics and clinical manifestations of the main syndromes of the disease, understand the relationship between the occurrence and development of the disease and the distribution of TCM syndromes, and provide an objective basis for standardizing the syndrome differentiation of the disease in TCM, so as to promote the progress of the disease. Methods: To draw up the clinical questionnaire of orthostatic hypotension in the elderly, and to observe the characteristics of TCM symptoms of orthostatic hypotension in the elderly through on-the-spot investigation and related examinations on the outpatients and inpatients of both Sino-Japanese Friendship Hospital and Dongzhimen Hospital. Results The incidence of orthostatic hypotension in the elderly was concealed, characterized by dizziness, fatigue and decreased activity in the supine position. 126 cases of this disease were analyzed and studied: 1. Analysis: There are four main TCM syndromes: deficiency of both qi and Yin (63.5%) and deficiency of spleen and kidney (12.7%) and mutual obstruction of phlegm and blood stasis (9.5%) and deficiency of both yin and Yang (7.1%). The prevalence of hypertension increased with age, including 26 cases (20.6%) aged 60-69, 35 cases (27.8%) aged 70-79, 54 cases (42.9%) aged 80-90 and 11 cases (8.7%) aged over 90. Analysis: 90 cases (71.4%) of mental workers, 24 cases (19.0%) of manual workers, 12 cases (9.5%) of uncertainties. _Statistical analysis of complications: most of the patients with three or more basic diseases, including hypertension (82 cases, 65.1%) and cerebral infarction (80 cases, 63.5%) more than half of them; 78 patients completed 24-hour ambulatory blood pressure monitoring, including non- Spoon blood pressure accounted for the vast majority (72 cases, 92.3%)._Analysis of TCM syndrome types and related factors: the distribution of syndrome types over 70 years old was significantly different (P 0.05), mainly deficiency of both Qi and Yin and blood stasis blocking collaterals of subtypes; occupational distribution of each syndrome type was not significantly different (P 0.05), subtype of blood stasis blocking collaterals in the distribution of combined hypertension was significantly different (P 0.05), others (P 0.05). Conclusion Qi-yin deficiency, spleen and kidney deficiency, phlegm and blood stasis obstruction, yin-yang deficiency are the four main basic syndromes of senile orthostatic hypotension, of which Qi-Yin Deficiency and blood stasis obstruction are the overwhelming majority. Blood stasis is the most important pathological factor in nearly half of the deficiency of both Qi and Yin. The onset of orthostatic hypotension in the elderly is characterized by concealed onset, incorrect estimation of onset time, headache, head distension, shortness of breath, dry mouth, dry stool, and frequent urination. Postural hypotension in the elderly is often associated with more than three complications, including hypertension and cerebral infarction (50%), while diabetes, coronary heart disease, renal insufficiency and other common basic diseases seem to have no strong correlation with postural hypotension in the elderly, hypertension, 24h ambulatory blood pressure is different. Often closely related to orthostatic hypotension, analysis may be the same disease in different stages of development, the prominent manifestations of each other, mutual influence. The more obvious the distribution.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
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