本文選題：腦卒中 + 異病同治��； 參考：《成都中醫(yī)藥大學》2015年博士論文

【摘要】：目的：1.從中醫(yī)學角度探討心腦異病同治的理論基礎,為中風醒腦液治療心血管疾病提供理論依據(jù)；2.通過臨床研究,系統(tǒng)評價中風醒腦液對NSTEMI的治療作用,為中風醒腦液干預治療心血管疾病提供科學依據(jù)。方法：1.理論研究：(1)回顧中醫(yī)學關于“心痛”“胸痹”等類似疾病的認識和研究,并歸納其與現(xiàn)代醫(yī)學AMI的聯(lián)系。(2)探討中醫(yī)學關于心腦異病同源及異病同治的理論基礎。(3)探討中風醒腦液治療NSTEMI的實踐基礎及理論依據(jù)。2.臨床研究(1)本研究采用隨機、平行、對照方法,將84例符合納入標準的NSTEMI患者隨機分為治療組和對照組,其中治療組43例,對照組41例,對兩組納入病例要求基線齊性,具有可比性。(2)兩組患者在均予西醫(yī)常規(guī)搶救治療措施的基礎上,治療組另予中風醒腦液干預治療,療程14d。(3)病程中按照擬定的診療計劃在不同的時間點檢測或記錄ECG、VLP. CK-MB、cTnI、胸痛發(fā)作次數(shù)及持續(xù)時間、鎮(zhèn)痛藥物使用劑量、超聲心動圖(LVEF、 E/A、WMSI)等,并記錄不良安全事件。觀察結束后對兩組檢查結果進行統(tǒng)計分析比較。結果：1.古人對“真心痛”等類似AMI的疾病診治經(jīng)驗豐富,與現(xiàn)代醫(yī)學觀點具有類似之處；中醫(yī)學理論支持心腦異病同源、異病同治的觀點；中風醒腦液治療NSTEMI符合中醫(yī)理論。2.臨床研究(1)入院時兩組患者的基線水平一致,各項基線檢測值無統(tǒng)計學差異。(2)中風醒腦液治療后兩組患者的缺血性心電圖均成好轉趨勢,但是治療組改善趨勢更為明顯。與同組內入院時相比較,治療組在24h的結果就顯示差異具有統(tǒng)計學意義(P0.05),而對照組則是在72h。兩組間結果比較顯示在24h、48h時治療組優(yōu)于對照組(P0.05)。(3)兩組患者在療程中VLP均成好轉趨勢,但治療組更為明顯。組間比較顯示治療組的指標在第1周及第2周時均明顯優(yōu)于對照組(P0.05)。(4)兩組CTnI和CK-MB在病程初期達峰值后均呈下降趨勢,治療組較對照組的cTnI和CK-MB下降趨勢更為明顯,兩組間結果比較顯示差異在第48h、72h時更為突出(P(0.01)。(5)兩組患者胸痛發(fā)作次數(shù)及持續(xù)時間均成下降趨勢,治療組更為明顯,兩組在25-48h時間段內的數(shù)據(jù)具有顯著性差異(P0.05),第7日兩組癥狀已無明顯差別。(6)組間比較結果顯示治療組在各時間段內鎮(zhèn)痛藥劑量均明顯低于對照組(P0.05)。(7)兩組在各個時間段的LVEF、E/A、WMSI指標均趨于好轉,治療組趨勢更明顯。在第7d、14d時治療組的WMSI指標均優(yōu)于對照組(P0.05),而且在第14d時治療組LEVF指標也優(yōu)于對照組(P0.05),整個觀察過程中未見兩組間E/A具有統(tǒng)計學差異(p0.05)。結論：1.中醫(yī)學對AMI類似疾病的臨床診治具有豐富的理論和實踐基礎；中醫(yī)學理論支持心腦異病同治的觀點；2.中風醒腦液的理法方藥適合臨床治療心血管急癥,其治療AMI符合中醫(yī)學異病同治理論；3.中風醒腦液可以顯著改善急性期NSTEMI患者的ECG、VLP、CK-MB、cTnI、超聲心動圖(LVEF、E/A、WMSI),降低胸痛發(fā)作次數(shù)及持續(xù)時間、鎮(zhèn)痛藥物使用劑量,較單純西藥治療具有明顯優(yōu)勢；4.中風醒腦液治療NSTEMI臨床療效確切,安全可靠,無不良反應；5.中風醒腦液是治療NSTEMI的有效方劑。
[Abstract]:Objective: 1. to explore the theoretical basis of treating heart and brain disease with the same treatment from the perspective of traditional Chinese medicine, and to provide the theoretical basis for the treatment of cardiovascular diseases by the stroke Xingnao liquid; 2. through the clinical study, the therapeutic effect of apoplexy Xingnao liquid on NSTEMI is systematically evaluated, and the scientific basis for the intervention and treatment of cardiovascular diseases by the cerebral apoplexy solution is provided. Method: 1. theoretical studies: (1) The understanding and Research on similar diseases such as "heart pain" "chest pain" and other similar diseases in traditional Chinese medicine (TCM). (2) discuss the theoretical basis of traditional Chinese medicine on the homology of different diseases of the heart and brain and the treatment of the same disease. (3) the practical basis and theoretical basis of the treatment of apoplexy in the treatment of AMI (1) clinical study (1) this study was a random, flat study. 84 cases of NSTEMI patients were randomly divided into the treatment group and the control group, including 43 cases in the treatment group and 41 cases in the control group. The two groups were included in the baseline homogeneity and comparable. (2) on the basis of the routine treatment of Western medicine in the two groups, the treatment group was given the intervention therapy of apoplectic wake up solution, and the treatment group was treated with treatment, treatment and treatment of the treatment group. In the course of course 14D. (3), we detected or recorded ECG, VLP. CK-MB, cTnI, the number and duration of chest pain, the dosage of analgesic drugs, LVEF, E/A, WMSI, etc., and recorded the adverse safety events. After the observation, the results of the two groups were statistically analyzed and compared. The results were 1. ancient times. People are rich in the diagnosis and treatment of AMI like diseases, such as "true heart pain" and so on. It is similar to the modern medical viewpoint; the theory of traditional Chinese medicine supports the point of view of the homology of different diseases of heart and brain, and the same treatment with different diseases. The baseline level of the two groups of patients at the admission is consistent with the.2. clinical study of TCM theory (1). Statistical difference. (2) the ischemic electrocardiogram of the two groups of patients after the stroke was improved, but the improvement trend of the treatment group was more obvious. Compared with the same group, the results of the treatment group in 24h showed a statistically significant difference (P0.05), while the results in the group of 72h. were compared to 24h, 48h in the group of two groups. The treatment group was better than the control group (P0.05). (3) the two groups were improved during the course of treatment, but the treatment group was more obvious. The comparison between the group and the treatment group showed that the index of the treatment group was obviously superior to the control group at first and 2 weeks (P0.05). (4) the two groups of CTnI and CK-MB were decreasing in the initial stage of the course of the disease, and the treatment group was cTnI and CK-M compared with the control group. The downward trend of B was more obvious. The results showed that the difference between the two groups was more prominent in 48h and 72h (P (0.01). (5) the number and duration of chest pain in the two groups were decreased, the treatment group was more obvious, the data in the two groups were significantly different (P0.05), and there was no significant difference between the two groups of the two groups on the seventh day. (6) the group of two groups had no significant differences. The comparison results showed that the dosage of the analgesic drug in the treatment group was significantly lower than that of the control group (P0.05). (7) the LVEF, E/A, WMSI indexes of the two groups tended to improve, and the trend of the treatment group was more obvious. The WMSI index in the treatment group was better than that of the control group at 7d and 14d, and the LEVF index in the treatment group was also better than the control group at 14d. Group (P0.05), there was no statistical difference between the two groups in the whole observation process (P0.05). Conclusion: 1. Chinese medicine has a rich theoretical and practical basis for the clinical diagnosis and treatment of similar diseases of AMI; the theory of traditional Chinese medicine supports the viewpoint of the same treatment of heart and brain diseases; 2. the rational prescription of the cerebral apoplexy solution is suitable for the clinical treatment of cardiovascular emergencies, and the treatment of AM I accords with the theory of treatment of different diseases in Chinese medicine; 3. apoplexy Xingnao liquid can significantly improve ECG, VLP, CK-MB, cTnI, echocardiography (LVEF, E/A, WMSI) in acute NSTEMI patients, reduce the number and duration of chest pain, and the dosage of analgesic drugs has obvious advantages compared with that of pure western medicine; the clinical efficacy of the treatment of NSTEMI in the treatment of apoplexy is true. The clinical efficacy of the treatment of NSTEMI is true. Cut, safe and reliable, no adverse reactions; 5. stroke Xingnao liquid is an effective prescription for treating NSTEMI.

【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R542.22

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