本文關(guān)鍵詞：基于醫(yī)案回顧的中風(fēng)病急性期氣虛血瘀證臨床特點(diǎn)及演變趨勢(shì)研究　出處：《北京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 中風(fēng)病 氣虛血瘀證 臨床特點(diǎn) 演變

【摘要】：目的：通過(guò)病例回顧分析中風(fēng)病始發(fā)態(tài)氣虛血瘀證臨床特點(diǎn),探討陽(yáng)(氣)虛化風(fēng)病機(jī)的臨床內(nèi)涵,并根據(jù)病例分析得出的中風(fēng)病始發(fā)態(tài)氣虛血瘀證臨床特點(diǎn),總結(jié)前人辨識(shí)始發(fā)態(tài)氣虛血瘀證的臨床依據(jù)；同時(shí)通過(guò)病例回顧觀察始發(fā)態(tài)氣虛血瘀證在中風(fēng)病急性期不同時(shí)點(diǎn)的演變,分析中風(fēng)病急性期氣虛血瘀證演變趨勢(shì)。方法：收集發(fā)病3天以內(nèi)的中風(fēng)病住院病例1049例,其中中醫(yī)證候診斷符合氣虛血瘀證的病例85例,使用統(tǒng)一的調(diào)查量表《中風(fēng)病醫(yī)案信息調(diào)查表》,采集患者發(fā)病1-3天、5-7天、10-14天三個(gè)時(shí)點(diǎn)的信息。采集內(nèi)容主要包括患者的基本信息、發(fā)病誘因、起病形式、中醫(yī)四診信息、既往史、個(gè)人史、家族史、診斷、方藥等資料。將采集內(nèi)容進(jìn)行整理并建立中風(fēng)病醫(yī)案數(shù)據(jù)庫(kù),首先對(duì)中風(fēng)病醫(yī)案信息進(jìn)行描述性統(tǒng)計(jì)分析,并對(duì)比分析氣虛血瘀證和非氣虛血瘀證臨床表征的不同,尋找對(duì)氣虛血瘀證有特異性診斷價(jià)值的臨床表征,然后回顧分析以氣虛血瘀證為首發(fā)證候的中風(fēng)病在不同年代、發(fā)病不同時(shí)點(diǎn)的呈現(xiàn)規(guī)律和演變趨勢(shì)。結(jié)果：1、以氣虛血瘀證為首發(fā)證候的中風(fēng)病患者共計(jì)85例,占同期住院中風(fēng)病總?cè)藬?shù)的8.10%,在所有中風(fēng)病始發(fā)態(tài)中醫(yī)證候中位居第四位；平均發(fā)病年齡為66.76±10.393歲,其中60-70歲和70-80歲是發(fā)病的兩個(gè)高峰,與非氣虛血瘀證相比在年齡上無(wú)明顯差異(P0.05)；氣虛血瘀證患者多發(fā)于秋冬季節(jié),尤以冬季發(fā)病率最高,與非氣虛血瘀證相比在季節(jié)上無(wú)明顯差異(P0.05)：在有明確發(fā)病誘因的患者中氣虛血瘀證以勞累最為多見,與非氣虛血瘀證相比在發(fā)病誘因上無(wú)明顯差異(P0.05)；氣虛血瘀證最常見的既往史由高到低依次為高血壓、中風(fēng)、冠心病,占比分別為56.47%、51.76%、32.94%,氣虛血瘀證組存在既往中風(fēng)病史、冠心病史、房顫病史患者百分率均高于非氣虛血瘀證組(P0.05)。2、中風(fēng)病急性期氣虛血瘀證患者臨床常見癥狀按出現(xiàn)頻率由高到低依次為神疲乏力或倦怠嗜臥或少氣懶言(57.65%)、頭暈(48.24%)、便干(32.94%)、飲水嗆咳(25.88%)、心悸(25.88%)、肢痛不移(24.71%)、胸悶(24.71%)、大便三日或數(shù)日未解(23.53%)、不寐(20.00%)、頭痛(20.00%)、咳嗽(16.47%)、步履不穩(wěn)(16.47%)、納差(14.12%)、口干(11.76%)、惡嘔(10.59%)、小便頻數(shù)(10.59%)、小便失禁(10.59%)、憋氣(10.59%)；在神疲乏力或倦怠嗜臥或少氣懶言、便干、肢痛不移、胸悶、面色萎黃、憋氣、四末不溫、短氣、余尿不盡或不暢、便溏、手足腫脹、大便黏膩不爽等癥狀較非氣虛血瘀證組比例升高(P0.05)；從舌象來(lái)看,氣虛血瘀證組患者中出現(xiàn)舌淡、舌暗、舌體胖大、舌邊有齒痕、白苔、薄苔的百分率高于非氣虛血瘀證組(P0.05)；從脈象來(lái)看,氣虛血瘀證組患者中出現(xiàn)緩脈、沉脈、細(xì)脈、弱脈、澀脈、結(jié)代脈的百分率高于非氣虛血瘀證組(P0.05)。3、以氣虛血瘀證為首發(fā)證候的中風(fēng)病在90年代以前、1990-1994、1995-1999、2000年以后四個(gè)時(shí)間段中發(fā)病率呈現(xiàn)下降中轉(zhuǎn)升,總體趨勢(shì)為逐漸升高,2000年以后發(fā)病率最高,為13.68%。4、氣虛血瘀證在中風(fēng)病發(fā)病1-3天、5-7天、10-14天出現(xiàn)頻率分別為8.10%、14.68%、24.69%,隨發(fā)病時(shí)間的推移,氣虛血瘀證所占比例逐漸增大。首發(fā)證候?yàn)闅馓撗鲎C的85例中風(fēng)病患者在發(fā)病5-7天時(shí)有60例保持原有證候不變,而在發(fā)病10-14天時(shí)有50例保持原有證候不變,以痰濕蒙塞心神、痰熱瘀血、陰虛風(fēng)動(dòng)為始發(fā)態(tài)證候的中風(fēng)病患者在發(fā)病5-7天時(shí)最容易演變?yōu)闅馓撗鲎C,演變率分別為28.57%、23.53%、16.67%。5、以氣虛血瘀證為首發(fā)證候的中風(fēng)病,中藥治療大法為益氣活血,基本方藥為補(bǔ)陽(yáng)還五湯的組成即赤芍、當(dāng)歸、黃芪、川芎、地龍、桃仁、紅花。同時(shí)根據(jù)患者臨床癥狀的不同,隨證加減。結(jié)論：1、中風(fēng)病始發(fā)態(tài)氣虛血瘀證患者臨床特異性癥狀包括：面色萎黃、神疲乏力或倦怠嗜臥或少氣懶言、胸悶、憋氣、短氣、肢痛不移、手足腫脹、四末不溫、余尿不盡或不暢、便溏、大便黏膩不爽,舌象為舌淡、舌暗、舌體胖大、舌邊有齒痕、白苔、薄苔,脈象為緩脈、沉脈、細(xì)脈、弱脈、澀脈、結(jié)代脈；始發(fā)態(tài)為氣虛血瘀證與中風(fēng)病史、冠心病史、房顫病史相關(guān)。上述臨床表現(xiàn)可作為辨識(shí)中風(fēng)病始發(fā)態(tài)氣虛血瘀證的臨床依據(jù)。2、中風(fēng)病從始發(fā)態(tài)到發(fā)病14天,氣虛血瘀證比重不斷增加,與既往中風(fēng)病恢復(fù)期氣虛血瘀證較為多見相吻合；中風(fēng)病始發(fā)態(tài)氣虛血瘀證者,約60%在中風(fēng)病發(fā)病14天以內(nèi)不發(fā)生變化,其余40%中有一半以上向風(fēng)痰瘀血痹阻脈絡(luò)證演變。3、中風(fēng)是氣機(jī)逆亂所致,陽(yáng)亢化風(fēng),風(fēng)痰瘀血痹阻脈絡(luò)已經(jīng)成為公認(rèn)的中風(fēng)病發(fā)病病機(jī),陽(yáng)(氣)虛化風(fēng),氣虛血瘀所致中風(fēng),也應(yīng)引起高度重視,始發(fā)態(tài)為氣虛血瘀證者屬陽(yáng)(氣)虛化風(fēng),治療大法為益氣活血。
[Abstract]:Objective: through the retrospective analysis of clinical features of stroke originating state of qi deficiency and blood stasis syndrome, to explore the clinical meaning of Yang (gas) virtual wind disease machine, and according to the clinical characteristics of stroke with Qi deficiency and blood stasis syndrome cases originating state analysis, summarize the clinical basis of previous identification of starting states of qi deficiency and blood stasis; at the same time by retrospective observation of origin the state of qi deficiency and blood stasis syndrome evolution in the acute stage of stroke and analysis of acute stroke with Qi deficiency and blood stasis syndrome evolution trend. Methods: 1049 cases were collected within 3 days of onset of stroke patients, the diagnosis of TCM syndrome with Qi deficiency and blood stasis syndrome 85 cases, questionnaire < apoplexy medical record information questionnaire the use of a unified collection >, patients 1-3 days, 5-7 days, 10-14 days and three point information. The acquisition includes basic information, patients with predisposing factors, mode of onset, four diagnostic information of TCM, not only The diagnosis of history, personal history, family history, medicine and so on. The content of the collection sorting and the establishment of apoplexy medical record database, first carries on the descriptive statistical analysis on the apoplexy medical record information, and the comparative analysis of qi deficiency and blood stasis and Qi deficiency and blood stasis syndrome clinical characterization of different clinical characterization for a specific diagnostic value for Qi deficiency and blood stasis, and then analyzed retrospectively with Qi deficiency and blood stasis syndrome as the first stroke in different ages, and the evolution trend of incidence trend at different time points. Results: 1, with Qi deficiency and blood stasis syndrome as the first stroke patients with 85 cases, accounting for the total number of hospitalized stroke 8.10%. Ranked fourth in all stroke syndromes in the state of origin; the average age was 66.76 + 10.393 years, 60-70 years and 70-80 years old is the peak incidence of two, compared with the non Qi deficiency and blood stasis in the age of no significant difference ISO (P0.05); patients with Qi deficiency and blood stasis syndrome is more common in autumn and winter, especially in winter, the highest incidence rate, compared with Qi deficiency and blood stasis syndrome has no obvious difference in the season (P0.05): when there is a clear predisposing factors in patients with Qi deficiency and blood stasis with fatigue is the most common, compared with Qi deficiency and blood stasis syndrome without obvious the difference in incidence incentives (P0.05); the most common syndrome of qi deficiency and blood stasis history from high to low were hypertension, stroke, coronary heart disease, accounted for 56.47%, 51.76%, 32.94%, Qi deficiency and blood stasis group had previous history of stroke, coronary heart disease history, history of atrial fibrillation patients were all higher than that of qi deficiency and blood stasis group (non.2, P0.05) in acute stroke patients with Qi deficiency and blood stasis of common clinical symptoms according to the frequency from high to low is fatigue or lethargy lying or less lazy (57.65%), dizziness (48.24%), dry stool (32.94%), hydroposia (25.88%), (25.88%), limb palpitations 鐥涗笉縐，

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