發(fā)布時(shí)間：2018-03-11 04:27

  本文選題：老年腦梗塞　切入點(diǎn)：肺部感染　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：老年腦梗塞急性期肺部感染中醫(yī)證型分布組合繁多復(fù)雜,目前尚無(wú)統(tǒng)一標(biāo)準(zhǔn),這不利于臨床應(yīng)用以及臨床診療水平的提高。本研究目的：(1)探討中醫(yī)證型分布及演變規(guī)律,進(jìn)行規(guī)范化和標(biāo)準(zhǔn)化研究,以期更好的指導(dǎo)臨床應(yīng)用。(2)選擇證型分布最常見的證型(痰熱壅肺證),開展中醫(yī)辨證治療,觀察其臨床療效,評(píng)價(jià)辨證治療的效果,并探求其作用機(jī)理,為臨床推廣應(yīng)用提供臨床依據(jù)。方法：(一)證型分布規(guī)律研究：采用前瞻性調(diào)查研究的方法,收集2014年3月～2015年4月間在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院腦病中心顱腦科確診的老年腦梗塞急性期肺部感染住院病人120例,采集一般情況、證素,概括證型轉(zhuǎn)歸等內(nèi)容。(由經(jīng)驗(yàn)豐富的3位醫(yī)生同時(shí)對(duì)每位患者進(jìn)行證素及證型判定,其結(jié)果的判定同時(shí)需要2位醫(yī)師的認(rèn)可才能成立。)收集患者入院第1天證素情況,分別統(tǒng)計(jì)第1-5天、6-10天、11～14天證型分布及最常見證型轉(zhuǎn)化情況,并將結(jié)果填入設(shè)計(jì)好的調(diào)查表中,建立原始臨床數(shù)據(jù)庫(kù)后,將數(shù)據(jù)導(dǎo)入SPSS 19.0,對(duì)證素總體分布情況、證型分布情況進(jìn)行頻數(shù)統(tǒng)計(jì),從而歸納總結(jié)出主要證型分布規(guī)律以及隨著病程轉(zhuǎn)化情況。(二)痰熱壅肺證辨證治療的研究：收集2015年5月～2016年1月間在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院腦病中心顱腦科確診為老年腦梗塞急性期肺部感染痰熱壅肺證的在院病人60例,隨機(jī)分為對(duì)照組和治療組(在現(xiàn)代醫(yī)學(xué)常規(guī)治療基礎(chǔ)上,口服或鼻飼清熱化痰合劑,辨證加減通腑合劑、益氣養(yǎng)陰合劑),每組30人。觀察兩組患者治療前后中醫(yī)癥狀積分、肺部感染癥狀體征評(píng)分、實(shí)驗(yàn)室生化指標(biāo)(白細(xì)胞及降鈣素原)變化情況；NIHSS評(píng)分(入院時(shí)、治療前、治療后)、肺部感染控制時(shí)間。驗(yàn)證清熱化痰合劑(辨證加減通腑合劑、益氣養(yǎng)陰合劑)治療老年腦梗塞急性期肺部感染痰熱壅肺證的臨床療效,并探求其作用機(jī)理。結(jié)果：(一)證型分布研究：1.老年腦梗塞急性期肺部感染的主要證型分布：痰熱壅肺證(48.3%),氣虛痰濁阻肺證(16.7%),陰陽(yáng)兩虛痰閉證(13.3%),氣虛血瘀痰阻證(6.7%),瘀熱蘊(yùn)毒證(3.3%),氣陰兩虛證(3.3%)。痰熱壅肺證為老年腦梗塞急性期肺部感染最常見的證型。2.痰熱壅肺證58例患者在第6-10天期間有30例兼有腑實(shí)證,10例兼有氣陰兩虛證。在11-14天期間,腑實(shí)、氣陰兩虛證病例進(jìn)一步增加,分別為32例,30例。(二)痰熱壅肺證治療的研究：1.治療組在入院時(shí)患者NIHSS評(píng)分與治療前NIHSS評(píng)分進(jìn)行比較有顯著性統(tǒng)計(jì)學(xué)差異(P0.05),對(duì)照組在入院時(shí)患者NIHSS評(píng)分與感染治療前NIHSS評(píng)分進(jìn)行比較也有顯著性統(tǒng)計(jì)學(xué)差異(P0.05)。治療組與對(duì)照組在治療后NIHSS評(píng)分、治療前后兩組差值比較無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。2.治療組與對(duì)照組在肺部感染控制時(shí)間相比有明顯統(tǒng)計(jì)學(xué)差異(P0.05),兩組患者在治療后白細(xì)胞及降鈣素原異常比較無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),兩組患者治療期間死亡人數(shù)無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。3.治療組與對(duì)照組在治療后中醫(yī)癥候評(píng)分、治療前后中醫(yī)癥候評(píng)分差值比較、治療后肺部感染癥狀體征評(píng)分比較均有顯著性統(tǒng)計(jì)學(xué)差異(P0.05)結(jié)論：(一)證型分布研究：1.老年腦梗塞急性期肺部感染證型分布主要有6種,依次為：痰熱壅肺證,氣虛痰濁阻肺證,陰陽(yáng)兩虛痰閉證,氣虛血瘀痰阻證,瘀熱蘊(yùn)毒證,氣陰兩虛證。2.痰熱壅肺證是老年腦梗塞急性期肺部感染最常見的證型,隨著病程推移很多患者兼有腑實(shí)證、氣陰兩虛證。(二)痰熱壅肺證治療的研究：1.老年腦梗塞急性期肺部感染影響患者近期預(yù)后,增加患者死亡率,是加重患者病情獨(dú)立危險(xiǎn)因素。2.清熱化痰合劑基礎(chǔ)上辨證加用通腑、益氣養(yǎng)陰合劑較單純現(xiàn)代醫(yī)學(xué)常規(guī)治療可有效的控制肺部感染,減少肺部感染治療時(shí)間。但急性期內(nèi)對(duì)改善患者神經(jīng)功能缺損癥狀與單純現(xiàn)代醫(yī)學(xué)常規(guī)治療相比無(wú)明顯差異。3.清熱化痰合劑基礎(chǔ)上辨證加用通腑、益氣養(yǎng)陰合劑可改善中醫(yī)臨床癥狀,提高中醫(yī)療效。
[Abstract]:Objective: acute cerebral infarction in elderly pulmonary infection syndromes combination complex, at present there is no uniform standard, which is not conducive to the clinical application and improve the level of clinical diagnosis and treatment. The purpose of this study is: (1) to investigate the evolution and distribution of TCM syndrome type, research and standardization of norms, in order to better guide clinical application. (2) syndrome type selection of the most common syndromes (phlegm heat in the lung), in TCM treatment, observe the clinical curative effect evaluation, treatment effect, and to explore its mechanism, to provide clinical basis for the clinical application. Methods: (a) study on rule of Syndrome Distribution: methods a prospective study, from March 2014 to April 2015 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine encephalopathy diagnosed senile cerebral infarct in acute stage of pulmonary infection in hospitalized patients in 120 cases, collected in general, Summarize the contents of syndrome elements, syndrome type of outcome. (to recognized by 3 doctors experienced at the same time for each patient the syndrome and syndrome type determination, determine the results of the 2 physicians also need to set up.) were collected on the first day syndrome, the statistics were 1-5 days, 6-10 days, 11~14 day card type distribution and the most common syndrome type transformation, and results in the designed questionnaire, establish the original clinical database, import data into SPSS 19, the overall distribution of syndrome elements, frequency statistical distribution of syndromes, we summarized the main syndromes distribution and transformation (with the course of disease. Two) on the treatment of phlegm heat obstructing lung syndrome: from May 2015 to January 2016 in the center of the First Affiliated Hospital of Guangzhou University of Chinese Medicine encephalopathy were diagnosed as cerebral lung phlegm heat syndrome of senile cerebral infarction in acute stage of pulmonary infection in hospital 60 patients were randomly divided into control group and treatment group (on the basis of modern medicine conventional therapy, oral or nasal feeding phlegm mixture, syndrome differentiation and Tongfu mixture, supplementing qi and nourishing Yin mixture), each group of 30 people. Two groups were observed before and after treatment in patients with symptoms and signs of TCM symptom score, pulmonary infection score, biochemical indexes (the white blood cell and procalcitonin (NIHSS) changes; score on admission, before treatment, after treatment), pulmonary infection control time. Verify the phlegm mixture (prescription of Tongfu mixture, Yiqi Yangyin mixture) clinical efficacy of the treatment of phlegm heat in the lung of senile cerebral infarction in acute stage of pulmonary infection, and to explore its mechanism. Results: (a) the distribution of Syndrome Distribution: 1. main syndromes of pulmonary infection in elderly acute cerebral infarction: phlegm heat in the lung (48.3%), Qi deficiency and phlegm obstructing lung and syndrome of deficiency of yin and Yang (16.7%), two (13.3%), phlegm syndrome of qi deficiency and blood stasis phlegm Card (6.7%), blood stasis and heat toxin syndrome (3.3%), two Qi and yin deficiency syndrome (3.3%). Lung phlegm heat syndrome is the most common type of.2. lung phlegm heat syndrome of senile cerebral infarction in acute stage of pulmonary infection in 58 patients in the first 6-10 days during the 30 cases with positive organs, 10 cases with two Qi and yin deficiency syndrome. In the period of 11-14 days, constipation, further increasing Qi and yin deficiency syndrome with two cases, 32 cases respectively, 30 cases (two). Study on the treatment of phlegm heat in the lung in the treatment group: 1. patients on admission NIHSS score and NIHSS score before treatment were compared with significant statistical differences (P0.05 in the control group), admission NIHSS score of patients with NIHSS infection before treatment were compared with significant statistical differences (P0.05). The treatment group and the control group after treatment NIHSS score before and after treatment, the difference between the two groups is no significant difference (P0.05).2. treatment group and control group in pulmonary infection control the time had significant compared No statistical difference (P0.05), after treatment in two groups of white blood cells and procalcitonin abnormalities is no significant difference (P0.05), two groups of patients during treatment with the death toll has no obvious statistical difference (P0.05).3. in treatment group and control group after treatment of TCM syndrome score, TCM symptom score before and after treatment treatment comparison of symptoms and signs of pulmonary infection after treatment scores were significantly statistical difference (P0.05) conclusion: (a) the distribution of syndromes: 1. senile acute cerebral infarction pulmonary infection syndromes mainly have 6 kinds, were: Qi deficiency and phlegm heat in the lung, phlegm obstructing lung and syndrome of deficiency of Yin and Yang, phlegm two closed card, blood stasis and sputum, blood stasis heat toxin syndrome, Qi Yin deficiency two.2. syndrome of phlegm heat obstructing lung syndrome is the most common in elderly cerebral infarction in acute stage of pulmonary infection, with the course of time many empirical patients with Fu, two Qi and yin deficiency syndrome (two). The treatment of phlegm heat obstructing the lung The study: the impact of short-term prognosis in patients with acute cerebral infarction in 1. elderly patients with pulmonary infection, increased mortality, increase the patient's condition is an independent risk factor of.2. mixture on the basis of syndrome differentiation of phlegm with Tongfu, invigorating qi and nourishing Yin mixture compared with modern medicine conventional therapy can effectively control lung infection, reduce the treatment time but acute lung infection. In the improvement of patients with neurological symptoms and simple modern medicine conventional therapy showed no significant difference.3. mixture on the basis of syndrome differentiation of phlegm with Tongfu, invigorating qi and nourishing Yin mixture can improve clinical symptoms, improve the therapeutic effect of traditional Chinese medicine.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7

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