本文選題：缺血性腦卒中　切入點(diǎn)：中醫(yī)證型　出處：《遼寧中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察首次發(fā)病的缺血性腦卒中(Cerebral ischemic stroke,CIS)患者急性期(72小時(shí)內(nèi))中醫(yī)證型的特點(diǎn)、證候總積分與NIHSS評(píng)分的差異,以探索其間的內(nèi)在聯(lián)系。材料與方法:1.通過(guò)望問(wèn)聞切四診合參采集缺血性腦卒中患者急性期(72小時(shí)內(nèi))的所有癥狀和體征,根據(jù)《中風(fēng)病辨證診斷標(biāo)準(zhǔn)》中各項(xiàng)目?jī)?nèi)容分值進(jìn)行相應(yīng)的賦分值處理,分別計(jì)算患者風(fēng)證、火熱證、痰證、瘀證、氣虛證、陰虛陽(yáng)亢證六個(gè)基礎(chǔ)證的證候分值,然后根據(jù)該分值進(jìn)行證型診斷,計(jì)算證型的證候總積分;同時(shí)采用NIHSS評(píng)分量表對(duì)患者神經(jīng)功能缺損程度進(jìn)行評(píng)分,記錄總評(píng)分。2.數(shù)據(jù)統(tǒng)計(jì)處理:(1)計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差表示;(2)證型間證候總積分、神經(jīng)功能缺損評(píng)分比較符合正態(tài)采用t檢驗(yàn),不符合正態(tài)采用秩和檢驗(yàn);(3)證候積分與NIHSS評(píng)分的關(guān)系采用相關(guān)性分析。結(jié)果:1.缺血性腦卒中急性期(72小時(shí)內(nèi))不同主證證型分布以風(fēng)證為主證的證型所占比例最大,陰虛陽(yáng)亢為主證者次之。2.相兼證型分布以二證相兼證型所占比例最大(約58.0%),三證相兼次之,單一證型、四證、五證相兼證型比例相對(duì)較小,無(wú)六證相兼病例。3.不同主證證型間比較:(1)證候總積分比較:以風(fēng)、火熱、痰為主證的證型與氣虛為主證者比較差異有統(tǒng)計(jì)學(xué)意義(ρ0.05),而以風(fēng)為主證者與以陰虛陽(yáng)亢為主證者比較差異亦有統(tǒng)計(jì)學(xué)意義(ρ0.05);(2)NIHSS評(píng)分比較:差異無(wú)統(tǒng)計(jì)學(xué)意義(ρ0.05);(3)相關(guān)性分析:各組間證候總積分與其N(xiāo)IHSS評(píng)分(除以氣虛為主證者外)呈顯著正相關(guān)(ρ0.01),尤以痰證為主者相關(guān)程度最密切。4.虛實(shí)側(cè)重證型間比較:(1)證候總積分與NIHSS評(píng)分比較:差異均有統(tǒng)計(jì)學(xué)意義(ρ0.01),且以標(biāo)實(shí)為主者較以本虛為主者證候總積分與NIHSS評(píng)分更高;(2)相關(guān)性分析:虛實(shí)側(cè)重不同證型的證候總積分與NIHSS評(píng)分呈正相關(guān)(ρ0.01)。5.相兼證型間比較:(1)證候總積分與NIHSS評(píng)分比較:單一證型、兩證相兼證型與其他各組比較差異均有統(tǒng)計(jì)學(xué)意義(ρ0.05),三證、四證、五證相兼的證型間差異無(wú)統(tǒng)計(jì)學(xué)意義(ρ0.05);(2)相關(guān)性分析:除單一證型外,余各組證候總積分與神經(jīng)功能缺損評(píng)分均呈正相關(guān)(ρ0.05),且隨證候總積分越高,NIHSS評(píng)分也越高。結(jié)論:1、首次缺血性腦卒中72小時(shí)內(nèi)中醫(yī)證型相對(duì)簡(jiǎn)單,以二證相兼證型涵蓋比例最大。2、缺血性卒中急性期內(nèi)以風(fēng)、火熱、痰為主證的證型其證候程度重于氣虛為主證者。3、側(cè)重于實(shí)證的證型其證候程度與神經(jīng)功能缺損程度均重于以虛證為主的證型。4、三證、四證、五證相兼的證型其證候與神經(jīng)功能缺損程度均較以單證、二證相兼者更加嚴(yán)重。5、證候總積分(證候程度達(dá)中度以上)與NIHSS評(píng)分呈正相關(guān)。
[Abstract]:Objective: to observe the characteristics of TCM syndromes, the difference between the total score of syndromes and NIHSS score in patients with ischemic stroke within 72 hours of acute phase. Materials and methods: 1. To collect all symptoms and signs of ischemic stroke patients within 72 hours of acute phase. According to the "criteria for diagnosis of apoplexy Syndrome differentiation", the corresponding score was assigned to each item, and the syndromes of six basic syndromes, namely, wind syndrome, fire and heat syndrome, phlegm syndrome, blood stasis syndrome, qi deficiency syndrome, yin deficiency and yang hyperactivity syndrome, were calculated respectively. According to the score, the syndrome type was diagnosed, and the total syndromes integral of the syndrome type was calculated. At the same time, the NIHSS scale was used to evaluate the degree of neurological impairment of the patients. Record total score .2.Data-statistical processing: 1) the measurement data were measured by mean 鹵standard deviation to represent the total integral of syndromes and syndromes between syndromes, and the scores of neurological impairment were in accordance with normal state and t test. The relationship between syndromes score and NIHSS score was analyzed by correlation analysis. Results: 1. Within 72 hours of acute phase of ischemic stroke, the distribution of different main syndromes was the largest with wind syndrome as the main syndrome type. The distribution of two syndromes and syndromes was the largest (about 58.0%, three syndromes and two syndromes were second, single syndrome type, four syndrome type, five syndromes phase and syndromes type) were relatively small. Comparison between different types of principal syndromes: comparison of the total score of syndromes: wind, fire, heat, There was a significant difference between the syndrome type of phlegm and qi deficiency (蟻 0.05), and the difference between wind syndrome and yin deficiency and yang hyperactivity (蟻 0.05). The difference was not statistically significant (蟻 0.05). Sex analysis: there was a significant positive correlation between the total score of syndromes and their NIHSS score (except those with deficiency of qi) (蟻 0.01, especially phlegm syndrome). Comparison: there was significant difference (蟻 0.01g, and the total integral of syndrome and NIHSS score were higher than those with deficiency): the total integral of syndromes with different syndromes was positively correlated with the NIHSS score (蟻 0.01g. 5. both syndromes and syndromes). Comparison of total score of syndromes and NIHSS score: single syndrome type, There were significant differences between the two syndromes and the other groups (蟻 0.05, three, four and five syndromes, respectively). There was no significant correlation analysis between the two syndromes (蟻 0.05) and the other groups (蟻 0.05): except the single syndrome type, there was no significant difference between the two syndromes (蟻 0.05). There was a positive correlation between the total score of syndromes and the score of neurological deficit (蟻 0.05), and the higher the total score of syndromes was, the higher the score of NIHSS was. Conclusion: 1, the TCM syndrome type is relatively simple within 72 hours after the first ischemic stroke. The proportion of two syndromes and syndromes was the largest. 2. The acute phase of ischemic stroke was characterized by wind and heat. The degree of syndromes of phlegm-predominant syndrome is more serious than that of qi deficiency syndrome. The degree of syndromes and nerve function defect of syndrome type with emphasis on empirical evidence is more serious than that of syndrome type .4 with deficiency syndrome, with three syndrome types and four syndromes with deficiency syndrome. The syndromes of the five syndromes and the degree of neurological impairment were more serious than those of the two syndromes. The total score of syndromes was positively correlated with the NIHSS score.
【學(xué)位授予單位】：遼寧中醫(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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本文編號(hào)：1599884