本文選題：中醫(yī)體質(zhì) + 腦分水嶺梗死�。� 參考：《山東中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:探討幕上腦分水嶺梗死患者中醫(yī)體質(zhì)分布特點(diǎn),腦分水嶺梗死的病灶分型、中醫(yī)體質(zhì)及頸內(nèi)動(dòng)脈系統(tǒng)大血管狹窄之間的關(guān)系。方法:收集經(jīng)頭顱CT或MRI及臨床證實(shí)的127例幕上腦分水嶺梗死(cerebral watershed infarction,CWI)患者的一般信息及臨床資料;采用體質(zhì)評分量表評估每位入組患者的中醫(yī)體質(zhì)類型;根據(jù)影像學(xué)資料分析幕上腦分水嶺梗死患者的病灶分型;同時(shí)采集頸內(nèi)動(dòng)脈系統(tǒng)中的病變血管及其狹窄程度;運(yùn)用統(tǒng)計(jì)軟件SPSS19.0對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:(1)氣虛質(zhì)、痰濕質(zhì)、陽虛質(zhì)在入組患者中各占21.26%、16.54%、14.96%。(2)男女腦分水嶺梗死發(fā)病年齡的差異有統(tǒng)計(jì)學(xué)意義,男性發(fā)病年齡低于女性;60歲及60歲以上患者有90例,占70.87%。(3)各體質(zhì)類型間頸內(nèi)動(dòng)脈系統(tǒng)大血管狹窄率及狹窄部位的差異均無統(tǒng)計(jì)學(xué)意義。(4)皮質(zhì)上型(32.94%)、皮質(zhì)下上型(31.76%)、皮質(zhì)后型(19.61%)三種類型構(gòu)成比較高。按皮質(zhì)型、皮質(zhì)下型、混合型進(jìn)行分析得出:皮質(zhì)型37例(29.13%)、皮質(zhì)下型25例(19.69%)、混合型65例(51.18%),提示混合型構(gòu)成比最大。(5)頸內(nèi)動(dòng)脈、大腦中動(dòng)脈、大腦前動(dòng)脈占所有病變血管的百分比分別為41.50%(61/147)、48.98%(72/147)、9.52%(14/147)。(6)大腦中動(dòng)脈與頸內(nèi)動(dòng)脈比較重度狹窄或閉塞發(fā)生率的差別有統(tǒng)計(jì)學(xué)意義。(7)各病灶分型間頸內(nèi)動(dòng)脈系統(tǒng)大血管狹窄部位的差異有統(tǒng)計(jì)學(xué)意義。(8)氣虛質(zhì)、痰濕質(zhì)、陽虛質(zhì)在狹窄組中各占20.18%、16.51%、15.60%。不同體質(zhì)類型間血管狹窄程度的差異無統(tǒng)計(jì)學(xué)意義,進(jìn)一步將體質(zhì)分為實(shí)性體質(zhì)、虛性體質(zhì)、平和體質(zhì),分析得出仍無統(tǒng)計(jì)學(xué)意義。(9)各病灶分型間血管狹窄程度的差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:(1)氣虛質(zhì)、痰濕質(zhì)、陽虛質(zhì)為幕上腦分水嶺梗死患者高危體質(zhì)。(2)腦分水嶺梗死患者老年人多見。男性發(fā)病年齡低于女性。(3)不能認(rèn)為各體質(zhì)間頸內(nèi)動(dòng)脈系統(tǒng)大血管狹窄率及狹窄部位不同。(4)皮質(zhì)上型、皮質(zhì)下上型、皮質(zhì)后型出現(xiàn)頻率較多。在皮質(zhì)型、皮質(zhì)下型、混合型三者中,以混合型所占比例最大。(5)幕上腦分水嶺梗死以大腦中動(dòng)脈和頸內(nèi)動(dòng)脈狹窄或閉塞為主,且大腦中動(dòng)脈病變率更高,大腦中動(dòng)脈較頸內(nèi)動(dòng)脈發(fā)生重度或閉塞的頻率更高。(6)混合型較皮質(zhì)型發(fā)生頸內(nèi)動(dòng)脈和大腦中動(dòng)脈病變頻率高,皮質(zhì)型較混合型大腦前動(dòng)脈病變率高。(7)不能認(rèn)為各體質(zhì)類型間血管狹窄程度不同。(8)混合型較皮質(zhì)下型在血管重度狹窄或閉塞上發(fā)生率更高。
[Abstract]:Objective: to investigate the distribution characteristics of TCM constitution in patients with supratentorial cerebral watershed infarction, the types of lesions in cerebral watershed infarction, the relationship between TCM constitution and the stenosis of internal carotid artery system. Methods: the general information and clinical data of 127 patients with cerebral watershed infarction with supratentorial cerebral watershed infarction confirmed by CT or MRI were collected, and the physique types of each patient were evaluated by physique score scale. According to the imaging data, the focus classification of the patients with supratentorial cerebral watershed infarction was analyzed. At the same time, the pathological vessels and the degree of stenosis in the internal carotid artery system were collected. The statistical software SPSS19.0 was used to analyze the data statistically. Results (1) Qi deficiency, phlegm and dampness, yang deficiency accounted for 21.26% of the patients respectively. There were significant differences in the age of onset of cerebral watershed infarction between men and women. The onset age of male patients was lower than that of female patients aged 60 years or over. There was no significant difference in the stenosis rate and the stenotic site of the internal carotid artery system among the three types of constitution. There was no significant difference among the three types. There was no significant difference among the three types: the superior cortical type (32.94), the subcortical type (31.7661) and the posterior type (19.61)). According to the analysis of cortical type, subcortical type and mixed type, it was found that 37 cases of cortical type were involved in 29.13 cases, 25 cases of subcortical type were involved in 19.69C, and 65 cases of mixed type were 51.18T, which suggested that the mixed type had the largest ratio of internal carotid artery and middle cerebral artery. The percentage of anterior cerebral artery in all diseased vessels was 41. 50% 1477% and 48. 98% respectively. There was a significant difference in the incidence of severe stenosis or occlusion between middle cerebral artery and internal carotid artery compared with internal carotid artery. The difference of QI is statistically significant. Phlegm dampness and yang deficiency accounted for 20.18% and 16.51% respectively in the stenosis group. There was no significant difference in vascular stenosis between different physique types. The constitution was further divided into solid constitution, vacuity constitution, peaceful constitution, The results showed that there was no significant difference in the degree of vascular stenosis among different types of lesions. Conclusion (1) Qi deficiency, phlegm dampness and yang deficiency are high risk constitution in patients with supratentorial cerebral watershed infarction. The incidence age of male was lower than that of female. (3) the rate of large vessel stenosis of internal carotid artery system and different stenosed sites were not considered among different physique. The upper cortical type, subcortical type and postcortical type appeared more frequently. Among the cortical type, subcortical type and mixed type, the mixed type accounted for the largest proportion. 5) the main type of supratentorial cerebral watershed infarction was stenosis or occlusion of the middle cerebral artery and the internal carotid artery, and the lesion rate of the middle cerebral artery was higher. The middle cerebral artery (MCA) was more frequently involved in the internal carotid artery (ICA) and middle cerebral artery (MCA) than in the cortical type (P < 0.05). The cortical type is higher than the mixed type of anterior cerebral artery lesion rate. 7) it can not be considered that the degree of vascular stenosis is different among different physical types.) the mixed type has a higher incidence of severe stenosis or occlusion than the subcortical type.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7

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