發(fā)布時間：2018-04-25 19:21

  本文選題：糖尿病足 + 中醫(yī)證型　； 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過對133例住院糖尿病足病患者的中醫(yī)證候分布情況及臨床資料的研究,探討糖尿病足的中醫(yī)證候分布規(guī)律和中醫(yī)證型間臨床檢驗指標、下肢動脈彩超、Wagner分級、內(nèi)科治療有效率之間的關(guān)系,以期為糖尿病足的辨證論治提供客觀的依據(jù)。材料與方法:選取2015年2月至2016年10月于錦州市中心醫(yī)院內(nèi)分泌科住院的糖尿病足患者共計133例,通過中醫(yī)望、聞、問、切四診進行辨證分型,統(tǒng)計納入患者的性別、年齡、病程、體重指數(shù)和白細胞計數(shù)、血糖、血脂、下肢動脈彩超、Wagner分級、有效率等臨床資料,對其進行回顧性分析,并且分析中醫(yī)證型間臨床資料的關(guān)系。結(jié)果:1.一般資料的情況:男性80例,女性53例,男:女=1.51:1;年齡大于60歲的患者占總體的57.89%;糖尿病病程大于5年的患者占總體的87.22%;BMI大于25 kg/m2的患者占總體的89.47%。2.中醫(yī)證型分布:血脈瘀阻證氣血兩虛證濕熱壅盛證寒濕阻絡(luò)證熱毒傷陰證。3.中醫(yī)證型間年齡的關(guān)系,氣血兩虛證最大,與血脈瘀阻證、寒濕阻絡(luò)證相比,差異有統(tǒng)計學(xué)意義(p㩳0.05);糖尿病病程的關(guān)系,氣血兩虛證最長,與血脈瘀阻證、熱毒傷陰證相比,差異有統(tǒng)計學(xué)意義(p㩳0.05);體重指數(shù)的關(guān)系,濕熱壅盛證最大,與其他四組證型相比,差異有統(tǒng)計學(xué)意義(p㩳0.05)。4.中醫(yī)證型間白細胞計數(shù)的關(guān)系,濕熱壅盛證最高,與其他四組證型相比較,差異有統(tǒng)計學(xué)意義(p㩳0.05);空腹血糖的關(guān)系,濕熱壅盛證最高,與血脈瘀阻證、氣血兩虛證相比,差異有統(tǒng)計學(xué)意義(p㩳0.05);糖化血紅蛋白的關(guān)系,熱毒傷陰證最高,與其他四組證相比,差異有統(tǒng)計學(xué)意義(p㩳0.05)。5.中醫(yī)證型間甘油三酯的關(guān)系,寒濕阻絡(luò)證最高,與血脈瘀阻證、氣血兩虛證、濕熱壅盛證相比,差異有統(tǒng)計學(xué)意義(p㩳0.05);總膽固醇的關(guān)系,寒濕阻絡(luò)證最高,與血脈瘀阻證相比,差異具有統(tǒng)計學(xué)意義(p㩳0.05);高密度脂蛋白的關(guān)系,各組證型相比無統(tǒng)計學(xué)差異(p0.05);低密度脂蛋白的關(guān)系,寒濕阻絡(luò)證最高,與血脈瘀阻證、濕熱壅盛證型相比,差異有統(tǒng)計學(xué)意義(p㩳0.05)。6.中醫(yī)證型間下肢動脈病變情況的關(guān)系:血脈瘀阻證以輕中度為主,與其他四組證型相比較,差異有統(tǒng)計學(xué)意義(p㩳0.05);氣血兩虛證以重度及閉塞為主,與其他四組證型相比較,差異有統(tǒng)計學(xué)意義(p㩳0.05)。7.中醫(yī)證型與Wagner分級的關(guān)系:血脈瘀阻證以輕型為主,與其他四組證型相比較,差異有統(tǒng)計學(xué)意義(p㩳0.05);氣血兩虛證以重型為主,與其他四組證型行比較,差異有統(tǒng)計學(xué)意義(p㩳0.05)。8.中醫(yī)證型間有效率的比較:經(jīng)過內(nèi)科治療后,血脈瘀阻證有效率為85.00%,氣血兩虛證有效率為78.13%,濕熱壅盛證有效率為72.00%,熱毒傷陰證有效率為66.67%,寒濕阻絡(luò)證有效率為79.17%。血脈瘀阻證與氣血兩虛證、濕熱壅盛證、熱毒傷陰證、寒濕阻絡(luò)證與相比,差異有統(tǒng)計學(xué)意義(p㩳0.05)。結(jié)論:1.糖尿病足以血脈瘀阻證最常見,其次是氣血兩虛證、濕熱壅盛證、寒濕阻絡(luò)證,熱毒傷陰證最少見。2.病程長、年齡大、超重和肥胖的男性糖尿病患者可能發(fā)生糖尿病足。3.血脈瘀阻證多見于糖尿病足初期,患者下肢血管病變程度較輕,內(nèi)科治療有效率較高。4.氣血兩虛證多見于糖尿病足后期,患者年齡較大,糖尿病病程較長,下肢動脈病變較重,下肢缺血明顯。5.濕熱壅盛證患者體重控制差,感染程度較重,空腹血糖升高明顯。6.所有患者糖化血紅蛋白均升高,熱毒傷陰證患者升高明顯,血糖控制最差,內(nèi)科治療效果較差。7.大部分患者均存在血脂代謝異常,寒濕阻絡(luò)證患者甘油三酯、總膽固醇和低密度脂蛋白水平最高,血脂紊亂明顯。
[Abstract]:Objective: To explore the distribution of TCM syndromes and clinical data of 133 patients with diabetic foot disease, and to explore the distribution of TCM syndromes and the clinical test index between TCM syndrome types, color Doppler ultrasound of lower extremity, Wagner classification, and the relationship between medical treatment efficiency, so as to provide customers with the syndrome differentiation and treatment of diabetic foot. Materials and methods: a total of 133 diabetic foot patients hospitalized in Department of endocrinology of Jinzhou Central Hospital from February 2015 to October 2016 were divided into 133 cases by TCM looking, hearing, asking, and cutting diagnosis. The statistics were included in the patients' sex, age, course of disease, body mass index and white blood cell count, blood sugar, blood lipid, arterial color Doppler of lower extremity, Wagn Er classification, efficiency and other clinical data, retrospective analysis and analysis of the relationship between the clinical data of TCM syndrome. Results: 1. general information: male 80 cases, female 53 cases, male: female =1.51:1; patients older than 60 years accounted for 57.89% of the total; patients with diabetes course for more than 5 years accounted for 87.22% of the total; BMI greater than 25 kg/m2 The patients accounted for the overall 89.47%.2. syndrome type distribution: Blood Stasis Syndrome Qi and blood two deficiency syndrome of damp heat syndrome, cold dampness and dampness and collaterals syndrome.3. TCM syndrome age relationship, Qi and blood two deficiency syndrome maximum, compared with blood stasis syndrome and cold dampness obstruction syndrome, the difference has statistical significance (P? 0.05); the relationship between diabetes course, Qi and blood two deficiency syndrome is the longest, Compared with blood stasis syndrome, the difference was statistically significant (P 0.05). The relationship between body mass index and damp heat syndrome was the largest, compared with the other four groups, the difference was statistically significant (P? 0.05) the relationship between the white blood cell count of.4. syndrome type, the highest damp heat syndrome, compared with the other four groups, the difference was statistically significant ( P? 0.05); the relationship between fasting blood glucose, the highest damp heat syndrome, the difference between the blood stasis syndrome and the Qi and blood two deficiency syndrome, the difference has statistical significance (P? 0.05); the relationship between the glycated hemoglobin and the heat toxin negative syndrome is the highest. Compared with the other four groups, the difference is statistically significant (P? 0.05) the relationship between triglycerides in the.5. TCM syndrome type, the highest cold dampness obstruction syndrome, and the highest Blood stasis syndrome, Qi and blood two deficiency syndrome, the syndrome of damp heat accumulation, the difference was statistically significant (P? 0.05); the relationship of total cholesterol, cold dampness obstruction syndrome was the highest, compared with blood stasis syndrome, the difference was statistically significant (P? 0.05); the relationship between high density lipoprotein, no statistical difference (P0.05), low density lipoprotein relationship, cold dampness The obstruction of collaterals was the highest, compared with blood stasis syndrome and damp heat syndrome, the difference was statistically significant (P? 0.05).6. TCM syndrome types of lower extremity artery disease: blood stasis syndrome was mainly light and moderate, compared with other four groups, the difference was statistically significant (P? 0.05); Qi and blood two deficiency syndrome was mainly severe and occlusion, and the other four groups The difference was statistically significant (P? 0.05).7. TCM syndrome type and Wagner classification: blood stasis syndrome was mainly light, compared with the other four groups, the difference was statistically significant (P? 0.05); Qi and blood two deficiency syndrome was mainly heavy, and compared with the other four groups, the difference was statistically significant (P? 0.05).8. TCM Syndrome Types Efficiency comparison: after medical treatment, the effective rate of blood stasis syndrome was 85%, the effective rate of Qi and blood two deficiency syndrome was 78.13%, the effective rate of damp heat syndrome was 72%, the effective rate of hot and toxic Yin Syndrome was 66.67%, the effective rate of cold dampness obstructing collaterals was 79.17%. blood stasis syndrome and Qi and blood two deficiency syndrome, damp heat obstructing syndrome, heat toxic injury Yin Syndrome, cold dampness obstructing collaterals syndrome and comparison, The difference was statistically significant (P 0.05). Conclusion: 1. diabetes is the most common blood stasis syndrome, followed by Qi and blood two deficiency syndrome, damp heat stagnation syndrome, cold dampness obstructing collaterals, the least.2. disease course long, age, overweight and obese male diabetic patients with diabetic foot.3. blood stasis may be seen in the early stage of diabetic foot. The lower extremity vascular disease degree is lighter, the effective rate of.4. Qi and blood two is more common in the late stage of diabetes foot, the patient is older, the course of diabetes is longer, the lower extremity artery disease is heavy, the lower limb ischemia obviously.5. damp heat syndrome, the weight control is poor, the infection degree is heavy, the fasting blood sugar is obviously increased.6. all patients saccharification blood The increase of erythropoiet was increased, the patients with heat and poison Yin Syndrome increased obviously, the blood sugar control was the worst, the most of the patients with poor therapeutic effect in internal medicine had abnormal lipid metabolism, the triglycerides in the cold dampness obstructing syndrome patients, the highest levels of total cholesterol and low density lipoprotein, and the obvious dyslipidemia in.7..

【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

【參考文獻】

相關(guān)期刊論文 前10條

1 邸鐵濤;張春玲;陳露;宋慶娜;侯丹;劉洹穎;;糖尿病足潰瘍的發(fā)病機制及難愈合原因分析[J];貴陽中醫(yī)學(xué)院學(xué)報;2017年01期

2 楊殷;楊彩哲;;糖尿病足發(fā)生截肢的相關(guān)危險因素的meta分析[J];山西醫(yī)科大學(xué)學(xué)報;2016年07期

3 劉娜;溫學(xué)紅;朱朝軍;閆衛(wèi)利;;糖尿病足的中醫(yī)辨證分型臨床檢測指標的差異分析[J];云南中醫(yī)中藥雜志;2016年05期

4 晉溶辰;黃政德;張晉如;周秋紅;;糖尿病足潰瘍高危體質(zhì)的臨床特征及對傷口愈合影響的研究[J];湖南中醫(yī)藥大學(xué)學(xué)報;2016年04期

5 馬海燕;;中西醫(yī)結(jié)合治療糖尿病足壞疽48例[J];中醫(yī)臨床研究;2015年23期

6 王瓊;冼紹祥;陳潔;袁天慧;張家仕;李其飛;;老老年高血壓病證候要素分布規(guī)律初步探索[J];時珍國醫(yī)國藥;2015年04期

7 李崢t，

本文編號：1802620