發(fā)布時間：2018-05-04 07:34

  本文選題：冠心病介入術(shù)后 + 中醫(yī)證型　； 參考：《云南中醫(yī)學(xué)院》2016年碩士論文

【摘要】：目的研究昆明地區(qū)冠心病介入術(shù)后患者的證型分布情況及演變規(guī)律,探析介入術(shù)后再狹窄患者的中醫(yī)證型特點及危險因素,以期為臨床防治冠心病介入術(shù)后再狹窄提供一定的參考依據(jù)。方法本研究參照《冠心病中醫(yī)辨證標(biāo)準(zhǔn)》(1990年修訂)制作調(diào)查問卷,通過調(diào)查問卷形式分別采集昆明地區(qū)冠心病患者介入術(shù)后1周、3月、6月的中醫(yī)臨床四診等信息,以SPSS 22.0軟件進行數(shù)據(jù)統(tǒng)計,分析術(shù)后患者證型分布特點及證型演變規(guī)律、術(shù)后再狹窄的中醫(yī)證型特點及再狹窄的危險因素。結(jié)果1.本次研究共收集冠心病介入術(shù)后有效病例207例,經(jīng)臨床信息采集整理,統(tǒng)計分析后發(fā)現(xiàn):介入術(shù)后1周患者出現(xiàn)頻數(shù)最多的證型為血瘀證114例,占總病例數(shù)的55.1%,其次為痰濁證99例(47.8%)和氣虛證79例(38.2%),依次為氣滯證、陰虛證、寒凝證、陽虛證,提示患者術(shù)后一周以血瘀證、痰濁證、氣虛證為主要證型;術(shù)后3月患者依然以氣虛證、血瘀證、痰濁證為主要證型;術(shù)后6月患者出現(xiàn)頻數(shù)前三的證型為氣虛證110例(53.1%)、血瘀證93例(44.9%)和陰虛證76例(36.7%),依次為痰濁證、氣滯證、陽虛證、寒凝證,提示患者術(shù)后6月以氣虛證、血瘀證、陰虛證為主要證型。2.術(shù)后1周、3月、6月三個時間點的觀察期內(nèi),血瘀證、痰濁證比例以緩慢趨勢持續(xù)下降,氣虛證、陽虛證、陰虛證持續(xù)上升,其中陰虛證變化明顯,寒凝證、氣滯證無明顯變化,血瘀證、氣虛證、痰濁證在整個觀察周期內(nèi)一直為主要證型;實證呈減少趨勢、虛癥呈增多趨勢。3.再狹窄組中血瘀證(59.5%)、陰虛證(57.1%)、氣虛證(57.1%)最為常見,其次為痰濁證氣滯證陽虛證寒凝證,無再狹窄中證型排序為氣虛證血瘀證陰虛證痰濁證氣滯證陽虛證寒凝證。兩組相比較,再狹窄組的血瘀證、痰濁證、陰虛證顯著高于無再狹窄組(P0.05),有統(tǒng)計學(xué)意義。4.以患者為單位的單因素分析結(jié)果顯示,再狹窄組與無再狹窄組的男性、吸煙、高血壓、糖尿病的分布及BMI具有顯著性差異(P0.05)。為進一步驗證,以再狹窄為因變量,將單因素結(jié)果中P0.05的變量:男性、吸煙、高血壓、糖尿病、BMI放入logistic多因素回歸模型,結(jié)果顯示:吸煙、高血壓、糖尿病為再狹窄發(fā)生的獨立危險因素(P0.05),OR依次為:3.287、2.955、4.476。結(jié)論1.昆明地區(qū)207例冠心病介入術(shù)后患者中醫(yī)證型以血瘀證、氣虛證、痰濁證多見。2.昆明地區(qū)207例冠心病介入術(shù)后患者于術(shù)后一周至術(shù)后六月血瘀證、痰濁證逐漸減少,氣虛證、陰虛證、陽虛證逐漸增多;術(shù)后有實證向虛癥轉(zhuǎn)化的趨勢。3.昆明地區(qū)207例冠心病介入術(shù)后患者再狹窄組中的血瘀證、痰濁證、陰虛證顯著高于無再狹窄組,與介入術(shù)后再狹窄的發(fā)生有一定的相關(guān)性,提示術(shù)后應(yīng)注重化祛痰化瘀、滋陰扶正。4.吸煙、高血壓、糖尿病為再狹窄發(fā)生的獨立危險因素,提示臨床中應(yīng)重視對這些因素的干預(yù)措施以降低術(shù)后再狹窄的發(fā)生概率。
[Abstract]:Objective to study the distribution and evolution of syndrome types in patients with coronary artery disease after coronary intervention in Kunming, and to explore the characteristics and risk factors of TCM syndromes in patients with restenosis after interventional operation. In order to provide a reference for clinical prevention and treatment of restenosis after coronary intervention. Methods according to the criteria of TCM Syndrome differentiation of Coronary Heart Disease (revised in 1990), the questionnaire was made in this study, and the information of four clinical diagnoses of coronary heart disease in Kunming area were collected in 1 week, 3 months and 6 months after intervention, respectively. The data were collected by SPSS 22.0 software, and the distribution and evolution of syndrome types were analyzed. The characteristics of TCM syndromes and risk factors of restenosis after operation were analyzed. Result 1. This study collected 207 effective cases of coronary heart disease after interventional operation. After clinical information collection and statistical analysis, it was found that 114 cases of blood stasis syndrome were the most frequent syndrome in the first week after interventional operation. It accounted for 55.1% of the total cases, followed by phlegm turbid syndrome (99 cases, 47.8 cases) and Qi deficiency syndrome (79 cases, 38.2%), followed by Qi stagnation syndrome, yin deficiency syndrome, cold coagulation syndrome, yang deficiency syndrome, which indicated that the main syndrome types were blood stasis syndrome, phlegm turbid syndrome and qi deficiency syndrome one week after operation. The main syndromes were Qi deficiency syndrome, blood stasis syndrome and phlegm turbidity syndrome in 3 months after operation; Qi-deficiency syndrome in 110 cases of Qi-deficiency syndrome in the first three types of frequency in 6 months after operation, blood stasis syndrome in 93 cases (44.9) and Yin deficiency syndrome in 76 cases (36.7%), followed by phlegm turbid syndrome, Qi stagnation syndrome, Yang deficiency syndrome. Cold coagulation syndrome, suggesting that six months after the operation, Qi deficiency syndrome, blood stasis syndrome, yin deficiency syndrome as the main syndrome type. 2. During the observation period of 1 week, 3 months and 6 months after the operation, the proportion of blood stasis syndrome and phlegm turbid syndrome continued to decrease, qi deficiency syndrome, yang deficiency syndrome and yin deficiency syndrome continued to rise, in which Yin deficiency syndrome changed obviously, cold coagulation syndrome and qi stagnation syndrome did not change significantly. Blood stasis syndrome, qi deficiency syndrome, phlegm turbid syndrome has been the main syndrome type in the whole observation cycle; In the restenosis group, blood stasis syndrome (59.5), yin deficiency syndrome (57.1), Qi deficiency syndrome (57.1), phlegm turbid syndrome, qi stagnation syndrome, yang deficiency syndrome, cold coagulation syndrome, and no restenosis syndrome were ranked as qi deficiency syndrome, blood stasis syndrome, yin deficiency syndrome, phlegm stagnation syndrome, qi stagnation syndrome, cold coagulation syndrome. Compared with the two groups, the blood stasis syndrome, phlegm turbidity syndrome and yin deficiency syndrome in the restenosis group were significantly higher than that in the non-restenosis group (P 0.05), with statistical significance. 4. Univariate analysis showed that there were significant differences in distribution of smoking, hypertension, diabetes and BMI between restenosis group and non-restenosis group (P 0.05). To further verify, taking restenosis as dependent variable, the variables of P05 in univariate results: male, smoking, hypertension, diabetes mellitus were put into logistic multivariate regression model. The results showed that: smoking, hypertension, The independent risk factor for the occurrence of restenosis was: 1: 3.287 / 2.955 / 4.476. Conclusion 1. Blood stasis syndrome, qi deficiency syndrome and phlegm turbidity syndrome were the most common syndromes in 207 patients with coronary heart disease after coronary intervention in Kunming. From one week to six months after intervention, 207 patients with coronary heart disease in Kunming area had blood stasis syndrome, phlegm and turbid syndrome gradually decreased, qi deficiency syndrome, yin deficiency syndrome and yang deficiency syndrome increased gradually, and there was a tendency of positive change to deficiency syndrome after operation. The blood stasis syndrome, phlegm turbid syndrome and yin deficiency syndrome in 207 patients with restenosis after coronary intervention in Kunming area were significantly higher than those without restenosis, which were related to the occurrence of restenosis after interventional operation, which suggested that we should pay attention to expelling phlegm and removing blood stasis after operation. Nourishing yin and nourishing recuperation. Smoking, hypertension and diabetes were independent risk factors for restenosis, which suggested that the intervention measures should be paid more attention to in order to reduce the probability of restenosis after operation.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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