本文選題：腦梗死 + 急性期�。� 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的：應(yīng)用核磁共振成像(MRI)技術(shù)中DWI序列分析179例急性期腦梗死患者MRI影像學(xué)特點,探討MRI在急性期腦梗死中醫(yī)辨證中的應(yīng)用價值,分析急性期腦梗死MRI表現(xiàn)與中醫(yī)辨證分型的相關(guān)性,進而為急性期腦梗死患者中醫(yī)辨證分型提供MRI影像學(xué)依據(jù)。方法：納入患者在遼寧中醫(yī)藥大學(xué)附屬第二醫(yī)院住院且經(jīng)臨床醫(yī)師診斷為急性期腦梗死患者179例,統(tǒng)計相關(guān)指標,運用統(tǒng)計學(xué)方法處理相關(guān)數(shù)據(jù),進而對急性期腦梗死的MRI表現(xiàn)與中醫(yī)辨證分型關(guān)系的相關(guān)性進行分析。結(jié)果：一般資料顯示在179例患者中,男性98例,女性81例,男性略多于女性,年齡段在60-89歲的患者發(fā)病率高,其中年齡段在60-75歲的發(fā)病率最高。性別在急性期腦梗死的中醫(yī)辨證分型中無統(tǒng)計學(xué)意義;年齡在急性期腦梗死中醫(yī)辨證分型中無統(tǒng)計學(xué)意義。在本次納入的急性期腦梗死患者中,其證型分布情況為風(fēng)火上擾證17例,占9.5%,風(fēng)痰阻絡(luò)證80例,占44.7%,痰熱腑實證11例,占6.1%,氣虛血瘀證48例,占26.8%,陰虛風(fēng)動證23例,占12.8%,其中風(fēng)痰阻絡(luò)證80例(44.7%)發(fā)病例數(shù)最多,其次為氣虛血瘀證48例(26.8%),陰虛風(fēng)動證23例(12.8%)。在179例急性期腦梗死患者中,就發(fā)病部位而言,風(fēng)火上擾證22例(皮質(zhì)病變4例占18.2%,放射冠病變3例占13.6%,基底節(jié)病變11例占50.0%,后循環(huán)病變4例占18.2%),風(fēng)痰阻絡(luò)證共116例(皮質(zhì)病變18例占15.5%,放射冠病變30例占25.9%,基底節(jié)病變48例占41.4%,后循環(huán)區(qū)病變20例占17.2%),痰熱腑實證16例(皮質(zhì)病變5例占31.3%,放射冠病變4例占25.0%,基底節(jié)病變4例占25.0%,后循環(huán)病變3例占18%),氣虛血瘀證85例(皮質(zhì)病變13例占15.3%,放射冠病變21例占24.7%,基底節(jié)病變22例占25.9%,后循環(huán)病變29例占34.1%),陰虛風(fēng)動證50例(皮質(zhì)病變4例占8%,放射冠15例占30%,基底節(jié)病變13例占26.0%,后循環(huán)病變18例占36.0%),經(jīng)統(tǒng)計學(xué)處理,差異有統(tǒng)計學(xué)意義,風(fēng)火上擾證和風(fēng)痰阻絡(luò)證在基底節(jié)處多發(fā),氣虛血瘀證和陰虛風(fēng)動證在后循環(huán)分布區(qū)多發(fā)。在179例急性期腦梗死患者中,就合并病而言,風(fēng)火上擾證24例(伴高血壓病12例占50.0%,伴糖尿病6例占25.0%,伴冠心病3例占12.5%,伴高脂血癥3例占12.5%),風(fēng)痰阻絡(luò)證121例(伴高血壓病45例占37.2%,伴糖尿病28例占23.1%,伴冠心病30例占24.8%,伴高脂血癥18例占14.9%),痰熱腑實證18例(伴高血壓病5例占27.8%,伴糖尿病4例占22.2%,伴冠心病2例占11.1%,伴高脂血癥7例占38.9%),氣虛血瘀證85例(伴高血壓病14例占16.5%,伴糖尿病28例占32.9%,伴冠心病22例占25.9%,伴高脂血癥21例占24.7%),陰虛風(fēng)動證52例(伴高血壓病14例占26.9%,伴糖尿病17例占32.7%,伴冠心病15例占28.8%,伴高脂血癥6例占11.5%),經(jīng)統(tǒng)計學(xué)處理,差異有統(tǒng)計學(xué)意義,風(fēng)火上擾證和風(fēng)痰阻絡(luò)證合并高血壓病較其他合并病多,陰虛風(fēng)動證和氣虛血瘀證合并糖尿病較其他合并病較多,痰熱腑實證合并高脂血癥較其他合并癥病較多。在179例急性期腦梗死患者中,單發(fā)病灶91例,占50.9%,多發(fā)病例88例,占49.1%,風(fēng)火上擾證17例(單發(fā)10例占58.8%,多發(fā)7例占41.2%),風(fēng)痰阻絡(luò)證80例(單發(fā)49例占61.3%,多發(fā)31例占38.7%),痰熱腑實證11例(單發(fā)6例占54.5%,多發(fā)5例占45.5%)氣虛血瘀證48例(單發(fā)17例占35.4%,多發(fā)31例占64.6%,陰虛風(fēng)動證23例(單發(fā)9例占39.1%,多發(fā)14例占60.9%),經(jīng)統(tǒng)計學(xué)處理,差異有統(tǒng)計學(xué)意義,故風(fēng)火上擾證和風(fēng)痰阻絡(luò)證以單發(fā)病灶為主,氣虛血瘀和陰虛風(fēng)動證以多發(fā)病灶為主。結(jié)論：急性期腦梗死頭顱MRI表現(xiàn)中的梗死灶部位與中醫(yī)辨證分型存在相關(guān)關(guān)系;急性期腦梗死中醫(yī)辨證分型與合并癥存在相關(guān)關(guān)系;急性期腦梗死梗死灶類型與中醫(yī)辨證份分型存在相關(guān)關(guān)系。影像學(xué)表現(xiàn)可以成為診斷急性期腦梗死中醫(yī)臨床辨證分型的參考依據(jù)。
[Abstract]:Objective: to analyze the MRI imaging characteristics of 179 patients with acute cerebral infarction by DWI sequence in MRI technique, explore the application value of MRI in TCM syndrome differentiation of acute cerebral infarction, analyze the correlation between MRI manifestations of acute cerebral infarction and TCM syndrome differentiation, and then provide MRI for TCM syndrome differentiation in acute cerebral infarction patients. Imaging basis. Methods: the patients were hospitalized in Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine and 179 patients were diagnosed as acute cerebral infarction by clinician. The related indexes were statistically analyzed. The correlation between the MRI performance of acute cerebral infarction and the relationship between TCM syndrome differentiation and classification was analyzed. General data showed that among the 179 patients, 98 were male, 81 women were female, male was slightly more than women, and the age group was 60-89 years old, with the highest incidence at the age of 60-75. There was no statistical significance in the TCM syndrome differentiation of acute cerebral infarction in the acute phase of cerebral infarction. Among the patients with acute cerebral infarction, the syndrome distribution was 17 cases of wind fire disturbance, 9.5%, 80 cases of wind phlegm obstructing collaterals, 11 cases of phlegm and Fu Fu, 48 cases of qi deficiency and blood stasis, 48 cases of qi deficiency and blood stasis, 26.8% of qi deficiency and blood stasis, 23 cases of yin deficiency and movement syndrome, and 12.8%, among them, 80 cases of wind phlegm obstructing collaterals (44.7%) were the most cases, followed by qi deficiency. There were 48 cases of blood stasis syndrome (26.8%) and 23 cases (12.8%) with Yin deficiency and wind movement syndrome. Among the 179 cases of acute cerebral infarction, 22 cases (4 cases of cortical lesions, 18.2%, 3 cases of radiological crown, 13.6%, 11 in basal ganglia, 50% of basal ganglia), and wind phlegm obstructing collaterals were in 179 cases of acute cerebral infarction. 30 cases of crown lesion accounted for 25.9%, basal ganglia 48 cases accounted for 41.4%, posterior circulation area 20 cases accounted for 17.2%), phlegm heat syndrome in 16 cases (5 cases of cortical lesions 31.3%, 4 cases of radial crown lesion 25%, basal ganglia 4 cases 25%, recurrent pathological changes in 3 cases), Qi deficiency and blood stasis syndrome, basal ganglia, basal ganglia There were 22 cases of pathological changes, 29 cases of posterior circulation disease (34.1%), 50 cases of yin deficiency and wind movement syndrome (4 cases of cortical lesions, 15 cases in 30%, 13 of basal ganglia and 13 cases 26% and 18 cases of posterior circulation lesion in 36%). The difference was statistically significant after statistical treatment. The symptoms of wind fire disturbance and wind phlegm obstructing collaterals were more frequent in basal ganglia, Qi deficiency and blood stasis and yin deficiency. In 179 cases of acute cerebral infarction, among the patients with acute cerebral infarction, there were 24 cases of wind fire disturbance (12 cases with hypertension, 6 cases with diabetes 25%, 3 cases with coronary heart disease in 12.5%, 3 cases with hyperlipidemia in 12.5%), 121 cases of wind phlegm obstructing collaterals (accompanied by hypertension, 45, 37.2%, accompanied with diabetes 28 taken up, accompanied by diabetes). 30 cases of coronary heart disease accounted for 24.8%, 18 cases with hyperlipidemia (14.9%), 18 cases of phlegm heat syndrome (5 cases with hypertension, 4 cases with 22.2%, 2 cases with coronary heart disease, 2 cases 11.1% and 7 cases of hyperlipidemia), Qi deficiency and blood stasis syndrome, accompanied by diabetes mellitus cases accounted for, accompanied by coronary heart disease, accompanied by hyperlipidemia, accompanied by hyperlipidemia. 1 cases accounted for 24.7%), 52 cases of yin deficiency and wind movement (14 cases with hypertension, 17 cases of diabetes with 32.7%, 15 cases with coronary heart disease in 28.8%, 6 cases with hyperlipidemia in 11.5%), the difference was statistically significant after statistical treatment, the wind fire disturbance and wind phlegm obstructing collaterals with high blood pressure were more than the other complications, yin deficiency wind and Qi deficiency and blood stasis syndrome In 179 cases of acute cerebral infarction, 91 cases, 50.9%, 88 cases, 49.1%, 17 cases (58.8%, 7 cases, 41.2%), and 80 cases of wind phlegm obstructing collaterals (49 cases accounted for 61.3%, multiple 31) in the acute cerebral infarction patients in 179 cases. Cases accounted for 38.7%), 11 cases of phlegm heat syndrome (6 cases in 54.5%, 5 cases 45.5%) Qi deficiency and blood stasis syndrome, 48 cases (17 cases, 35.4%, 31 cases 64.6%, 23 cases of yin deficiency and wind movement), and statistical processing, the difference has statistical significance, so the wind fire disturbance and wind phlegm obstructing collaterals are mainly single focus. There is a correlation between the location of the infarct area in the MRI manifestations of cerebral infarction in acute cerebral infarction and the syndrome differentiation of TCM; there is a correlation between TCM syndrome differentiation and syndrome differentiation in acute cerebral infarction, and there is a correlation between the acute cerebral infarction type and the TCM syndrome differentiation. Image manifestation can be used as a reference for diagnosis of acute cerebral infarction in TCM.
【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】：R277.7

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