本文選題：不穩(wěn)定型心絞痛 + 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(guò)分析不穩(wěn)定型心絞痛(unstable angina pectoris,UA)中醫(yī)證型與冠狀動(dòng)脈病變程度和心率變異性(heart rate variability,HRV)三者之間的關(guān)系,為UA患者冠狀動(dòng)脈病變程度的預(yù)判及自主神經(jīng)功能受損情況的判斷提供參考。方法:收集2015年3月至2016年12月在遼寧中醫(yī)藥大學(xué)附屬醫(yī)院心血管科住院并行冠狀動(dòng)脈造影(coronary angiography,CAG)檢查確診為UA的患者,在入選的168例患者中,按中醫(yī)證型分為氣滯血瘀證組(43例),氣虛血瘀證組(57例),痰瘀互結(jié)證組(68例);按冠狀動(dòng)脈病變支數(shù)分為單支病變組(53例),雙支病變組(60例),多支病變組(55例);按冠狀動(dòng)脈狹窄程度分為:輕度狹窄組(27例),中度狹窄組(79例),重度狹窄組(62例)。冠狀動(dòng)脈造影結(jié)果檢查正常且行24小時(shí)動(dòng)態(tài)心電圖者54例為對(duì)照組。在入院72小時(shí)內(nèi)采用12導(dǎo)動(dòng)態(tài)心電圖儀(型號(hào):BI9800)記錄所有受試者HRV時(shí)域指標(biāo),NN間期標(biāo)準(zhǔn)差(standard deviation of all normal intervals,SDNN)、NN間期平均值的標(biāo)準(zhǔn)差(standard deviation of the average values of NN intervals,SDANN)、NN間期標(biāo)準(zhǔn)差的均值(mean value of the standard deviations of all NN intervals,SDNN INDEX)、相鄰NN間期差值的均方根(the square root of the mean of sum of the squares of differences between adjacent R-R intervals,RMSSD)、相鄰NN間期的差值超過(guò)50ms的心搏數(shù)占NN間期總搏數(shù)的百分比(the percentage of adjacent NN intervals differing by more than 50ms,PNN50)、相鄰NN間期的差值超過(guò)50ms的心搏數(shù)(the adjacent NN intervals differing by more than 50ms,NN50)、HRV三角指數(shù),記錄24小時(shí)。結(jié)果:1.把單支、雙支、多支病變分三個(gè)等級(jí),進(jìn)行秩和檢驗(yàn),氣滯血瘀證組,氣虛血瘀證組,痰瘀互結(jié)證組的病變支數(shù)等級(jí)分布有統(tǒng)計(jì)學(xué)差異(p0.01),UA病變支數(shù)在各組間有痰瘀互結(jié)證組氣虛血瘀證組氣滯血瘀證組的趨勢(shì)。2.按冠狀動(dòng)脈狹窄程度分輕度、中度、重度病變分三個(gè)等級(jí),經(jīng)秩和檢驗(yàn)得出氣滯血瘀證組,氣虛血瘀證組,痰瘀互結(jié)證組,病變狹窄程度無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);但UA狹窄程度有痰瘀互結(jié)證組氣虛血瘀證組氣滯血瘀證組的趨勢(shì)。3.其中氣滯血瘀證組、氣虛血瘀證組和痰瘀互結(jié)證組的HRV時(shí)域指標(biāo)SDNN、SDANN、SDNN INDEX均明顯低于對(duì)照組(P0.05);痰瘀互結(jié)證組SDNN明顯低于氣滯血瘀證組和氣虛血瘀證組(P0.05);相鄰NN間期差值的均方根RMSSD在痰瘀互結(jié)證組和氣滯血瘀證組也明顯低于對(duì)照組(P0.05);HRV三角指數(shù)在痰瘀互結(jié)證組與氣虛血瘀證組明顯低于對(duì)照組(P0.05),且痰瘀互結(jié)證組明顯低于氣滯血瘀證組(P0.05)。4.單支病變組、雙支病變組與多支病變組SDNN、SDANN、SDNN INDEX均低于對(duì)照組(P0.05),且多支病變組SDNN、SDANN低于單支病變組和雙支病變組(P0.05);RMSSD、相鄰NN間期的差值超過(guò)50ms的心搏數(shù)占NN間期總搏數(shù)的百分比PNN50、三角指數(shù)在多支病變組和雙支病變組低于對(duì)照組(P0.05),且三角指數(shù)在多支病變組和雙支病變組低于單支病變組(P0.05)。5.SDNN在輕度狹窄組、中度狹窄組、重度狹窄組均明顯低于對(duì)照組(P0.05),且重度狹窄組明顯低于輕度狹窄組和中度狹窄組(p0.05);SDANN在各組間有對(duì)照組輕度狹窄組中度狹窄組重度狹窄組(p0.05);SDNN INDEX在重度狹窄組和中度狹窄組明顯低于對(duì)照組和輕度狹窄組(p0.05);三角指數(shù)在中度狹窄組與重度狹窄組明顯低于對(duì)照組(p0.05),且重度狹窄組明顯低于輕度狹窄組(p0.05)。結(jié)論:1.UA中醫(yī)證型與冠狀動(dòng)脈病變程度有相關(guān)性,氣滯血瘀證、氣虛血瘀證和痰瘀互結(jié)證三組中,痰瘀互結(jié)證病變程度最重,其次為氣虛血瘀證,氣滯血瘀證的病變程度最輕。2.UA患者HRV降低,存在著自主神經(jīng)功能受損;中醫(yī)證型與HRV存在相關(guān)性,痰瘀互結(jié)證組HRV明顯低于氣虛血瘀證組和氣滯血瘀證組;HRV隨著冠狀動(dòng)脈病變程度的加重而降低。
[Abstract]:Objective: to analyze the relationship between the TCM syndrome types of unstable angina pectoris (UA) and the degree of coronary artery disease and heart rate variability (heart rate variability, HRV) three, and to provide a reference for the prediction of the degree of coronary artery disease and the judgment of the damage of autonomic nerve function in the patients of UA. Method: collect March 2015 By December 2016 at the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, coronary angiography (CAG) was used to check the patients with UA. Among the 168 patients selected, they were divided into qi stagnation and blood stasis syndrome group (43 cases), Qi deficiency and blood stasis syndrome group (57 cases), phlegm stasis syndrome group (68 cases), and the coronary artery lesion branch. The number was divided into single branch lesion group (53 cases), double branch lesion group (60 cases) and multiple branch lesion group (55 cases). The degree of coronary artery stenosis was divided into mild stenosis group (27 cases), moderate stenosis group (79 cases), severe stenosis group (62 cases). Coronary angiography results were normal and 24 hour dynamic electrocardiogram (54 cases) were used as control group. 12 guide was used within 72 hours of admission. The dynamic electrocardiograph (model: BI9800) records all the subjects' HRV time domain index, the standard deviation of the NN interval standard (standard deviation of all normal intervals, SDNN), the standard deviation of the NN interval value. All NN intervals, SDNN INDEX), the root mean square root of the difference value of the adjacent NN interval (the square root of the mean) E than 50ms, PNN50), the difference of the adjacent NN interval exceeded 50ms's heart beat number (the adjacent NN intervals differing by), recorded for 24 hours. Results: 1. single branch, double branch and multi branch lesion were divided into three grades, rank sum test, qi stagnation and blood stasis syndrome group, Qi deficiency and blood stasis syndrome group, phlegm stasis syndrome group's pathological branch There were statistical differences (P0.01), and the number of UA lesions in each group had phlegm and blood stasis syndrome group. The trend.2. of qi stagnation and blood stasis syndrome group was divided into three grades according to the degree of coronary stenosis, which were divided into mild, moderate and severe pathological changes. There was no statistical difference in degree (P0.05), but the degree of UA stenosis was in the group of qi stagnation and blood stasis syndrome group of qi deficiency and blood stasis syndrome group.3. in which qi stagnation and blood stasis syndrome group, Qi deficiency and blood stasis syndrome group and phlegm stasis syndrome group HRV time domain index SDNN, SDANN, SDNN INDEX were significantly lower than the control group (P0.05); SDNN of phlegm stasis syndrome group was obviously lower than qi stagnation and blood stasis syndrome group. Syndrome group and Qi deficiency and blood stasis syndrome group (P0.05); the root mean square root RMSSD of adjacent NN interval in phlegm and stasis syndrome group and qi stagnation and blood stasis syndrome group was also significantly lower than the control group (P0.05); HRV triangle index in the phlegm stasis syndrome group and Qi deficiency and blood stasis syndrome group was significantly lower than the control group (P0.05), and the phlegm stasis syndrome group was significantly lower than the qi stagnation and blood stasis syndrome group (P0.05).4. single branch The SDNN, SDANN, and SDNN INDEX in the double branch group and the multiple branch lesion group were lower than the control group (P0.05), and the multiple branch lesion group was SDNN, SDANN was lower than the single branch and the double branch lesion group (P0.05); RMSSD, the difference of the adjacent NN interval exceeded the 50ms number in the percentage of the total NN interval, and the trigonometric index was in the multiple lesion group and the double branch lesion. The group was lower than the control group (P0.05), and the trigonometric index was lower than the single branch lesion group (P0.05) in the mild stenosis group, the moderate stenosis group and the severe stenosis group were significantly lower than the control group (P0.05), and the severe stenosis group was significantly lower than the mild narrow group and the moderate stenosis group (P0.05), and the SDANN in the control group was lighter than the control group (P0.05). Severe stenosis group (P0.05) in moderate stenosis group, SDNN INDEX in severe stenosis group and moderate stenosis group was significantly lower than control group and mild stenosis group (P0.05); trigonometric index in moderate stenosis group and severe stenosis group was significantly lower than that of control group (P0.05), and severe stenosis group was significantly lower than that of mild stenosis group (P0.05). Conclusion: 1.UA TCM syndrome type and the group of severe stenosis (P0.05). Among the three groups, the degree of coronary artery disease was related, qi stagnation and blood stasis syndrome, Qi deficiency and blood stasis syndrome and phlegm stasis syndrome were the most serious, followed by qi deficiency and blood stasis syndrome,.2.UA patients with the lightest degree of qi stagnation and blood stasis syndrome HRV decreased, there was a loss of autonomic nerve function, the TCM syndrome type was correlated with HRV, and the syndrome group of phlegm and blood stasis syndrome was H RV was significantly lower than that of qi deficiency and blood stasis syndrome group and qi stagnation and blood stasis syndrome group; HRV decreased with the aggravation of coronary artery lesion.
【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】：2017
【分類號(hào)】：R259

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相關(guān)期刊論文 前10條

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