本文選題：慢性阻塞性肺疾病 + 肺動脈高壓��； 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的本研究以慢性阻塞性肺疾病合并肺動脈高壓為切入點(diǎn),借鑒詢證醫(yī)學(xué)理念和數(shù)理統(tǒng)計(jì)方法,對其中醫(yī)證素進(jìn)行相關(guān)統(tǒng)計(jì)分析。并嘗試探討本病中醫(yī)證素分布規(guī)律,深化中醫(yī)對本病的認(rèn)識,使中醫(yī)辨證更加規(guī)范化、客觀化、標(biāo)準(zhǔn)化,同時為該病辨證標(biāo)準(zhǔn)的創(chuàng)建提供客觀依據(jù),為臨床防治提供參考。研究方法1.文獻(xiàn)研究計(jì)算機(jī)檢索相關(guān)期刊論文(CNKI)、萬方學(xué)術(shù)期刊數(shù)據(jù)庫、中文科技期刊數(shù)據(jù)庫(VIP)以及中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)收集近15年有關(guān)慢性阻塞性肺疾病合并肺動脈高壓中醫(yī)證型研究的相關(guān)文獻(xiàn),從中進(jìn)行證素提取,并利用統(tǒng)計(jì)學(xué)方法進(jìn)行頻次、聚類和關(guān)聯(lián)分析,以探索其特征及規(guī)律。2.臨床研究對52例慢性阻塞性肺疾病合并肺動脈高壓患者進(jìn)行臨床調(diào)查問卷填寫,在四診信息的基礎(chǔ)上進(jìn)行中醫(yī)積分辨證,并利用方差分析、非參數(shù)檢驗(yàn)等統(tǒng)計(jì)方法,對其中醫(yī)證素分布特點(diǎn)進(jìn)行探索性分析。結(jié)果1.文獻(xiàn)研究結(jié)果共檢出符合標(biāo)準(zhǔn)文獻(xiàn)25篇,病例總數(shù)共2098例,提取病位證素2個,分別是肺(64.45%)和腎(35.55%)。病性證素5個,其中實(shí)性證素2個,為血瘀(38.78%)和痰濁(28.67%);虛性證素3個,分別為氣虛(26.75%)、陽虛(1.29%)和陰虛(4.52%)。證素組合類型可歸納為三種,包括單證素形式(15.92%)、雙證素形式(46.66%)、三證素形式(37.42%),其中雙證素出現(xiàn)頻率最高,尤以血瘀+痰濁最為多見。從病性虛實(shí)角度而言,以虛實(shí)兼夾組合居多,占52.76%。聚類分析可分為4大類,C1:肺、腎、陽虛;C2:氣虛;C3:痰濁、血瘀;C4:陰虛。關(guān)聯(lián)分析共挖掘支持度≥10%、置信度≥80%的證素組合27組,其中血瘀→痰濁的支持度為63.49%,置信度達(dá)100.00%;血瘀→氣虛、痰濁的支持度為37.42%,置信度為100.00%;痰濁→肺、血瘀的支持度34.60%,置信度100.00%;血瘀→氣虛的支持度為59.25%,置信度為81.01%。2.臨床研究結(jié)果共提取證素25個,其中病位證素8個,病性證素17個。病位證素主要為肺(100.00%)、心(21.15%)、脾(21.15%)、腎(17.31%);病性證素中虛性證素主要為氣虛(51.92%)、陽虛(38.46%)、血虛(15.38%)、陰虛(13.46%),實(shí)性證素主要為痰(59.62%)、血瘀(30.77%)、濕(21.15%)、飲(17.31%)、氣滯(15.38%)。病性證素組合形式共7種,其中雙證素組合形式構(gòu)成比最大,占36.54%,以氣虛+陽虛組合和痰+血瘀組合多見。單證素組合形式構(gòu)成比僅次于雙證素,為19.23%,其中氣虛出現(xiàn)頻數(shù)最多。三證素組合形式構(gòu)成比為13.46%,以痰+血瘀+氣滯組合多見。結(jié)論本研究運(yùn)用綜合的數(shù)理統(tǒng)計(jì)方法以及四診信息資料的提取,可以得出的結(jié)論有:1.文獻(xiàn)挖掘的病位證素為肺腎兩臟,提示該病首傷于肺,漸累及腎,最終可致肺腎兩臟同病。病性虛性證素中氣虛所占比例最大,可見氣虛是發(fā)病之本,陰虛和陽虛均可在氣虛的基礎(chǔ)上演變而來。歸屬于病性實(shí)性證素的痰瘀形成后,反可因壅而致氣滯亦甚,阻塞胸肺,加重病情。此數(shù)據(jù)結(jié)果與慢性阻塞性肺疾病合并肺動脈高壓的病程特征相符合,其具有慢性、進(jìn)行性、不可逆性、復(fù)雜性的特點(diǎn)。本病病性組合以虛實(shí)兼夾組合多見,虛、痰、瘀是本病遷延纏綿,反復(fù)發(fā)作的重要原因。2.調(diào)查問卷可總結(jié)出本病發(fā)展的大致順序:肺→心脾→腎→五臟。此過程恰巧是一個病邪深入的過程,也是一個由單一病位向復(fù)合病位發(fā)展的過程,體現(xiàn)了本病復(fù)雜繁多,呈進(jìn)行性發(fā)展的特點(diǎn)。從病性證素可以看出,氣損及陽,陽虛不能化氣行水,使得痰濁、氣滯、瘀血互結(jié),使得本病虛實(shí)夾雜,病情反復(fù),病程纏綿,經(jīng)久難愈。
[Abstract]:Objective to study the TCM Syndromes of chronic obstructive pulmonary disease (COPD) with pulmonary hypertension, and to explore the distribution of TCM syndromes, deepen the understanding of TCM, and make the TCM syndrome differentiation more standardized, objective and standardized, and at the same time, at the same time It provides an objective basis for the establishment of the syndrome differentiation criteria for the disease, and provides a reference for clinical prevention and control. Research methods 1. literature search of Chinese journal full text database (CNKI), Wanfang academic journal database, Chinese sci-tech journal database (VIP) and Chinese biomedical literature database (CBM) for the collection of chronic obstructive pulmonary disease in the last 15 years The related literature of the TCM syndrome type of the disease combined with pulmonary hypertension was extracted, and the statistical methods were used to carry out frequency, cluster and correlation analysis to explore the characteristics and regularity of.2. clinical study on 52 cases of chronic obstructive pulmonary disease with pulmonary hypertension. On the basis of traditional Chinese medicine integral syndrome differentiation, and using variance analysis, non parametric test and other statistical methods, the distribution characteristics of TCM syndromes were explored. Results the results of 1. literature study found 25 standard literature, total number of cases were 2098 cases, and 2 cases were extracted from the lung (64.45%) and kidney (35.55%). Among them, the disease syndrome factor was 5. There are 2 sex syndrome elements, blood stasis (38.78%) and phlegm (28.67%), 3 deficiency syndrome elements, Qi deficiency (26.75%), Yang deficiency (1.29%) and yin deficiency (4.52%). The combination of syndrome elements can be classified into three types, including the form of syndrome element (15.92%), double syndrome (46.66%), and three syndrome (37.42%), among which the frequency of bisyndrome is the highest, especially blood stasis + phlegm turbidity From the point of view of disease and deficiency, 52.76%. cluster analysis can be divided into 4 categories: C1: lung, kidney, Yang deficiency, C2: Qi deficiency, C3: phlegm, blood stasis and C4: Yin deficiency. Association analysis is a combination of 27 groups of syndromes that support the degree of support more than 80%, and the support of blood stasis to phlegm is 63.49%, confidence is 100%, blood stasis and blood stasis. Qi deficiency, phlegm turbidity of 37.42%, confidence of 100%; phlegm to lung, lung, blood stasis of 34.60%, confidence 100%; blood stasis to Qi deficiency of 59.25%, the confidence of the 81.01%.2. clinical research results of a total of 25 of the total, including 8 of the disease position syndrome, 17 of the disease, heart (21.15%), the heart (21.15%), spleen (2), spleen (2 (21.15%), spleen (2) (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2), spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2), spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2). 1.15%), kidney (17.31%); the deficiency syndrome elements in the disease syndrome are mainly Qi deficiency (51.92%), Yang deficiency (38.46%), blood deficiency (15.38%) and yin deficiency (13.46%). The real syndrome elements are mainly phlegm (59.62%), blood stasis (30.77%), wet (21.15%), drink (17.31%), Qi Stagnation (15.38%). The combination of syndrome elements is the largest, accounting for 36.54% and Qi deficiency. The combination of Yang deficiency and phlegm + blood stasis is more common. The constituent ratio of the combination form of the syndrome element is only second to the double syndrome element, which is 19.23%, among which the frequency of qi deficiency is the most. The composition ratio of the three syndromes is 13.46%, and the combination of phlegm + blood stasis + qi stagnation is common. Conclusion this study can be obtained by using the comprehensive mathematical statistics method and the extraction of four diagnosis information data. The conclusions are as follows: 1. the disease location in the literature is the two dirty of the lung and kidney, suggesting that the disease first wound in the lungs, gradually accumulate the kidney, and eventually lead to the same disease of the two organs of the lung and kidney. The result of this data is consistent with the course characteristics of chronic obstructive pulmonary disease combined with pulmonary hypertension. It has the characteristics of chronic, progressive, irreversible, complex characteristics. The combination of the disease and the combination of deficiency and solid, deficiency, phlegm, and blood stasis is the prolonged and repeated onset of this disease. The.2. survey questionnaire can summarize the general sequence of the development of the disease: lung, heart, spleen, kidney, and five zang organs. This process happens to be a process of disease and evil. It is also a process of developing from single disease to complex position, which embodies the characteristics of complicated and progressive development of the disease. Deficiency can not transform Qi into running water, making phlegm, qi stagnation and blood stasis intermingled. This makes the deficiency and excess of the disease mixed, and the condition is repeated.
【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

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