“一元论”病因诊断在心率矛盾反应中的临床应用
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摘要
目的应用"一元论"病因诊断理论,辩证分析心率矛盾反应的本质,确定病因,科学治疗。方法选择2017年11月至2018年6月十堰市人民医院感染性疾病科收治的1例"肺炎、冠心病、多浆膜腔积液,心率65次/min"69岁女性患者和1例"上消化道大出血、乙型肝炎后肝硬化,心率70次/min"41岁男性患者的临床资料,辩证分析心率矛盾反应的原因。结果应用"一元论"理论辩证分析上述2例患者肺部感染、胸腔积液与相对缓慢心率的矛盾反应和上消化道出血与相对缓慢心率的矛盾反应,最后确定患者的病因分别为"甲状腺功能减退症"和"肝硬化性心肌病"。结论在细致问诊、规范体检、辅助检查的基础上,应用"一元论"病因诊断理论,辩证分析心率矛盾反应,有助于临床正确诊断,减少误诊误治,达到科学治疗。
Objective To understand the concept of holism view and to analyse the etiological diagnosis of contradictory heart rate reaction.Methods A dialectic diagnosis thinking way was performed on 2 patients with contradictory heart rate admitted to the department of infectious disease in Shiyan People' s Hospital from November 2017 to June 2018. A 69-year-old woman with a history of pneumonia,coronary heart disease,polyserositis and with heart rate 65 beats a minute. The other patient was a 41-year-old man who presented with massive hemorrhage of gastrointestinal tract,liver cirrhosis after hepatitis B,and with heart rate 70 beats a minute. Results The "holistic view"theory was applied to analyze the contradictory responses of pulmonary infection,pleural effusion and relatively slow heart rate in the first patient,as well as upper gastrointestinal hemorrhage and relatively slow heart rate in the second patient. The 2 cases were eventually diagnosed as hypothyroidism and cirrhotic cardiomyopathy respectively. Conclusion Applying"holism view"dialectical analysis to the etiological diagnosis of contradictory heart rate reaction is helpful to get a correct diagnosis and giving the patients' reasonable treatments,on the basis of detailed inquiry,standardized physical examination and auxiliary examination.
Objective To understand the concept of holism view and to analyse the etiological diagnosis of contradictory heart rate reaction.Methods A dialectic diagnosis thinking way was performed on 2 patients with contradictory heart rate admitted to the department of infectious disease in Shiyan People' s Hospital from November 2017 to June 2018. A 69-year-old woman with a history of pneumonia,coronary heart disease,polyserositis and with heart rate 65 beats a minute. The other patient was a 41-year-old man who presented with massive hemorrhage of gastrointestinal tract,liver cirrhosis after hepatitis B,and with heart rate 70 beats a minute. Results The "holistic view"theory was applied to analyze the contradictory responses of pulmonary infection,pleural effusion and relatively slow heart rate in the first patient,as well as upper gastrointestinal hemorrhage and relatively slow heart rate in the second patient. The 2 cases were eventually diagnosed as hypothyroidism and cirrhotic cardiomyopathy respectively. Conclusion Applying"holism view"dialectical analysis to the etiological diagnosis of contradictory heart rate reaction is helpful to get a correct diagnosis and giving the patients' reasonable treatments,on the basis of detailed inquiry,standardized physical examination and auxiliary examination.
引文
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[12]郑先菊,谭华炳.以便秘为首发症状的甲状腺机能减退症误诊1例[J].西部医学杂志,2010,22(11):2185.
[13]高霞,刘敏,杨宁,等.左甲状腺素钠替代治疗改善甲状腺机能减退症患者左心室心肌弥漫性病变的研究[J].中国循环杂志,2016,31(4):349-353.
[14]李云静,雷旭,殷华,等.关注肝硬化性心肌病[J].世界华人消化杂志,2016,24(27):3846-3852.
[15]雷旭,谭华炳.肝硬化性心肌病诊治研究进展[J].中西医结合心脑血管病杂志,2014,12(11):1394-1396.
[16]王亚洁,陈丽萍,尚祉胤,等.B型利钠肽在肝硬化性心肌病中的作用进展[J].临床肝胆病杂志,2018,34(5):1111-1114.
[17]王风雷,李金科,李刚,等.肝炎后肝硬化患者Tei指数与ChildPugh分级的相关性研究[J].西南国防医药杂志,2013,23(2):129-131.
[18]王风雷,雷飞飞,杜卫星,等.肝炎后肝硬化患者心电图改变与Child-Pugh分级及预后的相关性[J].中国药物与临床杂志,2013,13(2):196-197.
[19]许亚琴,王小红.肝硬化性心肌病的临床心电学特点[J].中国现代医药杂志,2012,14(7):96-97.
[20]简佑容,陈世耀.肝硬化性心肌病病理生理学特点及治疗策略的研究进展[J].中国临床医学杂志,2018,25(3):481-486.
[21]雷旭,殷华,柏杏丽,等.气体信号分子硫化氢在肝硬化心肌病大鼠心肌组织中的变化[J].世界华人消化杂志,2015,23(35):5606-5612.
[22]雷旭,刘园园,谢杏榕,等.补阳还五汤对肝硬化性心肌病大鼠心肌组织内源性H2S的影响[J].时珍国医国药杂志,2018,29(6):1341-1343.
[2]曹传东,唐农.气一元论思想对钦安医学理论的影响探究[J].江苏中医药杂志,2018,50(2):5-8.
[3]孟庆岩,相光鑫,颜培正,等.从气一元论分析中医元整体观及其科学性[J].中国中医基础医学杂志,2017,23(4):445-446,452.
[4]祁青,陈松.浅议气一元论与针灸治则[J].湖北中医药大学学报,2017,19(4):52-54.
[5]胡大一.诊疗过程要有哲学思维[N].健康报,2018-03-16(005).
[6]胡大一.看病要透过现象看本质[N].健康报,2018-03-23(005).
[7]杨晶晶,张梅,张运.超声心动图在急危重症中临床应用的研究进展[J/CD].中华诊断学电子杂志,2017,5(3):149-153.
[8]邱华,谭华炳.甲状腺功能减退误诊为消化系统疾病研究现状[J/CD].中国肝脏病杂志(电子版),2016,8(1):33-35.
[9]谢能平,谭华炳.甲状腺功能减退误诊为慢性肝炎及慢性肾炎2年1例[J/CD].中国肝脏病杂志(电子版),2014,6(2):66-67.
[10]刘艳清,谭华炳.甲减致闭经误诊11年,以腹痛、呕吐就诊1例[J].西南国防医药杂志,2016,26(10):1225-1226.
[11]施占立,高明俐.甲状腺机能减退症并心包积液13例临床分析[J].中国地方病防治杂志,2015,30(6):545-546.
[12]郑先菊,谭华炳.以便秘为首发症状的甲状腺机能减退症误诊1例[J].西部医学杂志,2010,22(11):2185.
[13]高霞,刘敏,杨宁,等.左甲状腺素钠替代治疗改善甲状腺机能减退症患者左心室心肌弥漫性病变的研究[J].中国循环杂志,2016,31(4):349-353.
[14]李云静,雷旭,殷华,等.关注肝硬化性心肌病[J].世界华人消化杂志,2016,24(27):3846-3852.
[15]雷旭,谭华炳.肝硬化性心肌病诊治研究进展[J].中西医结合心脑血管病杂志,2014,12(11):1394-1396.
[16]王亚洁,陈丽萍,尚祉胤,等.B型利钠肽在肝硬化性心肌病中的作用进展[J].临床肝胆病杂志,2018,34(5):1111-1114.
[17]王风雷,李金科,李刚,等.肝炎后肝硬化患者Tei指数与ChildPugh分级的相关性研究[J].西南国防医药杂志,2013,23(2):129-131.
[18]王风雷,雷飞飞,杜卫星,等.肝炎后肝硬化患者心电图改变与Child-Pugh分级及预后的相关性[J].中国药物与临床杂志,2013,13(2):196-197.
[19]许亚琴,王小红.肝硬化性心肌病的临床心电学特点[J].中国现代医药杂志,2012,14(7):96-97.
[20]简佑容,陈世耀.肝硬化性心肌病病理生理学特点及治疗策略的研究进展[J].中国临床医学杂志,2018,25(3):481-486.
[21]雷旭,殷华,柏杏丽,等.气体信号分子硫化氢在肝硬化心肌病大鼠心肌组织中的变化[J].世界华人消化杂志,2015,23(35):5606-5612.
[22]雷旭,刘园园,谢杏榕,等.补阳还五汤对肝硬化性心肌病大鼠心肌组织内源性H2S的影响[J].时珍国医国药杂志,2018,29(6):1341-1343.