中风急性期中经络与中脏腑痰热腑实证临床特点对比研究
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摘要
目的探索中风病急性期中经络痰热腑实证与中脏腑痰热腑实证在神经功能缺损程度、不同时点中医证候分布、腑实持续时间等方面的临床特点。方法采用病历回顾研究的分析方法,对204例中经络痰热腑实证(以下简称中经络组)与217例中脏腑痰热腑实证(以下简称中脏腑组)的基本信息、发病时美国国立卫生院卒中量表(NIHSS)评分、腑气通畅与否及腑实持续时间、不同时段(发病1~3 d、发病4~7 d、发病8~14 d)中医证候分布进行数据结构化录入,对数据所得临床特点对比分析研究。结果中脏腑组患者NIHSS评分中除意识状态以外的神经功能缺损程度明显高于中经络组(P<0.01);中脏腑组患者平均腑气通畅时间明显长于中经络组(P<0.01),且急性期内中脏腑组腑气始终未通的比例明显高于中经络组;中经络组中痰热腑实证在发病1~14 d呈现逐渐递减趋势,中脏腑组痰热腑实证在发病1~7 d呈现递增趋势,发病8~14 d呈现递减趋势;中经络组气虚血瘀、风痰瘀血闭阻脉络证在4~14 d的出现例数明显高于1~3 d,中脏腑组阴虚风动、痰热瘀血、风痰瘀血在8~14 d出现例数明显高于1~3 d。结论痰热腑实证的持续时间与中风病病情严重程度呈正相关,即中脏腑痰热腑实证神经功能缺损重、持续时间长。
Objective To explore the clinical characteristics of pattern of phlegm heat and bowel excess in acute stage of stroke involving meridian-collateral or involving zang-fu organs from the aspects of severity of neurological impairment,pattern distribution at different time points and duration of bowel excess.Methods The basic information,scores of National Institute of Health Stroke Scale(NIHSS),whether bowel qi being unobstructed or not,duration of bowel excess,and pattern distribution at different time points(onset for 1 d to 3 d,onset for 4 d to 7 d and onset for 8 d to 14 d) were inputted based on structured data by using retrospective analysis of medical records in 204 cases of pattern of phlegm heat and bowel excess of stroke involving meridian-collateral(meridian-collateral group) and 217 cases of pattern of phlegm heat and bowel excess of stroke involving zang-fu organs(zang-fu organ group).The clinical characteristics from the data were compared,analyzed and studied.Results The severity of neurological impairment except of conscious state was significantly higher in zang-fu organ group than that in meridian-collateral group(P < 0.01).The average duration of unobstructed bowel qi was significantly longer in zang-fu organ group than that in meridian-collateral group(P < 0.01),and the percentage of patients with throughout obstructed bowel qi was significantly higher in zang-fu organ group than that in meridian-collateral group in acute stage of stroke.The pattern of phlegm heat and bowel excess showed a decline trend after stroke onset for 1 d to 14 d in meridian-collateral group,and showed an ascending trend after stroke onset for 1 d to 7 d and a decling trend after stroke onset for 8 d to 14 d in zang-fu organ group.The cases of pattern of qi deficiency with blood stasis or pattern of collaterals blocked by windphlegm and static blood were significantly higher in meridian-collateral group at 4-14 d than those at 1-3 d,and cases of pattern of wind stirring due to yin deficiency,pattern of phlegm heat and blood stasis or pattern of wind phlegm and blood stasis were significantly higher in zang-fu organ group at 8-14 d than those at time point 1.Conclusion The duration of pattern of phlegm heat and bowel excess is positively correlated to the severity of stroke,that is,neurological impairment is more serious and duration is longer in patients with pattern of phlegm heat and bowel excess of stroke involving zang-fu organs.
Objective To explore the clinical characteristics of pattern of phlegm heat and bowel excess in acute stage of stroke involving meridian-collateral or involving zang-fu organs from the aspects of severity of neurological impairment,pattern distribution at different time points and duration of bowel excess.Methods The basic information,scores of National Institute of Health Stroke Scale(NIHSS),whether bowel qi being unobstructed or not,duration of bowel excess,and pattern distribution at different time points(onset for 1 d to 3 d,onset for 4 d to 7 d and onset for 8 d to 14 d) were inputted based on structured data by using retrospective analysis of medical records in 204 cases of pattern of phlegm heat and bowel excess of stroke involving meridian-collateral(meridian-collateral group) and 217 cases of pattern of phlegm heat and bowel excess of stroke involving zang-fu organs(zang-fu organ group).The clinical characteristics from the data were compared,analyzed and studied.Results The severity of neurological impairment except of conscious state was significantly higher in zang-fu organ group than that in meridian-collateral group(P < 0.01).The average duration of unobstructed bowel qi was significantly longer in zang-fu organ group than that in meridian-collateral group(P < 0.01),and the percentage of patients with throughout obstructed bowel qi was significantly higher in zang-fu organ group than that in meridian-collateral group in acute stage of stroke.The pattern of phlegm heat and bowel excess showed a decline trend after stroke onset for 1 d to 14 d in meridian-collateral group,and showed an ascending trend after stroke onset for 1 d to 7 d and a decling trend after stroke onset for 8 d to 14 d in zang-fu organ group.The cases of pattern of qi deficiency with blood stasis or pattern of collaterals blocked by windphlegm and static blood were significantly higher in meridian-collateral group at 4-14 d than those at 1-3 d,and cases of pattern of wind stirring due to yin deficiency,pattern of phlegm heat and blood stasis or pattern of wind phlegm and blood stasis were significantly higher in zang-fu organ group at 8-14 d than those at time point 1.Conclusion The duration of pattern of phlegm heat and bowel excess is positively correlated to the severity of stroke,that is,neurological impairment is more serious and duration is longer in patients with pattern of phlegm heat and bowel excess of stroke involving zang-fu organs.
引文
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[5]王永炎,谢颖桢.化痰通腑法治疗中风病痰热腑实证的源流及发展(三)——意象诊疗模式下中风病痰热腑实证的涌现特征[J].北京中医药大学学报(中医临床版),2013,20(3):1-4.Wang YY,Xie YZ,Origin and development of therapy of resolving phlegm and relaxing bowels for treating syndrome of phlegm heat and bowel excess of stroke(III):springup features of syndrome of phlegm heat and bowel excess of stroke under imagery therapeutic mode[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medicine),2013,20(3):1-4.
[6]庾慧,邹旭.中医中风病急性期患者发病诱因的初步调查[J].中国中医急症,2000,9(5):217-218.Yu H,Zou X.An Investigation on Predisposing Factors in Patients with Acute Stroke[J].Journal of emergency in traditional chinese medicine,2000,9(5):217-218.
[7]谢颖桢,任晋婷,王振矗,等.化痰通腑法影响中风病患者意识状况的临床分析[J].北京中医药大学学报(中医临床版),2009,16(2):17-19.Xie YZ,Ren JT,Wang ZC,et al.Influence of therapy of resolving phlegm and relaxing bowels on consciousness in patients with stroke[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medicine),2009,16(2):17-19.
[8]王永炎,谢颖桢.化痰通腑法治疗中风病痰热腑实证的源流及发展(二)——化痰通腑法治疗后的不同证候演变及疾病转归与治疗[J].北京中医药大学学报(中医临床版),2013,20(2):1-3.Wang YY,Xie YZ.Origin and development of therapy of resolving phlegm and relaxing bowels for treating syndrome of phlegm heat and bowel excess of stroke(Ⅱ):Evolution,prog-nosis and treatment of different syndromes after applying therapy of resolving phlegm and relaxi[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medici-ne),2013,20(2):1-3.
[9]王永炎,谢颖桢.化痰通腑法治疗中风病痰热腑实证的源流及发展(一)——历史源流、证候病机及临床应用[J].北京中医药大学学报(中医临床版),2013,20(1):1-6.Wang YY,Xie YZ,Origin and development of therapy of resolving phlegm and relaxing bowels for treating syndrome of phlegm heat and bowel excess of stroke(I):history,origin,syndromes,pathogenesis and clinical application[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medicine),2013,20(1):1-6.
[10]丁元庆.中风病痰热腑实证辨治规律探讨[J].山西中医,2001,17(3):12-13.Ding YQ.Exploration on the Syndrome Differentiation Principle of the Heat-phlegm and Sthenic-fu Type of Apoplexy[J].Shanxi Journal of Traditional Chinese Medicine,2001,17(3):12-13.
[11]关少侠,谌剑飞,马雅玲.急性脑梗塞始发状态火热证与免疫细胞因子的关系研究[J].放射免疫学杂志,2000,13(6):331-332.Guan SX,Shen JF,Ma YL.Clinical Study on the Relationship Between HUO-RE(Fire-Heat)Syndrome and Plasma Immune Cell Factor Level Changes at Initial Condition of Acute Cerebral Infarction[J].Journal of Radioimmunology,2000,13(6):331-332.
[12]罗玉韵,关少侠,陈昕,等.中风急性期腑气不通证候组合及与垂体-肾上腺轴激素关系的研究[J].中西医结合心脑血管病杂志,2011,9(7):817-819.Lou YH,Guan SX,Chen X,et al.Relationship between the Syndrome Element Combination and Pituitary-adrenal Axis Hormone in Costive Patiens with Acute Stroke[J].Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease,2011,9(7):817-819.
[13]黄晓,符为民.缺血性中风(中经络)证候分类与血脂、血压、血液流变学关系的研究[J].中国中医急症,2002,11(1):32-33.Huang X,Fu WM.Study of Relationships between the Different Syndromes and the Blood-Liqid,Blood Pressure and Blood Rheologieal in Patients with Ischemic Stroke(Apoplexy Involing the Collaterals and the Channels)[J].Journal of Emergency in Traditional Chinese Medicine,2002,11(1):32-33.
[14]李学军,高燕洁,孟繁兴,等.脑卒中急性期脑肠肽变化的研究[J].吉林中医药,2012,32(11):1113-1115.Li XJ,Gao YJ,Meng FX,et al.Study on the change of cerebral apoplexy in acute cerebral apoplexy[J].Jilin Journal of Traditional Chinese Medicine,2012,32(11):1113-1115.
[15]李学军,高燕洁,陈志刚,等.中风急性期患者血浆脑肠肽变化与中医证型相关性研究[J].中国中医急症,2012,21(9):1407-1408.Li XJ,Gao YJ,Chen ZG,et al.Study on the changes of plasma encephalin peptide and the correlation of TCM syndromes in acute patients with stroke[J].Journal of Emergency in Traditional Chinese Medicine,2012,21(9):1407-1408.
[2]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.State Administration of Traditional Chinese Medicine Encephalopathy Emergency Group.Stroke diagnosis and curative effect evaluation standard(try the line)[J].Journal of Beijing University of Traditional Chinese Medicine,1996,19(1):55-56.
[3]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.Chinese Medical Association Branch of Neurology.China guide 2014 of diagnosis and treatment of acute ischemic stroke[J].Chinese Journal of Neurology,2015,48(4):246-257.
[4]中华全国中医学会内科学会.中风病中医诊断、疗效评定标准[J].中国医药学报,1986,1(2):56-57.Chinese Ssociety of TCM Physicians.Stroke therapeutic effect evaluation standard of TCM diagnosis[J].China Journal of Traditional Chinese Medicine and Pharmacy,1986,1(2):56-57.
[5]王永炎,谢颖桢.化痰通腑法治疗中风病痰热腑实证的源流及发展(三)——意象诊疗模式下中风病痰热腑实证的涌现特征[J].北京中医药大学学报(中医临床版),2013,20(3):1-4.Wang YY,Xie YZ,Origin and development of therapy of resolving phlegm and relaxing bowels for treating syndrome of phlegm heat and bowel excess of stroke(III):springup features of syndrome of phlegm heat and bowel excess of stroke under imagery therapeutic mode[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medicine),2013,20(3):1-4.
[6]庾慧,邹旭.中医中风病急性期患者发病诱因的初步调查[J].中国中医急症,2000,9(5):217-218.Yu H,Zou X.An Investigation on Predisposing Factors in Patients with Acute Stroke[J].Journal of emergency in traditional chinese medicine,2000,9(5):217-218.
[7]谢颖桢,任晋婷,王振矗,等.化痰通腑法影响中风病患者意识状况的临床分析[J].北京中医药大学学报(中医临床版),2009,16(2):17-19.Xie YZ,Ren JT,Wang ZC,et al.Influence of therapy of resolving phlegm and relaxing bowels on consciousness in patients with stroke[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medicine),2009,16(2):17-19.
[8]王永炎,谢颖桢.化痰通腑法治疗中风病痰热腑实证的源流及发展(二)——化痰通腑法治疗后的不同证候演变及疾病转归与治疗[J].北京中医药大学学报(中医临床版),2013,20(2):1-3.Wang YY,Xie YZ.Origin and development of therapy of resolving phlegm and relaxing bowels for treating syndrome of phlegm heat and bowel excess of stroke(Ⅱ):Evolution,prog-nosis and treatment of different syndromes after applying therapy of resolving phlegm and relaxi[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medici-ne),2013,20(2):1-3.
[9]王永炎,谢颖桢.化痰通腑法治疗中风病痰热腑实证的源流及发展(一)——历史源流、证候病机及临床应用[J].北京中医药大学学报(中医临床版),2013,20(1):1-6.Wang YY,Xie YZ,Origin and development of therapy of resolving phlegm and relaxing bowels for treating syndrome of phlegm heat and bowel excess of stroke(I):history,origin,syndromes,pathogenesis and clinical application[J].Journal of Beijing University of Traditional Chinese Medicine(Clinical Medicine),2013,20(1):1-6.
[10]丁元庆.中风病痰热腑实证辨治规律探讨[J].山西中医,2001,17(3):12-13.Ding YQ.Exploration on the Syndrome Differentiation Principle of the Heat-phlegm and Sthenic-fu Type of Apoplexy[J].Shanxi Journal of Traditional Chinese Medicine,2001,17(3):12-13.
[11]关少侠,谌剑飞,马雅玲.急性脑梗塞始发状态火热证与免疫细胞因子的关系研究[J].放射免疫学杂志,2000,13(6):331-332.Guan SX,Shen JF,Ma YL.Clinical Study on the Relationship Between HUO-RE(Fire-Heat)Syndrome and Plasma Immune Cell Factor Level Changes at Initial Condition of Acute Cerebral Infarction[J].Journal of Radioimmunology,2000,13(6):331-332.
[12]罗玉韵,关少侠,陈昕,等.中风急性期腑气不通证候组合及与垂体-肾上腺轴激素关系的研究[J].中西医结合心脑血管病杂志,2011,9(7):817-819.Lou YH,Guan SX,Chen X,et al.Relationship between the Syndrome Element Combination and Pituitary-adrenal Axis Hormone in Costive Patiens with Acute Stroke[J].Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease,2011,9(7):817-819.
[13]黄晓,符为民.缺血性中风(中经络)证候分类与血脂、血压、血液流变学关系的研究[J].中国中医急症,2002,11(1):32-33.Huang X,Fu WM.Study of Relationships between the Different Syndromes and the Blood-Liqid,Blood Pressure and Blood Rheologieal in Patients with Ischemic Stroke(Apoplexy Involing the Collaterals and the Channels)[J].Journal of Emergency in Traditional Chinese Medicine,2002,11(1):32-33.
[14]李学军,高燕洁,孟繁兴,等.脑卒中急性期脑肠肽变化的研究[J].吉林中医药,2012,32(11):1113-1115.Li XJ,Gao YJ,Meng FX,et al.Study on the change of cerebral apoplexy in acute cerebral apoplexy[J].Jilin Journal of Traditional Chinese Medicine,2012,32(11):1113-1115.
[15]李学军,高燕洁,陈志刚,等.中风急性期患者血浆脑肠肽变化与中医证型相关性研究[J].中国中医急症,2012,21(9):1407-1408.Li XJ,Gao YJ,Chen ZG,et al.Study on the changes of plasma encephalin peptide and the correlation of TCM syndromes in acute patients with stroke[J].Journal of Emergency in Traditional Chinese Medicine,2012,21(9):1407-1408.