出血性中风中医辨证与影像学改变的相关性研究
|
摘要
出血性中风属于现代医学的急性脑血管疾病,它起病急骤,往往在活动中突然发病,一般以突然昏仆,半身不遂,偏身麻木等为主症,常伴有头疼,头晕,恶心呕吐等症。是一组好发于中、老年人的急性脑血管病,其特点是发病率高、死亡率高、致残率高、并发症多等特点,因此又称“三高一多”症,是严重威胁人类健康的疾病。出血性中风又包括出血性中风和蛛网膜下腔出血,其病死率为40%～60%,存活者中70%～80%留有病残,且40%左右为重残。对于大量出血的临床患者,因其起病较急骤,所以在诊断方面显得尤为重要,所以出血性中风的影像学诊断研究已成为中西医学领域研究的重要课题。出血性中风的中医证候是一个动态变化的过程,临床所见出血性中风在几天、甚至是几个小时内就可发生明确的演变。危重病人可以很快从闭证转变为脱证,气虚血瘀证也可转为痰湿蒙塞心神证。
目前,在出血性中风中西医结合诊断方面有应用CT以出血的部位和出血分型与中医病性的相关性研究。但各家结果不尽一致,尤其将急性出血性中风影像学改变与中医病位证素的相关性研究较少。因此,本课题拟开展急性出血性中风影像学改变与中医病性、病位证素,证型的相关性研究。我们利用中西医结合相对照的方法对119例明确诊断的出血性中风的患者进行临床分期分型和影像学检查,同时采用中医望、闻、问、切四诊,搜集资料。同时按证素的范畴,归纳其病位病性,并进行证候组合。以探讨急性出血中风影像学改变与中医证相关性,以期能为中医辨证提供客观指标。
The acute bleeding apoplexy of summary belongs to the acute brain blood vessel disease of modern medical science, the disease is worried and sudden that it gets up, often had illness coming on among the activity suddenly, generally the confused servant suddenly, hemiplegia, lean towards body to be getting numb for main disease, often with headache, dizzy, nausea person who vomit disease. It is take place one group easily on in, cerebrovascular diseaseses acutes of the elderly,characteristic of it high in morbidity, mortality the high and lasting rate high, complication grade characteristics many, also called " more than three Senior One " disease, threaten disease of human health seriously. Bleeding apoplexy includes a of bleeding under bleeding apoplexy and spider's omentum again, its case fatality rate is 40%0%, 70%0% keep sick and incomplete of the persons who survive, and 40% are heavy and incomplete from side to side. As to a large number of clinical patients, because its disease is relatively urgent and sudden, seem particularly important in diagnosing, so person who bleed image of apoplexy learn, diagnose, study, become midwest medical field study important subject already. Person who bleed Chinese medicine card of apoplexy it waits to be one dynamic course of change, in how many days it will be clinical finding apoplexy of bleeding etc., even several hour can take place clear development. Critical patient can soon from close card change card of taking off into, deficiency of vital energy blood silt card can also transfer phlegm to to be wet to cover with to fill the mind card. At present, wind combine traditional Chinese and western medicine, diagnose respect have, employ CT with position that bleed and bleed person who divide study with Chinese medicine getting ill relevance among person who bleed. But every result is not the same, especially the acute bleeding apoplexy image will be studied and changed to study with the relevance with plain card of disease location of Chinese medicine less. So subject this plan, launch acute person who bleed apoplexy image study, change until Chinese medicine getting ill, disease location card plain, the relevance of the card type is studied. We utilize method contrasted to combine traditional Chineseand western medicine define to 119 bleeding that diagnose patient of apoplexy carry on clinical person who divide and image learn, check by stages, adopt Chinese medicine to hope, hear, ask, cut the four methods of diagnosis at the same time, collect the materials. According to card plain category, sum up its disease location disease, carry on card wait, make up at the same time. In order to probe into acute bleeding apoplexy image study, change with Chinese medicine card relevance, expect to offer the objective index dialectically for Chinesemedicine.
目前,在出血性中风中西医结合诊断方面有应用CT以出血的部位和出血分型与中医病性的相关性研究。但各家结果不尽一致,尤其将急性出血性中风影像学改变与中医病位证素的相关性研究较少。因此,本课题拟开展急性出血性中风影像学改变与中医病性、病位证素,证型的相关性研究。我们利用中西医结合相对照的方法对119例明确诊断的出血性中风的患者进行临床分期分型和影像学检查,同时采用中医望、闻、问、切四诊,搜集资料。同时按证素的范畴,归纳其病位病性,并进行证候组合。以探讨急性出血中风影像学改变与中医证相关性,以期能为中医辨证提供客观指标。
The acute bleeding apoplexy of summary belongs to the acute brain blood vessel disease of modern medical science, the disease is worried and sudden that it gets up, often had illness coming on among the activity suddenly, generally the confused servant suddenly, hemiplegia, lean towards body to be getting numb for main disease, often with headache, dizzy, nausea person who vomit disease. It is take place one group easily on in, cerebrovascular diseaseses acutes of the elderly,characteristic of it high in morbidity, mortality the high and lasting rate high, complication grade characteristics many, also called " more than three Senior One " disease, threaten disease of human health seriously. Bleeding apoplexy includes a of bleeding under bleeding apoplexy and spider's omentum again, its case fatality rate is 40%0%, 70%0% keep sick and incomplete of the persons who survive, and 40% are heavy and incomplete from side to side. As to a large number of clinical patients, because its disease is relatively urgent and sudden, seem particularly important in diagnosing, so person who bleed image of apoplexy learn, diagnose, study, become midwest medical field study important subject already. Person who bleed Chinese medicine card of apoplexy it waits to be one dynamic course of change, in how many days it will be clinical finding apoplexy of bleeding etc., even several hour can take place clear development. Critical patient can soon from close card change card of taking off into, deficiency of vital energy blood silt card can also transfer phlegm to to be wet to cover with to fill the mind card. At present, wind combine traditional Chinese and western medicine, diagnose respect have, employ CT with position that bleed and bleed person who divide study with Chinese medicine getting ill relevance among person who bleed. But every result is not the same, especially the acute bleeding apoplexy image will be studied and changed to study with the relevance with plain card of disease location of Chinese medicine less. So subject this plan, launch acute person who bleed apoplexy image study, change until Chinese medicine getting ill, disease location card plain, the relevance of the card type is studied. We utilize method contrasted to combine traditional Chineseand western medicine define to 119 bleeding that diagnose patient of apoplexy carry on clinical person who divide and image learn, check by stages, adopt Chinese medicine to hope, hear, ask, cut the four methods of diagnosis at the same time, collect the materials. According to card plain category, sum up its disease location disease, carry on card wait, make up at the same time. In order to probe into acute bleeding apoplexy image study, change with Chinese medicine card relevance, expect to offer the objective index dialectically for Chinesemedicine.
引文
[1]冯学功.中风病从毒论治研究概述.辽宁中医杂志.2002年06期:22-23
[2]刘茂才.中风病证候动态演变规律研究.新中医.2005年11期:45-47
[3]孙岩.出血性中风急性期中医治法研究.中国医药导报.2006年17期:23-25
[4]郑国庆.出血中风病因病机的发展及阐发.浙江中医学院学报2005年7月第29卷第4期:112-114
[5]全国中风协作组.中医杂志.1997年第10卷:12-13
[6]梁伟雄.中风病急性期中医证候分布规律的研究.广州中医药大学学报1997年第14卷第2期:23-24
[7]梁晖.出血性中风中经络血清sICAM,MDA变化的临床研究.福建中医学院学报2005年12月第15卷第6期61
[8]魏丹.脑出血中医临床证型与头CT表现的相关性.中医药研究.1999年第15卷第3期:24-25
[9]徐会晤.急性脑出血CT与中医辩证分型之间关系初探.陕西中医学院学报1994第1期:35-36
[10]刘茂才等.高血压性中、大量脑出血救治方案建立的思路.广州中医药大学学报.2001年3月第18卷第1期.
[11]吴艳华.通腑泻热豁痰法治疗急性期脑出血42例疗效观察.新中医.2003年12 月:124-125
[12]唐桂华.凉血散瘀合剂治疗脑出血.云南中医中药杂志2006年第27卷第1期:24-25
[13]刘庆宪.丹参治疗急性期脑出血.中医杂志.2005年第12卷.15
[14]吴文斌.水蛭提取液对实验性脑内血肿吸收的病理学及为的影响中国临床康复.2004年01期:35-36
[15]张吕军.破血逐瘀法治疗急性脑出血.浙江中医学院学报2001年7月
[16]黎杏群,金益强.平肝息风汤对脑溢血患者日常生活活动能力的影响.[J].湖南医科大学学报,1994,19(6):12-13
[17]郑健刚,周继曾,张存生,等.“醒脑开窍”针法治疗脑出血急性期实验研究.天津中医,1996,13(5)
[18]冯清明,陈松,等.化痰祛瘀针刺法对脑出血偏瘫患者血液AT-Ⅲ、tPA活性、PAI活性的影响.湖南中医药导报,1998,4(2)
[19]刘庆新等.《中西医结合分期治疗高血压脑出血的临床研究.中西医结合心脑血管病杂志2003年11月第1卷第11期:644-64562
[20]黄坚红等.分期选用活血化瘀药治疗高血压性脑出血32例疗效观察.新中医2005年11月第37卷第11期:30-31
[21]骆路明中风中医辨证施治四川中医2003年第21卷第1期:34-35
[22]张东兰等.安宫牛黄丸治疗脑出血中枢性发热36例.中成药2001年1月第23卷第1期:73-74
[23]阿泽云.参麦注射液对出血性中风老龄大鼠CA1区神经细胞形态结构的影响.中国中医药科技2002年第9卷第1期:23-24
[24]司银楚.三七总皂甙对脑出血大鼠前脑兴奋性氨基酸受体Glur2表达的作用.解剖学杂志.2001年4月第1期:73-74
[1]黄如训.出血性中风的分型分期治疗.中国神经精神疾病杂志1999年第25卷第3期:58-59
[2]朱文锋.病位证素特征.福建中医药.2005年8月第36卷:58-59
[3]王永炎.中医内科学.(上海科学技术出版社)2003年8月:121-124
[4]朱文锋.证素辩证新体系的内容及科学意义.医学与哲学.2005.26(1):48
[5]海霞.朱文锋教授谈证素辩证新体系.中国中医药报.2004年4月:43-44
[6]王维治主编,神经病学教材第五版[M].人民卫生出版社,2004;(7):15349
[7]黄如训,郭玉璞脑卒中的分型分期治疗[J].中国神经精疾病杂志,2001;27(1):73-74.
[8]国家中医药管理局脑病急症协作组,中风病辨证诊断标(试行)[J].北京中医药大学学报,1994;17(3):64-66
[9]周家宝,等.高血压出血性中风破入脑室的预后研究.中风与神经疾病杂志2005(1):7
[10]饶明利.高血压出血性中风继发脑干出血的病理与临床(附39例分析)中国神经精神疾病杂志,1983,1:6-8
[11]CaoG.Boali N qianJ.et.al.Intracerebral hemorrhage-inducedneuron death.J Neurosu gery,2001,48(4):875-883
[12]Nath FP.Kelly PT.Jenkins.At.et.al.effects of experimentalIntracerebral hemorrhageon blood flow,capillary permeability.Neurosugery,1981,66(4):552-562
[2]刘茂才.中风病证候动态演变规律研究.新中医.2005年11期:45-47
[3]孙岩.出血性中风急性期中医治法研究.中国医药导报.2006年17期:23-25
[4]郑国庆.出血中风病因病机的发展及阐发.浙江中医学院学报2005年7月第29卷第4期:112-114
[5]全国中风协作组.中医杂志.1997年第10卷:12-13
[6]梁伟雄.中风病急性期中医证候分布规律的研究.广州中医药大学学报1997年第14卷第2期:23-24
[7]梁晖.出血性中风中经络血清sICAM,MDA变化的临床研究.福建中医学院学报2005年12月第15卷第6期61
[8]魏丹.脑出血中医临床证型与头CT表现的相关性.中医药研究.1999年第15卷第3期:24-25
[9]徐会晤.急性脑出血CT与中医辩证分型之间关系初探.陕西中医学院学报1994第1期:35-36
[10]刘茂才等.高血压性中、大量脑出血救治方案建立的思路.广州中医药大学学报.2001年3月第18卷第1期.
[11]吴艳华.通腑泻热豁痰法治疗急性期脑出血42例疗效观察.新中医.2003年12 月:124-125
[12]唐桂华.凉血散瘀合剂治疗脑出血.云南中医中药杂志2006年第27卷第1期:24-25
[13]刘庆宪.丹参治疗急性期脑出血.中医杂志.2005年第12卷.15
[14]吴文斌.水蛭提取液对实验性脑内血肿吸收的病理学及为的影响中国临床康复.2004年01期:35-36
[15]张吕军.破血逐瘀法治疗急性脑出血.浙江中医学院学报2001年7月
[16]黎杏群,金益强.平肝息风汤对脑溢血患者日常生活活动能力的影响.[J].湖南医科大学学报,1994,19(6):12-13
[17]郑健刚,周继曾,张存生,等.“醒脑开窍”针法治疗脑出血急性期实验研究.天津中医,1996,13(5)
[18]冯清明,陈松,等.化痰祛瘀针刺法对脑出血偏瘫患者血液AT-Ⅲ、tPA活性、PAI活性的影响.湖南中医药导报,1998,4(2)
[19]刘庆新等.《中西医结合分期治疗高血压脑出血的临床研究.中西医结合心脑血管病杂志2003年11月第1卷第11期:644-64562
[20]黄坚红等.分期选用活血化瘀药治疗高血压性脑出血32例疗效观察.新中医2005年11月第37卷第11期:30-31
[21]骆路明中风中医辨证施治四川中医2003年第21卷第1期:34-35
[22]张东兰等.安宫牛黄丸治疗脑出血中枢性发热36例.中成药2001年1月第23卷第1期:73-74
[23]阿泽云.参麦注射液对出血性中风老龄大鼠CA1区神经细胞形态结构的影响.中国中医药科技2002年第9卷第1期:23-24
[24]司银楚.三七总皂甙对脑出血大鼠前脑兴奋性氨基酸受体Glur2表达的作用.解剖学杂志.2001年4月第1期:73-74
[1]黄如训.出血性中风的分型分期治疗.中国神经精神疾病杂志1999年第25卷第3期:58-59
[2]朱文锋.病位证素特征.福建中医药.2005年8月第36卷:58-59
[3]王永炎.中医内科学.(上海科学技术出版社)2003年8月:121-124
[4]朱文锋.证素辩证新体系的内容及科学意义.医学与哲学.2005.26(1):48
[5]海霞.朱文锋教授谈证素辩证新体系.中国中医药报.2004年4月:43-44
[6]王维治主编,神经病学教材第五版[M].人民卫生出版社,2004;(7):15349
[7]黄如训,郭玉璞脑卒中的分型分期治疗[J].中国神经精疾病杂志,2001;27(1):73-74.
[8]国家中医药管理局脑病急症协作组,中风病辨证诊断标(试行)[J].北京中医药大学学报,1994;17(3):64-66
[9]周家宝,等.高血压出血性中风破入脑室的预后研究.中风与神经疾病杂志2005(1):7
[10]饶明利.高血压出血性中风继发脑干出血的病理与临床(附39例分析)中国神经精神疾病杂志,1983,1:6-8
[11]CaoG.Boali N qianJ.et.al.Intracerebral hemorrhage-inducedneuron death.J Neurosu gery,2001,48(4):875-883
[12]Nath FP.Kelly PT.Jenkins.At.et.al.effects of experimentalIntracerebral hemorrhageon blood flow,capillary permeability.Neurosugery,1981,66(4):552-562