急性脑梗死患者静脉溶栓后中医证候要素演变

Evolution of TCM pattern elements after intravenous thrombolysis in patients with acute cerebral infarction

目的研究急性脑梗死经静脉溶栓治疗的患者,其在发病14天内的证候要素分布和随时间的演变情况。方法纳入脑梗死发病6 h内,经静脉重组组织型纤维蛋白酶原激活剂(rt-PA)溶栓的患者56例。分别在其发病的第1、3、5、7、14天采集中医证候要素信息。综合各项信息与数据,进行统计学处理分析。结果在患者的证候要素演变中,第1天内风证占主导地位,其次血瘀证及痰湿证所占比例也较高,随着病程进展,内风证在第3天迅速降低,至第14天消失;痰湿证、血瘀证有下降趋势,但所占比例仍较高。随着时点推移,气虚证逐渐增多,在第7天成为最主要证候要素。内火证在第5天升高后又趋于初始比例,阴虚证所占比例始终较低,且随时间推移有下降趋势。结论脑梗死超早期,患者证候要素以实证为主,其中以风证为主导,证候组合以风、痰、瘀之间的2个基本证候组合最多,其次是3个基本证候的组合。与既往研究脑梗死证候要素的演变规律结果相比较,本研究中患者在溶栓治疗后,其临床证候组合形式逐渐减少,且实证逐渐减少,气虚证更加突出。

Objective To study the distribution of pattern elements and their evolution over time in patients with acute cerebral infarction undergoing intravenous thrombolysis within 14 days of onset.Methods 56 patients with rt-PA intravenous thrombolysis within 6 hours after the onset of cerebral infarction were included.The information of TCM pattern elements was collected on the 1 st,3 rd,5 th,7 th and 14 th day after the onset of disease.Various information and data were synthesized for statistical analysis.Results In the evolution of the pattern elements of patients,the wind pattern was the dominart one on the 1 st day;the proportion of blood-stasis pattern and phlegm-dampness pattern was also high.As the disease progressed,the proportion of internal wind pattern rapidly decreased on the 3 rd day and disappeared on the 14 th day;the proportion of phlegm-dampness pattern and blood-stasis pattern showed a downward trend but still maintained high.As time passed,the proportion of qi-deficiency pattern gradually increased and became the highest one on the 7 th day.The proportion of internal-fire pattern rised on the 5 h day and tended to the initial level;the proportion of yin-deficiency pattern was always low with a downward trend over time.Conclusion In the early stage of cerebral infarction,excess pattern dominated the pattern elements of patients.Among them,wind pattern seems to be the main factor.The combination of every two of wind,phlegm and stasis patterns topped the list,followed by that of all three basic patterns.Compared with previous studies on the evolution of pattern elements of cerebral infarction,the patients’clinical pattern form in this study gradually reduces after thrombolytic therapy,with decreasing excess pattern and more prominent qi-deficiency pattern.