缺血性中风患者证型分布规律的研究

The Study on Differential Diagnosis and Influential Factor in Patients with Ischemia Apoplexy

目的：探讨缺血性中风患者证型分布规律。方法：将259例缺血性中风患者按照诊断标准纳入观察，填写病例观察表，由课题组具有副主任医师以上职称人员共同量化诊断证型和神经功能缺损程度评分，观察缺血性中风患者不同分期、病情程度、既往病史与证型的关系。结果：中风急性期前2周风证是最为常见证候，痰证次之；至发病2—4周，风证和痰证并重；在恢复期前3个月，血瘀证为最常见证候，痰证、火热证次之；在恢复期的后3个月，气虚、血瘀、痰阻为其主要证候；后遗症期以气虚血瘀为主要证候，阴虚阳亢、风证、痰证次之。中风病情轻、中、重度患者均以风证、痰证为主要证候，病情轻度患者血瘀证次之，病情中度患者火热证、血瘀证次之；病情重度患者火热证、血瘀证次之，但出现概率与风证、痰证相近；中风合并高血压、高脂血症、高黏血症的患者均以风证为主要证候，高血压患者阴虚阳亢证次之；高脂血症、高黏血症患者均以痰证、血瘀证次之；糖尿病患者以阴虚阳亢证和火热证为主要证候，风证次之。结论：缺血性中风病不同发展阶段，证型分布发生相应变化，患者病情程度越严重，其病机变化越复杂，且患者既往病史对缺血性中风病证型的分布有一定影响。

Obiective ： To study on differential diagnosis in patients with ischemia apoplexy. Methods ： The 259 cases observation schedule of ischemia apoplexy patients according to diagnostic criteria were written ; the differential diagnosis and neurologic impairment marks were judged by three associate chief physician engaged in nerves medical Department to observe the relationship among differential diagnosis and staging,pathogenetic condition, past medical history. Results： The wind syndrome were most common diagnosis and phlegm syndrome were second in first two weeks of acute stage of stroke. The wind syndrome and phlegm syndrome were common diagnosis in two - to - four weeks of acute stage of stroke. The syndrome of blood stasis were most common diagnosis, and phlegm syndrome and pyretic syndrome were second in first three months of convalescence stage of stroke. The syndromes of deficiency of vital energy, blood stasis, phlegm syndrome were common diagnosis in last three months of convalescence stage of stroke. The syndrome of deficiency of vital energy, blood stasis were common diagnosis, and asthenic yin causing predominant yang, wind, phlegm syndrome in sequel stage. The wind syndrome and phlegm syndrome were common diagnosis in different pathogenetic condition of stroke; syndrome of blood stasis were second in light patient＇s condition; the syndrome of fire -heat and syndrome of blood stasis were second in midrange patient＇s condition; the syndrome of fire -heat and syndrome of blood stasis were second in heavy patient＇s condition, but its probability were close to wind and phlegm syndrome. The wind syndrome were most common diagnosis in stroke complicating high blood pressure, hyperlipoidemia and hyperviscous - emia. The asthenic yin causing predominant yang were second in high blood pressure; and syndrome of blood stasis and phlegm were second in hyperlipoidemia and hyperviscous -emia; The asthenic yin causing predominant yang and fire - heat syndrome were most common diagnosis in diabetic;The wind syndrome were second. Conclusion： With development of stroke, the type of syndrome were changed; the more patient＇s condition seriously, the more complexly in pathogenesis change, and type of syndrome in stroke were influenced by past history of illness of sufferers.