231例不同季节开颅患者围手术期中医症状学调查

A TCM Symptomatic Survey of 231 Cases of Craniotomy in the Peri-Operative Period in Different Seasons

以围手术期中医症状为切入点 ,探讨开颅患者术后发热、尤其是湿热发热的成因。使用调查表的形式 ,详细记录不同季节 2 31例开颅患者一般情况、手术前 1～ 3d和术后 1～ 7d的症状。比较不同季节、手术前后症状学频次差异。结果手术前 ,频次统计排列在前 10位的症状春夏两季相近 ,两者与秋冬季比存在差异。术后出现症状减少、频次集中趋势 ,秋冬季与春夏季主要症状频次仍有差异。术前以头痛、视物异常、头晕头胀、呕吐、恶心一组“颅内压增高”症状为主 ,核心病机是阳气抑郁 ,木不疏土 ,气滞津停 ;术中损伤 ,触发了郁阴化热 ,津停成湿 ;术后以发热、口干、口中粘腻、腹胀、大便干结、头痛、纳少等为主的湿热证迅速形成。

The cause of postoperative fever, especially postoperative damp-heat, in the cases of craniotomy was studied by investigating the TCM symptoms in the peri operative period. The questionnaire was used to record the general materials and the symptoms appeared 3 days before the operation and 1～7 days after the operation of the patients. The frequencies of the symptoms before and after the operation in different seasons were compared. The results showed that before the operation, the symptoms located at the first 10 places by their frequencies were similar in spring and summer, while they were different in autumn and winter; and after the operation, the symptoms were reduced and their frequencies became less different, and there were differences between the frequencies of the main symptoms appeared in the period of spring and summer and those in the period of autumn and winter. Before the operation, the main symptoms were headache, abnormal vision, dizziness and fullness of head, vomiting and nausea. According to TCM theories, these symptoms were produced by the depression of yang qi, and the stagnation of qi and body fluid. During the operation, there was the heat produced by depression of yang and the dampness produced by the stagnation of body fluid. After the operation, there was the damp-heat syndrome with fever, dry mouth, greasy mouth, abdominal distension, constipation, headache and anorexia as its main symptoms.