急性肺栓塞中医证候分布及用药规律探讨

Investigation of Traditional Chinese Medicine Syndrome Distribution and Medication Rule for Acute Pulmonary Embolism

【目的】分析总结急性肺栓塞中医证候分布及用药规律,以指导中医药临床诊疗。【方法】回顾性分析广州中医药大学第一附属医院近4年来住院的急性肺栓塞患者资料,采集患者的一般信息、易患因素、发病时临床表现、中医证候特点、治疗转归等并录入数据库,分析中医证候分布及用药规律。【结果】共纳入139例患者,入院主诉以呼吸困难、胸痛多见,以舌质淡暗/暗红,弦脉及沉脉为主要舌脉象;在痰浊证、血瘀证和阳脱证3种证型中,血瘀证所占比例最大,痰浊证次之。按年龄分组,51~70岁中老年组在各证型中所占比例均为最高,≥71岁的老年组位居其次。30岁以下的青年组患者以血瘀证多见。治疗血瘀证常用方为血府逐瘀汤、桃红四物汤,治疗痰浊证常用方为瓜蒌薤白半夏汤及温胆汤,治疗阳脱证常用参附针等静脉滴注。【结论】急性肺栓塞可见于各个临床科室,痰浊证、血瘀证和阳脱证3种证型可较好地概括其发病过程。血瘀证患者在临床所占比例最多,应重视活血化瘀及健脾化痰法的临床应用,血府逐瘀汤、桃红四物汤及瓜蒌薤白半夏汤和温胆汤可作为主方加减运用。

Objective To analyze the distribution of traditional Chinese medicine（TCM） syndromes in patients with acute pulmonary embolism（APE） and to summarize the medication rule,so as to supply evidence for the clinical diagnosis and treatment of APE. Methods A retrospective study was carried out in the APE inpatients admitted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine in recent 4 years. The general data, clinical manifestations at the attack of APE, TCM syndromes, treatment and prognosis of the included patients were input into the database for the analysis of TCM syndrome distribution and medication rule.Results A total of 139 cases of APE patients were included into the study. The main manifestations at admission were dominated by dyspnea and chest pain, pale or darkish red tongue, string pulse and deep pulse. TCM syndromes were divided into three types,phlegm turbidity syndrome,blood stasis syndrome and yang collapse syndrome. The blood stasis syndrome accounted for the largest proportion and then came the phlegm turbidity syndrome. In various age groups,the 3 syndrome types accounted the highest proportion in the age group of 51-70 years old, and accounted higher proportion in the age group over 71 years old. Blood stasis syndrome was frequently seen in the age group below 30 years old. Xuefu Zhuyu Decoction and Tao Hong Siwu Decoction were frequently used for the treatment of blood stasis syndrome, Gualou Xiebai Banxia Decoction and WendanDecoction were often used for the phlegm turbidity syndrome, and Shenfu Injection was often used for yang collapse syndrome. Conclusion APE occurs in various clinical departments, and phlegm turbidity syndrome,blood stasis syndrome and yang collapse syndrome are the main syndrome patterns of APE. Blood stasis syndrome accounts the largest proportion in clinic. Therefore, Xuefu Zhuyu Decoction and Tao Hong Siwu Decoction,Gualou Xiebai Banxia Decoction and Wendan Decoction should be used as the indicated recipes for APE to activate blood and remove stasis, strengthen spleen and resolve phlegm.