100例急性心肌梗死患者中医体质类型分布及中医体质量表临床应用再探讨

Re-explore of Distribution of TCM Constitution Types and Clinical Application of TCM Constitution Scale in 100 Patients with Acute Myocardial Infarction

目的：探究100例急性心肌梗死（AMI）患者的中医体质类型分布,并对中医体质量表临床应用进行再探讨。方法：选取2015年6月—2016年12月于辽宁中医药大学附属医院的AMI患者,采用连续抽样调查法,对患者进行面对面调查。结果：根据＂体质九分法＂判定的主要体质类型分布情况,平和质24例,特禀质1例,3例有倾向性体质,2例体质判定不清,其余70例全部为病理体质。根据＂体质九分法＂判定的主要体质特征分布情况,单一体质中平和质24例,阳性质6例,气虚质、阴虚质各5例,气郁质、痰湿质各3例,血瘀质和湿热质各1例;兼杂体质中气虚兼阳虚4例,气阴两虚兼阳虚、气阴两虚兼气郁、气阴两虚兼气郁痰湿、气阴两虚兼痰湿、气虚痰湿兼气郁、气虚阳虚兼气郁各2例。＂专家判定＂的主要体质类型分布情况,平和质3例,特禀质1例,其余96例全部为病理体质,根据专家临床经验增加一种临床上极为常见的体质类型,即脾虚质。＂专家判定＂的主要体质特征分布情况,单一体质中平和质、脾虚质、湿热质各3例,气虚质、阴虚质、阳虚质、痰湿质各1例;兼杂体质中气郁脾虚兼痰湿质18例,脾虚痰湿质11例,气郁脾虚质10例,气郁脾虚湿热质7例,脾虚湿热质6例,气郁阴虚质、气阴两虚质各4例,阳虚脾虚痰湿质、气虚脾虚痰湿质各2例。结论：现有的中医体质判定量表是目前应用最为广泛的体质状态评价工具,但其判定结果与临床实际有一定差距。本研究通过对100例急性心肌梗死（AMI）患者的中医体质类型分布进行调查,并对其在临床应用中存在的问题进行深入总结探讨,以期不断的完善和修订该量表,使其更加符合中医临床实践,更好的为临床工作服务。

Objective：To explore the distribution of TCM constitution types in 100 patients with acute myocardial infarction（AMI）,and to re-explore the clinical application of TCM physique scale. Methods：Patients with AMI in affiliated hospital of Liaoning university of TCM from June 2015 to December 2016 were selected for face-to-face investigation by continuous sampling method. Results：The distribution of the main constitution types determined by the＂nine constitution classification＂included 24 cases of mild constitution,1 case of special constitution,3 cases of tendentious constitution,2 cases of unclear constitution judgment,and the remaining 70 cases of pathological constitution. The distribution of the main constitution characteristics determined by the＂nine constitution classification＂：single constitution included 24 cases of mild constitution,6 cases of Yang nature constitution,5 cases of Qi deficiency constitution,5 cases of Yin deficiency constitution,3 cases of Qi depression constitution,3 cases of phlegm dampness constitution,1 case of blood stasis and 1 case of damp heat constitution. Mixed constitution included 4 cases of Qi deficiency and Yang deficiency,2 cases of Qi Yin deficiency and Yang deficiency,2 cases of Qi Yin deficiency and Qi depression,2 cases of Qi Yin deficiency and Qi depression and phlegm dampness,2 cases of Qi Yin deficiency and phlegm dampness,2 cases of Qi deficiency and phlegm dampness and Qi depression,2 cases of Qi deficiency and Yang deficiency and Qi depression. According to the expert＇s judgment,3 cases were mild,1 case was special,and the other 96 cases were all pathological constitution. According to the expert＇s clinical experience,a very common constitution type,spleen deficiency constitution,was added. The distribution of the main constitution characteristics determined by the＂expert judgment＂：single constitution included 3 cases of mild constitution,3 cases of spleen deficiency constitution,3 cases of dampheat constitution,1 case of Qi deficiency constitution,1 case of Yin deficiency constitution,1 case of Yang deficiency constitution and 1 case of phlegm-dampness constitution. Mixed constitution included 18 cases of Qi depression and spleen deficiency with phlegm dampness,11 cases of spleen deficiency with phlegm dampness,10 cases of Qi depression and spleen deficiency,7 cases of Qi depression and spleen deficiency with damp heat,6 cases of spleen deficiency with damp heat,4 cases of Qi depression with Yin deficiency and 4 cases of Qi Yin deficiency,2 cases of Yang deficiency with spleen deficiency with phlegm dampness and 2 cases of Qi deficiency with spleen deficiency with phlegm dampness. Conclusion：The existing TCM Constitution Scale is the most widely used physique state evaluation tool,but its judgment result has a certain gap with the clinical practice. In this study,the TCM constitution type distributions of 100 acute myocardial infarction（AMI）patients were investigated,and the existing problems in clinical application were summarized and discussed for continuously improving and revising the scale,and making it more in line with the clinical practice of traditional Chinese medicine,so that it can provide a better service for clinical work.