症状性颈动脉狭窄病人支架置入前后中医证型变化探讨

Research on the Changes of TCM Syndromes before and after Carotid Artery Stenting in Patients with Symptomatic Carotid Artery Stenosis

目的探讨症状性颈动脉狭窄病人支架置入前后中医证型的变化规律。方法收集2010年1月—2015年12月我院86例行颈动脉支架置入术(CAS)治疗病人的临床资料,回顾性分析术前及术后1周中医证候变化及组合分布情况。结果 CAS病人术前证型分布依次是血瘀证(81.4%)、痰湿证(76.7%)、风证(55.8%)、气虚证(40.7%),而CAS术后1周证型分布依次以气虚证(80.2%)、血瘀证(79.1%)、痰湿证(50.0%)3种单证为主。术前证型组合以3证组合(40.7%)为主,其次是双证组合(32.6%),其中风证+血瘀证+痰湿证(17.4%)、血瘀证+痰湿证+气虚证(15.1%)组合出现频率最高,术后1周证型组合中以双证组合(44.2%)为主,其次是3证组合(37.2%),其中气虚证+血瘀证(29.1%)频数最高,其次是气虚证+痰湿证+血瘀证(20.9%)。结论症状性颈动脉狭窄病人CAS术后证型以气虚证、血瘀证为主,而痰湿证相对减少,CAS术后相关并发症的治疗可将上述证型的分布规律与病人的实际情况联系起来指导临床治疗。

Objective To investigate the changes of traditional Chinese medicine（ TCM） syndromes before and after carotid artery stenting（ CAS） in patients with symptomatic carotid artery stenosis.Methods We retrospectively analyzed these clinical data from 86 patients who performed the treatment of CAS at our department from January 2010 to December 2015. These clinical datas include baseline data,the change rules of TCM syndromes before and after CAS in patients. Results The distribution of preoperative syndromes in patients with the treatment of CAS were followed by blood stasis syndrome（ 81.4%）,phlegm-dampness syndrome（ 76.7%）,wind syndrome（ 55.8%）,Qi deficiency（ 40.7%）.The distribution of syndromes after 1 week of the postoperative CAS were Qi deficiency（ 80.2%）,blood stasis syndrome（ 79.1%） and phlegm-dampness syndrome（ 50.0%）.The distribution of preoperative syndromes was dominated by three combinations（ 40.7%）,followed by two combinations（ 32.6%）.There were combinations of wind syndrome plus blood stasis syndrome plus phlegm-dampness syndrome（ 17.4%）,and blood stasis syndrome plus phlegm-dampness syndrome plus qi deficiency syndrome（ 15.1%） in turn.At 1 week after the postoperative,the highest frequency were dominated by two syndrome combinations（ 44.2%）,followed by three syndrome combinations（ 37.2%）.There were combinations of blood stasis syndrome plus Qi deficiency syndrome（ 29.1%）,and blood stasis syndrome plus phlegm syndrome plus qi deficiency syndrome（ 20.9） in turn.Conclusion The main syndromes were qi deficiency syndrome and blood stasis after the postoperative with CAS,while phlegm dampness syndrome was relatively reduced.This program that the distribution of these syndromes can be company with the actual situation of patients can guide the Chinese medicine treatmen for the treatment of CAS related perioperative complications.