儿童注意缺陷多动障碍150例虚实辨证分析

Analysis of 150 cases of children with attention deficit hyperactivity disorder based on deficiency-excess syndrome differentiation

目的:探索儿童注意缺陷多动障碍(ADHD)中医学虚实辨证规律。方法:通过真实世界研究方法纳入2019年12月-2020年12月南京中医药大学附属医院儿科门诊接受中医药辨证治疗3个月的ADHD患儿,从病因学、临床特征、证型演变、共患病4个方面进行虚实辨证分析。结果:共观察150例ADHD患儿,通过总结分析发现病因涉及先天禀赋不足多导致虚证,后天调护不当表现虚证及因虚致实证。病程早期多为实证,后期多为虚实夹杂或者以虚证为主。同一患者在病程的不同时期,虚实病性会发生转化。具有共患病的病例多为虚实夹杂证。实证病程较长者,需要考虑是否为其他神经系统疾病为主要诊断而共患ADHD。结论:ADHD病程中虚实会发生转化,虚实转化与病程、应激程度、年龄、是否及早规范干预等因素相关;中医治疗通过补虚泻实,能达到改善病情目的。

Objective:To explore the law of syndrome differentiation between deficiency and excess in children with attention deficit hyperactivity disorder(ADHD).Methods:Using real world research methods,ADHD children who received TCM treatment for 3 months in the pediatric outpatient department of Affiliated Hospital of Nanjing University of Chinese Medicine from December 2019 to December 2020 are included in the study.The deficiency-excess syndrome differentiation analysis is conducted from four aspects:etiology,clinical characteristics,syndrome type evolution,and comorbidity.Results:A total of 150 children are observed.Through summary and analysis,it is found that the cause involves insufficient congenital endowments leading to deficiency syndrome,and the improper performance of acquired care leading to deficiency syndrome and the deficiency-excess syndrome.In the early stage of the disease,most of them were excess syndrome,and in the later stage,they were mostly mixed with deficiency syndrome or mainly deficiency syndrome.At different stages of the course of the disease,the disease nature of deficiency and excess could change in the same patient.The majority of cases with comorbidities were characterized by deficiencyexcess syndrome.For those with a longer course of the disease in excess syndrome,it was necessary to consider whether to co-suffer from ADHD for other neurological diseases as the main diagnosis.Conclusion:Deficiency and excess can transform during the course of ADHD.The conversion of deficiency to excess is related to factors such as the course of disease,stress level,age,and whether early standardized intervention is needed.TCM treatment can achieve the goal of improving the effects by reinforcingdeficiency and reducing excess.