糖尿病缺血性脑卒中恢复期中医证型观察及分析

Observation and Analysis of TCM Patterns in Diabetic Ischemic Stroke at Recovery Stage

目的探讨糖尿病缺血性脑卒中恢复期的中医临床证型的分布规律及发病机制,为临床中医辨证论治提供科学依据。方法采用流行病学调查方法,观察187例糖尿病缺血性脑卒中恢复期患者,根据中华中医药学会糖尿病分会制定的《糖尿病合并脑血管病中医诊疗标准》及《中药新药临床研究指导原则》等资料制定辨证分型的具体标准及临床证候调查表,通过望、闻、问、切采集患者入院1周内的临床症状、舌象、脉象信息,并进行辨证分型及相关统计分析。结果患者主要临床症状及体征出现频率排序前10位依次为肢体麻木、小便频多、口干口渴、倦怠乏力、自汗盗汗、失眠、头晕目眩、浮肿、舌质较暗、脉细涩;各中医证型以气虚血瘀、阴虚动风、风痰阻络三种证型最为多见。结论糖尿病缺血性脑卒中恢复期本虚标实,基本病机以气阴两虚为主,久而瘀阻脉络,风、痰、瘀等因素相互影响疾病转归愈后。

Objective To explore the distribution rule of clinical TCM patterns and occurrence mechanism so as to provide the scientific evidence for syndrome differentiation and treatment of TCM in clinic. Methods The epidemiological investigation method was adopted to observe 187 patients of diabetic ischemic stroke at recovery stage. In reference to Standard of diagnosis and treatment with TCM in diabetes complicated with cerebrovascular disease and Guides for the clinical research of new Chinese medicine implemented by Diabetes Branch of Chinese Medical Association,the specific criteria and clinical syndrome questionnaire were drafted. The clinical symptoms,tongue and pulse conditions were collected by the four diagnostic methods in the inpatients admitted in 1 week. The statistical analysis was conducted on TCM patterns and relevant data. Results The top 10 clinical symptoms and physical signs in terms of frequency were limb numbness,frequent urine,thirst and dry mouth,lassitude,spontaneous sweating and night sweating,dizziness and vertigo,puffy face,dark tongue,thready and choppy pulse. The most common patterns were qi deficiency and blood stagnation,wind stirring due to yin deficiency,and wind phlegm blocking collateral. Conclusion Diabetic ischemic stroke at recovery stage is deficiency in the root and excess in the symptoms. The basic pathogenesis is qi and yin deficiency. Stasis and blockage happens in chronic case. The interaction of wind,phlegm and stasis affects the outcome and prognosis of disease.