【作者】 林创明；

【导师】 尹克春；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 目的:研究病窦综合征人工心脏起搏器植入术围手术期的中医证型分布规律,分析中医证型与性别、年龄、病程等一般情况之间的关系,分析术前中医证型与原发病之间的关系,分析手术前后中医证型变化规律,分析术前中医证型与术后疗效的关系,从而有助于提高病窦综合征人工心脏起搏器围手术期中医辨证预后判断的准确性和规范性,提高临床治疗效果。方法:本课题调查广东省中医院2003年1月到2008年1月住院确诊病窦综合征并行人工心脏起搏器植入术的病人,共128例。所有资料从广东省中医院病案室的病例管理系统中查询得出。所有病例均详细了解病史,从记录的病例资料中于术前采集四诊资料,填写中医证候观察表,进行辨证,术后第三天采集四诊资料,填写中医证候观察表,进行辨证和症状疗效判断。统计128例病窦综合征人工心脏起搏器植入术患者各中医证型的出现频率,分析各种证型与一般情况的关系、与病窦综合征原发病的关系、与植入起搏器的关系,以及各种证型与疗效的关系。数据处理和统计学分析采用PSS13.0统计软件包进行分析,计量资料采用方差检验,计数资料采用卡方检验。结果:128例患者中,术前心气不足型30例、脾肾阳虚型28例、心阴亏虚型22例、阳虚瘀阻型28例、痰浊痹阻型20例,术后心气不足型12例、脾肾阳虚型24例、心阴亏虚型33例、阳虚瘀阻型25例、痰浊痹阻型34例。患者术前术后各中医证型组间性别行卡方检验,P＞0.05;患者术前术后各中医证型的平均年龄、平均病程间分别用方差检验,P＞0.05;患者术前的中医证型与原发病因间行卡方检验,P＞0.05;患者术前术后的中医证型之间行卡方检验,P＜0.01;患者术前各中医证型组间术后有效率行卡方检验,P＞0.05,但术前心气不足型、阳虚瘀阻型术后愈显率与术前脾肾阳虚、心阴亏虚、痰浊瘀阻术后愈显率比较经卡方检验,P＜0.05;结论:病窦综合征人工心脏起搏器植入术患者的中医证型的分布规律与患者的性别、年龄、病程无关;病窦综合征人工心脏起搏器植入术患者原发病因中以冠心病为主,本研究表明病窦综合征合并冠心病患者术前的中医证型以脾肾阳虚、心气不足、阳虚瘀阻为多,其它病因在本研究中的病例数较少,每个证型中的例数更少,意义不大;术前术后的中医证型比较有显著性差异,术前以心气不足、脾肾阳虚、阳虚瘀阻为主,术后则以心阴亏虚、痰浊痹阻为主,其中以心气不足型较术前明显减少,心阴亏虚型与痰浊痹阻型较术前有所增多,这可能与起搏器所起的作用,相当于中医“鼓舞心阳、补益心气”的作用,故对术后心气不足型明显减少,而气行则血行,故起搏器也能起到“化瘀通脉”的作用,故术后阳虚瘀阻型也有一定的减少;但起搏器相对人体毕竟为异物,且起搏器植入的过程为手术伤津耗气,故术后心阴亏虚型有所增多,加上外邪入侵,外邪引动内邪,故术后痰浊痹阻型有所增多;术前中医证型与术后疗效关系比较,表明术前证型为心气不足型和阳虚瘀阻型的术后愈显率较术前为脾肾阳虚型、心阴亏虚型和痰浊瘀阻型的术后愈显率高,但各术前中医证型与术后总有效率比较无显著性差异,这可能也与起搏器所起的作用,相当于中医的“鼓舞心阳、补益心气”,提高了心主血脉的功能,使脉来迟缓、心悸气短等心气虚的症状得到明显的改善,故对心气不足型疗效最为明显;而气行则血行,故起搏器也能起到“化瘀通脉”的作用,对阳虚瘀阻型的作用也较为明显;本病病位在心,故起搏器起到的鼓舞心阳、补益心气对各种证型导致的心阳、心气亏虚,心脉不通等均有疗效,本研究观察表明起搏器对心阴亏虚型和脾肾阳虚型及痰浊痹阻型也有效,也可能是通过该作用实现的。更多还原

【Abstract】 Objective:TO research the rule of perioperative TCM syndrome in the patients with sick sinus syndrome Implanting artificial cardiac pacemaker,and analyse the relationship between perioperative TCM syndrome and gender、age、course of diseases,the TCM syndrome before operation and primary disease,the change rule of TCM syndrome before and after operation,the TCM syndrome before operation and the effect after operation,in order to enhance the veracity and standardization of the clinical TCM analyse and estimating prognosis, and to enhance the clinical cure effect.Method:This subject survery the patients in Guangdong Province hospital of TCM from January 2003 to January 2008 diagnosed sick sinus syndrome implantation artificial cardiac pacemaker,a total of 128 cases.All the information get from the case management system in the medical record room of the Guangdong Provincial Chinese medicine hospital.All cases were detailedly realized medical history,collection the four symptom information at one day before surgery,fill out the observation forms of Chinese medicine syndrome, discerning the TCM Syndrome,four day after surgery gathering information to fill in TCM Syndrome Watcblist,discerning the TCM Syndrome and judging the effect.Statistics 128 cases of sick sinus syndrome artificial pacemaker implantation in patients with the TCM-frequency,and the analysis of the various syndromes of the general situation of relations with sick sinus syndrome incidence of the original,with the implantation of pacing The relationship,as well as various cards and the effect of the relationship. Data processing and statistical analysis using SPSS13.0 statistical analysis package,the measurement data used variance test,counting card information using the test.Result:In 128 patients,before operation,the deficiency of heart-QI is 30,the spleen kidney yan-deficiency is 28,the heart yin-deficiency is 22,the yan-deficiency blood- Stagnation is 28,the turbid phlegm Stagnation is 20, and after operation,the deficiency of heart-QI is 12,the spleen kidney yan-deficiency is 24,the heart yin-deficiency is 33,yan-deficiency bloodStagnation is 25,the turbid phlegm Stagnation is 34.The result of Chi-square test between the genders in each perioperative TCM syndrome is P＞0.05;The analysis of variance between the age and course of diseases in each perioperative TCM syndrome is P＞0.05;The result of Chi-square test between each TCM syndrome before operation in primary disease is P＞0.05;The result of Chi-square test between the TCM syndrome before and after operation is P＜0.01;The result of Chi-square test between each effective rate in each TCM syndrome is P＞0.05,but the result of Chi-square test between recovery excellence rate of the deficiency of heart-QI、the yan-deficiency blood-Stagnation and the spleen kidney yan-deficiency、the heart yin-deficiency、the turbid phlegm Stagnation is P＜0.05;Conclusion:There is no interrelation between the TCM syndrome and gender、age、course of diseases;The patients with sick sinus syndrome Implanting artificial cardiac pacemaker due to coronary heart disease in the main,this study shows that sick sinus syndrome patients with coronary heart disease before operation of the TCM to the spleen kidney yan-deficiency,the deficiency of heart-QI, the yan-deficiency blood-Stagnation,the number of other causes in this study is less,in each card even less,not very meaningful.There is significant difference between the TCM syndrome before and after operation;There is mainly to the deficiency of heart-QI、the spleen kidney yah-deficiency、the yah-deficiency blood-Stagnation before operation;There is mainly to the heart yin-deficiency and the turbid phlegm hinder after operation,While the deficiency of heart-QI is reducely and the heart yin-deficiency、the turbid phlegm Stagnation is increasedly comparing that of before operation,This may be related to the role played by the pacemaker,equivalent the TCM effect of "heart-yan inspired,heart-qi replenishing",so the deficiency of heart-QI after surgery significantly reduce,and the gas lines with the blood lines, pacemaker also have the effect of Huayu Tongmai,so the yah-deficiency blood-Stagnation after operation also difinitely reduce;But the pacemaker is foreign body relative to the human body,the surgery implanting the pacemaker have the effect of Injury-gas consumption,so the heart yin-deficiency after operation definitely manifold,plus waixie intrusion,waixie arose neixie,so the turbid phlegm Stagnation after operation definitely manifold;by compare the curative effect after operation between each TCM syndrome before operation, it is more recovery excellence rate in the deficiency of heart-QI and the heart-yan hinder before operation than that in the spleen kidney yan-deficiency、the heart yin-deficiency and the turbid phlegm hinder before operation,but there is no Significant difference in the effective rate after operation between each TCM syndrome before operation,This may be related to the role played by the pacemaker,equivalent the TCM effect of "heart-yan inspired,heart-qi replenishing",improve the effect of the heart dominating blood,and amend the heart-QI deficiency symptom of blood stream slowing heart-throb breathe hard,So the curative effect of the deficiency of heart-QI is very evidence,and the gas lines with the blood lines,pacemaker also have the effect of Huayu Tongmai,so the effect to the yan-deficiency blood-Stagnation is also obviously evidence;the focus of the disease is in the heart,so the effect of heart-yah inspired,heart-qi replenishing by the pacemaker also have effect to the deficiency of heart-QI and the heart-yan and heart-pluse illogical,This subject make know that pacemaker have effect to the spleen kidney yan-deficiency and the heart yin-deficiency and the turbid phlegm Stagnation,it may be according this effect.更多还原