【作者】 郭硕；

【导师】 邹旭；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 背景慢性心力衰竭作为一项临床综合征,其证候、证型具有多样性,对慢性心力衰竭的中医辨证进行规范,是慢性心力衰竭中医临床、科研、教学工作开展的必需基础。现有众多研究一致认为本病病机属虚实夹杂,本虚标实；本虚一般认为是气虚、阴虚、阳虚等病机来认识,且多认为阳虚是气虚病机的加重,而且病到后期多呈阴阳俱虚；而标实多认为是瘀血、水饮、痰湿、痰热病机；对本病病位一般认为与心、肾、脾、肺等脏器相互关联。比较一致的辨证分型尚未确立,目前的证候研究仍多由专家经验总结、文献总结及病例回顾得来,而较大规模的横断面调查、队列研究等尚未见诸报道。近年来应用聚类分析探索中医证候分布、证候实质及进行证候单元的创建等工作,充分说明将聚类分析引入中医证候研究的可行性与优越性。邓铁涛教授的“五脏相关、心脾相关”理论在心力衰竭临床辨治中取得很好的疗效,在进行理论探讨与梳理继承的同时,期待通过对慢性心力衰竭中医证候多元统计分析探讨这一理论的科学性。目的探讨慢性心力衰竭中医证候规律,同时探讨“心脾相关”理论在心力衰竭临床辨证中的科学性,并为临床辨治决策提供依据。方法制订形成慢性心力衰竭中医临床证候调查表。在广东省中医院心脏中心、广州军区总医院心内科,对符合入选标准的慢性心力衰竭患者进行中医证候信息的横断面调查。临床资料收集完成后,使用EpiData3.0与SPSS13.0软件进行数据的录入、管理和统计分析。结果333例慢性心力衰竭患者中医证候信息横断面调查显示：喘息气促,精神疲乏、倦怠乏力、胸闷、纳食减少、失眠、舌质淡、舌质暗、舌苔白、舌苔腻等10个症状,在急性加重期与慢性缓解期两组病例中出现频率均≥50%。273例慢性心力衰竭急性加重期患者的样品聚类分析聚为2类：气虚血瘀水停证及阳虚水泛,瘀血阻络(兼夹痰浊)证。60例慢性心力衰竭慢性缓解期患者的样品聚类分析聚为2类：气阳两虚血瘀证及气阴(血)两虚血瘀证。结论慢性心力衰竭基本病机特点可以概括为心脾气虚,痰湿瘀阻。慢性心力衰竭中医证候均体现了虚实夹杂的病机特点,急性加重期证型主要为：气虚血瘀水停证与阳虚水泛,瘀血阻络(兼夹痰浊)证；缓解期证型主要为气阳两虚血瘀证与气阴两虚血瘀证。结合文献研究及本次临床调查结果,初步了解慢性心力衰竭的证候规律。在目前的状况下开展慢性心力衰竭中医证候的多中心、大样本量的研究有一定的实际意义。更多还原

【Abstract】 ObjectivesTo investigate the main clinical characteristics of syndromes in TCM in patients with Chronic Heart Failure Syndrome, and to explore the" Heart and Spleen-related theory" in the clinical syndrome of heart failure, and to provide the basis for the decision of Diagnosis and Treatment.MethodsFirst, the questionnaire to collect the clinical symptoms in Chronic Heart Failure was established. Then, patients who met the inclusion criteria from the Heart Center of Guangdong Hospital of TCM and the Cardiology department of General Hospital of Guangzhou Military Region were surveyed, and their information were collected for this cross-sectional survey. Upon completion of the clinical data collection, EpiData3.0 and SPSS13.0 software database was established to record, manage, and statistiacally analyze the data.ResultThose symptoms of dyspnea, fatigue, weakness, chest pain, reduction of food intake, insomnia, pale tongue, dark tongue, white tongue and tongue coated appears≧50% among the 333 cases of patients with chronic heart failure syndromes in this cross-sectional survey of information. Cluster analysis of 273 cases of acute exacerbation of chronic heart failure patients gather 2 categories:the type of" Qi deficiency and blood stasis with water stagnation and the type of" Yang deficiency and blood stasis with water stagnation (with phlegm stagnation)". Cluster analysis of 60 cases in remission gather two categories:the type of "Yang and Qi deficiency with blood stasis" and the type of" Qi and Yin (blood) deficiency with blood stasis". ConclusionBasic pathogenesis of chronic heart failure characteristics can be summarized as "heart and spleen deficiency, phlegm and blood stasis block".The pathogenesis of Chronic heart failure syndromes can be grouped into two size:the difeciency of the Qi (Yang), on the other hand, phlegm, blood stasis blood and water stagnation. The rule of the syndrome of chronic heart failure was preliminary revealed in this study combined with literature research and clinical findings before. Under the present conditions, carrying out studies of multi-center, large sample size on chronic heart failure syndromes is of certain significance.更多还原