缺血性脑白质疏松症性眩晕的证候要素特征研究

【作者】 王谦；

【导师】 赵永烈；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2014， 硕士

【摘要】 目的脑白质疏松症常见于各种脑部疾病的病理过程中,单纯性脑白质疏松症是一种非特异性的脑缺血的表现,其诊断标准主要以CT及MRI的影像为主,无较典型的症状。临床上发现脑白质疏松症与脑供血有负相关关系,脑供血不足是导致单纯性脑白质疏松(或缺血性脑白质疏松)的根本原因,眩晕是常见的症状,进一步发展会演变为脑梗死、脑出血、血管性痴呆等疾病,给家庭和社会来严重的负担。在缺血性脑白质病变出现眩晕的早期阶段给予干预,是一项很重要的工作,而中医药在治疗眩晕方面积累了丰富的经验。为研究缺血性脑白质疏松症眩晕的中医证候学特点,进一步确定治疗缺血性脑白质疏松症眩晕的方法,本研究拟对缺血性脑白质疏松症眩晕的临床症状学以及证候学进行初步研究,得到其主症、基本证候要素并依据证候要素拟定治法、方药,初步验证治法疗效。方法1、收集2013年4月-2014年2月北京中医药大学东方医院脑病二科住院缺血性LA性眩晕患者119例。对其症状进行总结,得到其症状的出现率。并且根据《中医临床诊疗术语证候部分》由两名副主任以上医师对着119例患者的证候要素进行判断,得到缺血性LA性眩晕症候要素分布。2、收集北京中医药大学东方医院脑病二科门诊缺血性LA性眩晕患者21例,用化痰活血散结法,用药：红花、三七、半夏、陈皮、地龙、鳖甲等进行治疗,患者对其治疗前后的头晕症状用标尺法进行最低0分,最高10分的评分,观察其头晕症状是否好转。记录治疗前及治疗后的相关症状评分(0=无,1=时有,2=经常,3=持续),观察其中医相关症状是否好转。结果1、头晕症状119例,占100%,头昏沉感60例,占50.4%,为缺血性LA性眩晕的主要症状,此症状表现为慢性脑供血不足的典型症状。在这119例LA患者中症候要素中,痰证69例,占58.0%；血瘀证63例,占52.9%；阴虚证36例,占30.3%；血虚证29例,占24.4%；气滞证22例,占18.5%；气虚证21例,占17.6%；肾虚精亏证17例,占14.3%；风证15例,占12.6%。纯虚证15例,纯实证46例,虚实夹杂证58例。间见证以2种证间见为主占58.8%,其中痰、瘀血兼证占34.5%。2、治疗缺血性LA性眩晕患者21例,其头晕症状治疗前后评分,用配对样本t检验,t=6.478,df=20,p(双侧)<0.001,头晕症状明显好转。其头晕中医相关症状评分,用配对样本t检验,t=6.269,df=20,p(双侧)<0.001。治疗前后有显著差异,且治疗后症状分数明显低于治疗前,说明治疗明显有效。结论缺血性LA性眩晕主症以头昏沉、头重及失眠为主要症状,基本证候要素以痰、瘀为主,使用化痰活血散结法进行干预有效。更多还原

【Abstract】 Objiective Leukoaraiosis(LA) is commonly seeing in all kinds of the pathological process of the cerebral diseases. The simple LA is a non-specific imagenolgy diagnosis of the lack of perfusion of the brain, and the diagnostic criteria of LA is mainly due to the image of CT or MRI and LA performs with non-specific symptom. In the clinic practice, LA is known as the negative correlation with the perfusion of the brain, which is the main factor leading to the simple LA. The vertigo is the normal symptom of the LA, and turning to the further development, the cerebral infarction, cerebral hemorrhage and vascular dementia will perform. All these diseases will load the heavy burden to families and society. The therapy of LA at the early stage is a very critical work. Chinese medicine has accumulated rich experience on treating vertigo. To research the characteristics of TCM syndrome factors, and to make sure the therapy of the vertigo of ischemic LA, this research is preliminarily to conclude the symptoms and the syndrome factor. And, according all above, we make the therapeutic method and the prescription, and validate the efficacy of the treatment.Method1.Collection of119cases of ischemic LA of vertigo in the Dongfang Hospital of Beijing University of Traditional Chinese Medicine. Conclude the symptoms of the cases and obtain the occurrence rate of the symptoms. According to the Symptomatic partial of traditional Chinese medicine diagnosis and treatment technology, the two associate chief physicians or archiaters judge the symptom factor of the119cases, obtain the ischemic LA of vertigo.2. We use Safflower, Pseudo-ginseng, Pinellia ternata, Pericarpium citri reticulatae, Lumbricus, turtle shell and et al to reduce phlegm, invigorate the blood and remove stasis and to treat the21cases of ischemic LA of vertigo. Record the grade of the vertigo using visual analogue scale—the minimum is0and the maximum is10—before and after this3-month therapy. Obtain whether the symptom of vertigo will get better or not. Record the grade of relative symptom—0is never,1is occasionally,2is often,3is sustaining—before and after the therapy. Obtain whether the symptoms about the vertigo will get better or not.Result1.The first of the symptoms is dizziness, and its number is119and its proportion is100%. The second symptom is not clear, the number and proportion of which are60and50.4%. The result we can conclude is that the dizziness and not clearness are the main symptoms of the LA vertigo, and these symptoms are the typical symptoms of the chronic low-perfusion of the brain. In the119cases, The percentage rates for8syndrome factors are as follows:Phlegm58.0%, Stagnation of blood52.9%, Yin deficiency30.3%, Blood deficiency24.4, Stagnation of Qi18.5%,, Qi deficiency17.6%, kidney essence deficiency14.3%, Wind12.6%. In the119cases, the number of deficiency syndrome factor is15,the number of excess syndrome factor is46and the inclusion syndrome is58. The proportion of two-syndrome-factor inclusion is58.8%, and the proportion of inclusion of phlegm and blood stasis is34.5%.2.Treating21cases of inchemic LA of vetigo. Using the two grades of vertigobefore and af ter the therapy to T test, we can get that t=6.478, df=20, p (bilateral)<0.001. The vertigo symptom takes a turn for better. Using the two grades of relative symptom about vertigo before and after the therapy to T test, we can get that t=6.269, df=20, p (bilateral)<0.001. This therapy is absolutely effective to the LA vertigo.Conclusion The not clear is the main symptom of ischemia LA of vertigo. The main symptom factors are Phlegm and Stagnation of blood. The therapy of reducing phlegm, invigorating the blood and removing stasis is efficacious.更多还原