【作者】 常庚；

【导师】 高长玉；

【作者基本信息】 河北医科大学 ， 中西医结合临床， 2007， 硕士

【摘要】 目的:脑出血(Intracerebral hemorrhage)是指原发性非外伤性脑实质内出血,也称自发性脑出血。脑出血病因很多,发病机制复杂,但80%以上均由高血压型细小动脉病变引起,故也称高血压动脉硬化性脑出血或高血压性脑出血。在我国,因为高血压防治工作滞后,脑出血发病率高,占各类脑卒中的20%-30%,是病死率最高的脑卒中类型,严重危害人类的健康。脑出血属中医“中风”范畴,是中医急症之一。常因患者平素气血亏损,阴虚阳亢,阳化风动,挟痰气逆,蒙蔽清窍,或气血运行受阻,筋脉失于濡养所致。它起病急骤,往往在活动中突然发病,一般以突然昏仆,半身不遂,偏身麻木等为主症,常伴有头疼,头晕,恶心呕吐等症。中医对本病的辨证治疗积累了丰富的经验。目前,在脑出血中西医结合诊断方面有应用CT以出血的部位和出血分型与中医病性的相关性研究。但各家结果不尽一致,尤其将急性期脑出血影像学改变与中医病位证素的相关性研究较少。因此,本课题拟开展脑出血急性期影像学改变与中医病性、病位证素,证型的相关性研究。我们利用中西医结合相对照的方法对119例西医明确诊断的脑出血的患者进行临床分期分型和影像学检查,同时采用中医望、闻、问、切四诊,搜集资料。同时按证素的范畴,归纳其病位病性,并进行证候组合。以探讨急性期脑出血影像学改变与中医证相关性,以期能为中医辨证提供客观指标。方法:选择从2006年1月至2006年12月,河北医科大学第二医院的门诊、急诊及住院脑出血患者共119例,病例选择符合《中国脑血管病防治指南(2005)》制定的脑出血诊断标准。参照黄如训编订的脑卒中的分型分期治疗建议草案[1],并结合脑出血的病理改变和临床表现进行分期分型。入选病例均于脑出血48小时内行颅脑CT检查,根据出血量,出血部位,有无中线结构改变,有无血肿破入脑室进行分型分组。同时参照《中风病证候诊断标准》,《病位证素特征》[2]和《中医内科学》教材(上海科学技术出版社)[3]为中医辨证标准,进行中医辨证。中医辨证分为病性证素,病位证素,证型和中经络中脏腑。分析影像学改变与中医辨证相关性。所有资料均用SPSS11.5统计软件进行分析,计数资料应用X2检验和确切概率法。所有统计学处理以P<0.05认为有统计学差异。结果:1脑出血急性期影像学改变与中医病性证素的关系:在出血部位上,各组均以风证、火热证、痰证出现率较高。各出血部位之间在中医病性的比较上没有显著差异。急性早期火热证、痰证出现率在大量出血组高于中小量出血组,(P<0.01,P<0.05)有统计学意义。阴虚证出现率在中小量出血组高于大量出血组,(P<0.05)有统计学意义。火热证、瘀证的出现率在中线移位组高于无中线移位组,(P<0.01,P<0.05)有统计学意义。火热证、痰证出现率在血液破入脑室组高于无破入脑室组,有统计学意义。2脑出血急性期影像学改变与中医病位证素[4]的关系:急性期,不同部位分组均以肝,经络出现率较高。各出血部位分组之间在中医病位的比较上没有显著差异。患者病位在神,经络的出现率在大量出血组高于中小量出血组,(P<0.01,P<0.05)有统计学意义。病位在神,大肠的出现率在破入脑室组高于无破入脑室组,(P<0.01)有统计学意义。患者病位在神[5],大肠的出现率在中线移位组高于中线居中组,(P<0.05)有统计学意义。3急性期脑出血影像学与中经络中脏腑关系:在出血部位上,丘脑出血的出现率在中脏腑组高于中经络组(P<0.05)。中线移位、大量出血、破入脑室的发生率在中脏腑组远远高于中经络组,(P<0.01),有统计学意义。4急性期脑出血影像学改变与病情的关系:急性期重型患者出现率在大量出血组高于中小量出血组,(P<0.01)有统计学意义。轻型出现率在中小量出血组高于大量出血组,(P<0.01)有统计学意义。在中小量出血组内,轻型患者的出现率高于重型患者, (P<0.05)有统计学意义;在大量出血组内,患者的重型出现率高于轻型中型患者,(P<0.05)有统计学意义。重型患者出现率中线移位组高于中线居中组,(P<0.05)有统计学意义。轻型出现率中线居中组高于中线移位组,(P<0.05)有统计学意义。在中线移位组内,患者的重型出现率高于轻型患者,(P<0.05)有统计学意义。中线居中组内轻型患者的出现率高于重型患者,(P<0.05)有统计学意义。重型患者出现率在破入脑室组高于无破入脑室组,(P<0.05)有统计学意义。轻型出现率在无破入脑室组高于破入脑室组,(P<0.05)有统计学意义。在破入脑室组内,患者的重型出现率高于轻型患者,(P<0.05))有统计学意义。位证素,一定相关性。脑出血影像学改变可以成为中医辩证时的参考指标。2脑出血急性期影像学上表现的血肿量大小,血液有无破入脑室,中线的结构有无改变与临床病情变化有一定相关性,说明脑出血影像学改变在一定程度上反映病情的轻重。更多还原

【Abstract】 Objective: Intracerebral hemorrhage(ICH) is bleeding in incerebral parenehyma without external injury.It has various reasons and the pathogenesis is complicated.Hypertension is the main reason and the pathogenesis is complicated.In our country,due to the poor prevention,ICH has high incidence among people and the lethality is high.It do a lot of harm to our health.The stroke in TCM include the ICH.It often occurs in activity acutely.The patients may present with hemiplegia ,paresthesia,the disorder of consciousness and so on.The syndromes such as vomiting, headache,dizziness occur occassionly.TCM has abundant clicinal experience .Nowadays in some respects of TCM and modern medicine,some people apply CT to the research.According to the CT results,they combine the disease region and TCM . but the conclusion is not unaminous. To realize the relation between the the imageology with the property of TCM and type,we adopt the trational Chinese medicine combined with the modern medicine to study the patients of TCM.The patients examined CT and staged and typed.We collect some resource about 119 patients of the ICH.First we type the patients and give some Imageology examination.Meantime, we make out the property of the TCM and the disease region of TCM.We expect to find some objective indications about the differentiation of TCM.Method: The 119 cases of ICH are selected from the out-patient clinic (OPD) and emergency and hospitalized patients of hebei Medicine University affiliated the second hospital. Consulting the ICH staging standard of ruxun Huang。To examine the brain CT with the ICH patients in forty eight hour.We differ in different group according to bleeding volume ,bleeding situation,the structure of the line ,ventricle. According to the standard of《stroke syndrome differentiation of TCM diagnostic codec》,119 cases of hemorrhage (ICH) carried out the differentiation of syndromes. The analysis of all the materials used the SPSS11.5 statistics software, with the statistics difference of P < 0.05.Result: 1 The relation between the imageology and zhensu of TCM: In the bleeding part, pyretic syndrome, phlegm syndrome and the wind syndrome are high. The incidence of syndrome caused by phlegm and pyretic in massive bleeding group is higher than the patients of in midst-dimin bleeding group. the incidence of syndrome caused by Yin asthenic in massive bleeding group is lower than the patients of in midst-dimin bleeding group. the incidence of syndrome caused by syndrome of blood stasis, pyretic syndrome, phlegm syndrome in neutral-line displaced group is higher incidence than the patients in neutral-line centre group. the incidence of syndrome caused by syndrome of blood stasis, pyretic syndrome, phlegm syndrome in invade ventricle group is higher incidence than the patients in non-invade ventricle group.2 The relation between the the imageology with the disease region of TCM: in acute stage, every group has high incidence of oliver and channel. the incidence of disease region located in soul and the channel in neutral-line displaced group is higher than the patients of in in neutral-line centre. the incidence of disease region located in soul and the large intestine in massive bleeding group is higher than the patients of in midst-dimin bleeding group. the incidence of disease region located in soul and the large intestine in massive bleeding group is higher than the patients of in midst-dimin bleeding group.3 The relation between the imageology with stroke involving channel and stroke involving entrails : the incidence of massive bleeding, invade ventricle and neutral-line centre in stroke involving entrails is higher than stroke involving channel group. 4 The acute stage: the patients of gravis type in massive bleeding group has higher incidence of than the patients of gravis type in midst-dimin bleeding group.The patients of light type in midst-dimin bleeding group has higher incidence of than the patients of light type in massive bleeding group.In massive bleeding group, the patients of gravis type has higher incidence of than the patients of light type. The patients of gravis type in neutral-line displaced group has higher incidence of than the patients of gravis type in neutral-line centre bleeding group. The patients of light type in neutral-line centre group has higher incidence of than the patients of light type in neutral-line displaced group. The patients of gravis type in invade ventricle group has higher incidence of than the patients of gravis type in non-invade ventricle group. The patients of light type in non-invade ventricle group has higher incidence of than the patients of light type in invade ventricle group. In invade ventricle group, the patients of gravis type has higher incidence of than the patients of light type.Conclusion:The research show that the change of imageology of ICH is related to differentiation of TCM.The volume of bleeding,the structure of neutral-line centre and the bleeding invaded ventricle is related to the property of disease of TCM and the disease region of TCM. The volume of bleeding,the structure of neutral-line centre and the bleeding invaded ventricle is related to patient’s condition.The change of imageology of ICH reflect the patient’s condition.更多还原