【作者】 张君；

【导师】 刘莉；

【作者基本信息】 黑龙江中医药大学 ， 中西医结合临床（专业学位）， 2021， 硕士

【摘要】 目的:通过回顾性分析刘莉教授治疗射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFp EF)的病案处方,以此研究刘莉教授诊治该疾病的组方用药规律与特点,进而整理归纳并传承其诊疗的学术思想,为该病的临床治疗提供新思路和参考。方法:本研究选取并整理符合2018-2020年刘莉教授治疗HFp EF纳入标准的医案处方,基于中医传承辅助平台的数据收集模块将病案中的诊疗信息及中药处方进行录入,利用该平台的统计报表和数据分析模块,可对处方中药物的使用频次、性味归经、核心组合等数据进行挖掘。结果:本研究整理出符合纳入的病案105例,初诊处方共计105首。得出结果如下:1.经统计分析,本病多以女性患者为主,发病年龄主要集中在“60-69岁”和“≥70岁”。证候以气虚血瘀证、气虚血瘀兼水饮内停证居多。2.病案处方共涉及中药128种,其中药物类别以补虚药、活血化瘀药、化痰止咳平喘药、收涩药、解表药、利水渗湿药为主;药物使用以桂枝、黄芪、太子参、五味子、麦冬居多;药性以性温甘味多见,归经则以入肺、心、脾、肝、肾经为要。3.在组方规律中将支持度设置为60,置信度为0.95,得到药物组合62种,囊括了刘莉教授治疗HFp EF的8种核心药物;在新方分析中设置相关度为6,惩罚度为2,利用聚类分析对药物进行挖掘,得到核心组合8个和新处方4个。结论:1.刘莉教授在治疗HFp EF用药方面体现了以心为本、五脏相关的临证思路,药物主以性温味甘和入肺、心、脾、肝、肾经者居多。2.刘莉教授治疗HFp EF注重邪正兼顾、标本同治,以益气活血利水为主要治疗方法,擅用黄芪、太子参、仙鹤草等补虚之品以扶正;擅用丹参、茯苓、紫菀等活血利水化痰之品以祛邪。更多还原

【Abstract】 Objective:This paper through retrospectively analyzes the medical record prescription of Professor Liu Li in the treatment of heart failure with preserved ejection fraction,so as to study the characteristics of the prescription of Professor Liu Li in the diagnosis and treatment of the disease,and then sort out and inherit the academic thought of diagnosis and treatment.To provide new ideas and references for the clinical treatment of the disease.Methods:In this study,we selected and sorted out medical prescriptions that met the criteria for the treatment of heart failure with ejection fraction retention by Professor Liu Li from 2018 to 2020.Based on the data collection module of the TCM Inheritance Assist Platform,the diagnosis and treatment information and TCM prescriptions in the medical records are input,and the statistical statements and data analysis module of the platform can be used to mine the data such as the frequency of use of drugs in the prescription,the recurrence of sex and taste,and the core combination.Results:This study sorted out 105 cases that met the inclusion criteria,and included 105 initial prescriptions.The results are obtained as follows:1.According to statistical analysis,this disease is mainly female patients,and the onset age is mainly concentrated in“ 60-69 years old”and“ ≥ 70 years old”.The syndromes are mainly Qi deficiency and blood stasis syndrome,Qi deficiency and blood stasis combined with water drinking and internal suspension syndrome.2.Disease prescriptions involve 128 kinds of traditional Chinese medicine,among which the main categories of drugs were drugs for tonifying deficiency,promoting blood circulation,reducing phlegm and relieving cough and antiasthmatic,relieving exterior syndrome,diuretics and eliminating dampness were used most.The drug use was mainly Ramulus Cinnamomi,astragalus membranaceus,Radix pseudostellariae,Schisandra chinensis and Radix Ophiopogonis.The medicinal property is more warm and sweet,and the meridian is to enter the lung,heart,spleen,liver and kidney.3.In the formulation rules,the support was set to 60,confidence is 0.95,and 62 drug combinations among which including 8 core drugs of Professor Liu Li for the treatment of HFp EF were getted;In the new party analysis,the correlation is 6 and the punishment is 2,mining the drug using cluster analysis,obtaining 8 core combinations and 4 new prescriptions.Conclusion:1.In the treatment of HFp EF,Professor Liu Li showed the clinical thinking of heart-centered and five viscera related,and most of the drugs were warm and sweet and entered the meridian of lung,heart,spleen,liver and kidney.2.In the treatment of HFp EF,Professor Liu Li pays attention to both the positive and the evil,and treats the specimens together.The main treatment method is to replenish qi,promote blood circulation and improve water,and make good use of astragalus membranaceus,Radix pseudostellariae and hairyvein agrimony and so on to replenish deficiency.Use miltiorrhiza miltiorrhiza,poria cocos and aster to promote blood circulation,reduce water and reduce phlegm to dispel evil spirits.更多还原