基于临床路径数据的老年糖尿病方证用药规律研究  

Study on Regularity of Formula-Syndrome and Medication in Treatment of Senile Diabetes Based on Clinical Pathway Data

作　　者：刘梦阳[1] 靳冰[1] 刘征堂[1] LIU Mengyang;JIN Bing;LIU Zhengtang(Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]中国中医科学院西苑医院,北京100091

出　　处：《辽宁中医杂志》2022年第3期6-10,223,共6页Liaoning Journal of Traditional Chinese Medicine

基　　金：科技部国家重点研发计划(2020YFC2006103);第四批全国中医优秀人才(临床、基础)研修项目(国中医药人教发[2017]24号)

摘　　要：目的探讨老年糖尿病病例特点和方证用药规律,以期进一步优化临床路径,增强路径实用性,便于今后向以慢病管理为主的社区卫生领域推广实施。方法运用古今医案云平台对2019年1月1日—2020年1月31日于中国中医科学院西苑医院老年病科入老年糖尿病临床路径的住院患者进行数据标准化处理,并对药物进行频次分析、关联分析、聚类分析、复杂网络分析等。结果研究共纳入382例患者,涉及药物319味,其中使用频次较高的药物是川芎、茯苓、土茯苓等,药物四气以温为主,药物五味以甘味最多,药物归经以肝经为主,主要药对包括桑叶-蚕蛹、厚朴-土茯苓、山茱萸-茯苓等。通过层次聚类和复杂网络分析归纳出老年糖尿病的2个主要证型:湿热瘀阻、脾肾两虚兼有瘀热,并明确各自核心方药。结论老年糖尿病的中医辨治当以虚实为纲、三焦为目,从“湿热瘀阻”和“脾肾两虚兼有瘀热”2个证型入手执简驭繁更有利于临床路径的推广。Objective To explore the characteristics of senile diabetes and the law of prescriptions in order to further optimize the clinical pathway,enhance the practicability of the path and facilitate the popularization and implementation of community health in the area of chronic disease management in the future.Methods The Ancient and Modern Consilia Cloud Platform was used to standardize the data collected from the aged diabetic inpatients which admitted as clinical pathway from January 1,2019 to January 31,2020 in gerontology ward of Xiyuan Hospital.Frequency analysis,association analysis,cluster analysis and complex networks were used to analyze the herb frequency and the core prescriptions.Results A total of 382 patients were included in this study,involving 319 kinds of Chinese materia medica.The traditional Chinese medicine used with high-frequency were Chuanxiong(Chuanxiong Rhizoma),Fuling(Poria)and Tufuling(Smilacis Glabrae Rhizoma),and most of the drugs were mild in property,sweet in flavor and going along liver meridian.The commonly-used drug pairs were Sangye(Mori Folium)-Canyong(Silkworm pupa),Houpo(Magnoliae Officinalis Cortex)-Tufuling(Smilacis Glabrae Rhizoma),Shanzhuyu(Corni Fructus)-Fuling(Poria),etc.Through cluster analysis and complex networks,two main syndromes of diabetes mellitus in the elderly were summarized:blockade of damp-heat and blood stasis and deficiency of spleen and kidney combined with heat stagnation.The corresponding core prescriptions were obtained at the same time.Conclusion The TCM differentiation and treatment of senile diabetes should focus on deficiency-excess and triple energizer.From the above two types of syndromes,it is more conducive to the promotion of clinical pathway.

关 键 词：临床路径 数据挖掘 老年糖尿病 辨证分型 用药规律 

分 类 号：R259[医药卫生—中西医结合]