慢性心力衰竭急性加重期中医证候特征的多中心调查分析  

A Multi-Center Investigation and Analysis of TCM Pattern Characteristics in Acute Exacerbation of Chronic Heart Failure

作　　者：赵志强[1] 毛静远[1] 王贤良[1] 侯雅竹[1] 毕颖斐[1] 李彬[1] 赵英强[2] 牛天福[3] 李广平[4] 施乐[5] 崔晋荣[6] 王永刚[7] 贾秀丽[8] 樊瑞红[9] 林谦[10] 

机构地区：[1]天津中医药大学第一附属医院 [2]天津中医药大学第二附属医院 [3]山西省中医药研究院 [4]天津医科大学第二医院 [5]天津中医药大学附属北辰区中医医院 [6]山西中医学院中西医结合医院 [7]陕西中医学院第二附属医院 [8]天津市南开区中医医院 [9]天津市中医院 [10]北京中医药大学东方医院

出　　处：《中医杂志》2013年第12期1038-1042,共5页Journal of Traditional Chinese Medicine

基　　金："十一五"国家科技支撑计划项目(2006BAI08B02-01);国家中医药行业科研专项资助项目(201007001-02)

摘　　要：目的探讨慢性心力衰竭(简称心衰)急性加重期的中医证候特征。方法制定心衰中医证候流行病学调查量表,对我国华北地区10家医院的340例慢性心衰急性加重期患者进行现场调查,建立慢性心衰急性加重期中医证候信息数据库,对问诊、望诊、舌象采用双百分法进行权重系数分析,对脉象进行频数统计分析,并据此分析其证候要素、证候(证素组合)、病位分布规律。结果 340例慢性心衰急性加重期患者问诊症状权重系数最大的前3项依次为气短、憋气、乏力;望诊权重系数最大的前3项分别为精神倦怠、面色无华、口唇紫绀;舌象权重系数最大的前3项分别为舌质紫暗、舌红、舌苔少;脉象频次最高的前3项分别为沉、细、弦。虚证证素出现频次由高到低依次为气虚339(99.7%)、阴虚193(56.8%)、阳虚147(43.2%);实证证素出现频次由高到低依次为血瘀340(100%)、水饮298(87.6%)、痰浊190(55.9%)。出现最多的中医证候为气虚血瘀证339例(99.7%),在此基础上合并水饮或痰浊者为314例(92.4%)。累及病位按照频数排序分别为心(100%)、肾(100%)、肺(98.2%)、脾(75.0%)、肝(66.8%),累及3脏者占98.2%以上、累及4脏者占74.4%以上、累及5脏者占50.6%。结论慢性心衰急性加重期最基本的中医证候特点为气虚血瘀兼水饮或痰浊,病位以心肾为主,五脏皆可累及。Objective To research the TCM pattern characteristics in acute exacerbation of chronic heart failure （CHF）. Methods Totally 340 CHF patients in acute exacerbation from 10 hospitals in northern China were surveyed according to the TCM pattern epidemiological survey form. The TCM pattern database was established. Double percent method was used for weight coefficient analysis of inquiry, inspection and tongue image, and frequency statistics was used to analyze the pulse. The pattern factors, patterns （pattern element combinations） and distribution of disease location were analyzed. Results The top 3 maximum weight coefficients of inquiry were short of breath, feeling suffocated and fatigue. The top 3 maximum weight coefficients of inspection were mental fatigue, lusterless complexion and cyanotic lips. The top 3 maximum weight coefficients of tongue image were dark purple tongue, red tongue and less tongue fur. The top 3 frequencies of pulse were deep pulse, fine pulse and stringlike pulse. The deficiency pattern factors from high to low were qi deficiency （339 cases, 99.7%）, yin deficiency （193 cases, 56.8%） and yang deficiency （147 cases, 43.2%）. The repletion pattern factors from high to low were blood stasis （340 cases, 100%）, water-rheum （298 cases, 87.6%） and phlegm turbidity （190 cases, 55.9%）. The highly frequent pattern was qi deficiency blood stasis pattern （339 cases, 99.7%） and then combined with water-rheum or phlegm turbidity （314 cases, 92.4%）. The main organs implicated were the heart （100.0%）, kidney （100.0%）, lung （98.2%）, spleen （75.0%） and liver （66.8%）. Three organs were implicated in 98.2% patients, four organs in 74.4% patients and five organs in 50.6% patients. Conclusion The basic TCM pattern characteristic in acute exacerbation of CHF is qi deficiency blood stasis with water-rheum or phlegm turbidity. The main organs implicated are the heart and kidney, however all five organs are affected.

关 键 词：慢性心力衰竭 急性加重期 中医证候 流行病学调查 

分 类 号：R259[医药卫生—中西医结合]