161例高血压脑梗死的临床调研  

Clinical research of 161 cases of hypertensive cerebral infarction

作　　者：陈茹[1] 黄燕[2] 丁元庆[3] 

机构地区：[1]广州中医药大学,广东广州510405 [2]广东省中医院,广东广州510120 [3]山东中医药大学第一附属医院,山东济南250011

出　　处：《时珍国医国药》2014年第10期2459-2462,共4页Lishizhen Medicine and Materia Medica Research

摘　　要：目的探讨高血压合并脑梗死的病因病机,拓展脑梗死的二级预防。方法分析161例高血压(高血压合并脑梗死78例,高血压非脑梗死83例)临床资料,探讨高血压致脑梗死的病因病机。结果 (1)危险因素方面存在差异:高血压合并脑梗死组平均年龄、吸烟、打鼾、性情急躁、嗜咸、伴有冠心病史的比例较非脑梗死组更高(P<0.05)。(2)两组血压参数(病史年数、收缩压、舒张压、脉压及血压分级)无显著差异(P>0.05)。(3)脑梗死组颈动脉粥样硬化(carotid artery atherosclerosis,CAS)程度更著,颈动脉内中膜厚度(IMT)(右)、斑块数量及斑块面积方面具有统计学意义(P<0.05)。(4)两组证候分布无显著差异(P>0.05),阴虚阳亢、肝阳上亢是主要证候。结论 (1)CAS是发生脑梗死的主要病理机制,高血压促进了这一过程。(2)单纯降压达标并不能减少CAS与脑梗死的发病风险,全面干预血管危险因素是有效措施。(3)危险因素方面多与火热、痰瘀相关。(4)肝肾亏虚、肝阳上亢是高血压及高血压脑梗死的基本病机,风火痰瘀是主要病理因素。Objective To explore the etiology and pathogenesis of hypertension with cerebral infaction,to expand the secondary prevention of cerebral infaction. Methods To analyze clinical data of 161 cases of hypertension（ 78 cases complicated with cerebral infarction and 83 without）,to further explore the etiology and pathogenesis. Results（ 1） The average age,proportion of smoking,snoring,short-tempered,eosinophilic salty and with history of coronary heart disease were higher in cerebral infarction group than without cerebral infarction group（P〈0. 05）.（ 2） Blood pressure parameters（ history,systolic pressure,diastolic blood pressure,pulse pressure and blood pressure classification） made no significant difference（P〈0. 05）.（ 3） Degree of carotid artery atherosclerosis was more serious in cerebral infarction group than the other,showing significant differences in IMT（ right）,quantity and area of plaque（P〈0. 05）.（ 4） Distribution of syndromes made no significant difference（P〈0. 05）,syndrome of yin deficiency with yang hyperactivity and syndrome of upper hyperactivity of liver yang were the main syndromes. Conclusion（ 1） CAS is the major pathological mechanism of cerebral infarction which can be promoted by hypertension.（ 2） Simple control of blood pressure can not reduce the risk of CAS and cerebral infarction,comprehensive interventions of vascular risk factors are the effective measures.（ 3） Risk factors are mostly related to fire,heat,phlegm and stagnate.（ 4） Deficiency of liver and kidney syndrome and syndrome of upper hyperactivity of liver yang are the basic pathogenesis of hypertension and hypertension complicated with cerebral infarction,with fire,heat,phlegm and stagnate being the main pathological factors.

关 键 词：高血压 脑梗死 颈动脉粥样硬化 病因病机 

分 类 号：R284.2[医药卫生—中药学]