冠心病合并中风不同分期治则治法研究  被引量:7

Treatment Principle and Methods of Coronary Heart Disease Complicated with Stroke

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作  者:李艳娟[1,2] 李涵 张明雪[4] 易丹辉[5] 宋年斌 王丹[2] 

机构地区:[1]辽宁中医药大学,辽宁沈阳110847 [2]沈阳市第二中医医院,辽宁沈阳110101 [3]沈阳市健康教育中心,辽宁沈阳110031 [4]辽宁中医药大学附属医院,辽宁沈阳110032 [5]中国人民大学统计学院,北京100872

出  处:《中华中医药学刊》2017年第11期2756-2765,共10页Chinese Archives of Traditional Chinese Medicine

基  金:国家自然科学基金面上项目(81273698);辽宁省中医药临床学(专)科能力建设项目(2012-lnzyxzk-01);辽宁省特聘教授项目;沈阳市科技计划项目(F12-155-9-00)

摘  要:目的:探寻冠心病合并中风各阶段每一证型的主要治法、遣方、用药,筛选并制定有效的基础诊疗方案及证候层面的诊疗方案,为冠心病合并中风的中医规范化诊疗提供理论依据。方法:冠心病合并中风治则治法临床专家调查问卷。将调查问卷使用R3.1.2统计分析平台及Microsoft Office 2007办公软件,以列联表、堆叠条形图形式汇总统计,并应用组合分析、排序分析方法对数据进行统计分析。结果:得出冠心病合并中风的不同分期分期治则治法。急性期热毒炽盛、阴竭阳脱证,应用清热解毒、回阳救阴治法,方选犀角地黄汤等,用药优选清营解毒、温阳固脱、大补元气药;急性期风阳痰火、蒙蔽清窍证,应用潜阳熄风、泻火豁痰开窍治法,方选清热导痰汤等,用药优选清热化痰、化浊开窍、泻肝熄风药。恢复期气虚痰瘀证应用益气化痰、活血化瘀治法,益气类方选四君子汤等,用药优选补益元气、健脾化痰、养血活血药(祛痰类方选半夏白术天麻汤加减,用药优选健脾化痰药;祛瘀类方选黄芪桂枝五物汤加减,用药优选养血活血、活血化瘀药);恢复期气虚络滞证应用益气理血通络治法,方选补阳还五汤等,用药优选益气通络、养血活血、活血化瘀药。后遗症期气虚瘀阻证应用益气、活血化瘀治法,方选黄芪桂枝五物汤等,用药优选健脾益气、补益元气、活血化瘀、活血养血药。后遗症期肝肾亏虚证应用补益肝肾、燮理阴阳治法,方选大定风珠等,用药优选滋阴潜阳、补肾填精药。结论:冠心病合并中风不同分期治则治法研究得出了专家共识,具有一定的临床应用价值,可为冠心病合并中风的中医规范化诊疗提供科学的理论依据。Objective:To explore the main treatment methods, prescriptions and medication of each syndrome in coronary heart disease complicated with stroke, screening and developing effective method of basic diagnosis and treatment programs and the diagnosis and treatment and provide a theoretical basis for the traditional Chinese medicine standardized diagnosis and treatment of coronary heart disease and stroke. Methods : We used the expert questionnaire about treatment principles and methods of the coronary heart disease complicated with stroke. By using R3.1.2 statistical analysis platform and Microsoft Office 2007 office software, we got the basic method, prescription and medicine of each expert and carried out the statistical analysising on the data in the form of contingency table and stacked bar chart, with combination analysis and ranking analysis. Result : We obtained the treatment of coronary heart disease with stroke by different stages. To treat acute stage of the heat type and Yin causing Yang collapse syndrome, the application is heat clearing and detoxicaring, restoring yang to save yin, choosing Qingre Huatan Decoction. The preferred medication is clearing Ying heat - toxin, warming Yang, nourishing qi and medicine. To treat acute stage of the wind Yang phlegm fire and blockage of upper orifices syndrome ,the application is suppressing yang to extinguish wind, purging fire and eliminating phlegm, choosing Qingre Huatan Decoction. The preferred medication is clearing heat and resolving phlegm, clearing turbid and inducing resuscitation, purging the liver fire and wind extinguishing medicine. To treat syndrome of qi deficiency and phlegm stasis during convalescence,the application is invigorating Qi and resolving phlegm, promoting blood circulation and removing blood stasis, the tonifying decoction is Sijunzi Decoction. The preferred qi medication is invigorating Qi, invigorating spleen and resolving phlegm, nourishing blood and promoting blood circulation ( The Benefiting Qi Decoction is Banx- ia Baiz

关 键 词:冠心病 中风 治则治法 调查问卷 

分 类 号:R541.4[医药卫生—心血管疾病] R743.3[医药卫生—内科学]

 

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