本文關鍵詞：基于聚類分析探討心臟直視手術術后“汗證”的中醫(yī)證型　出處：《南京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 汗證 心臟直視手術 中醫(yī)辨證 因子分析 聚類分析

【摘要】：本研究主要采用收集病例的方法,對心臟直視手術術后"汗證"病人的中醫(yī)四診信息的相關數(shù)據進行統(tǒng)計學分析,進而探討心臟直視手術術后"汗證"的中醫(yī)辨證分型規(guī)律,為術后"汗證"提供中醫(yī)辨證依據,指導臨床診療。目的:探討心臟直視手術術后"汗證,"的中醫(yī)辨證分型規(guī)律,用以提供術后"汗證"中醫(yī)辨證依據,更好的指導臨床辨證及治療。方法:收集2016年6月—2017年2月期間在江蘇省中醫(yī)院心胸外科,以及南京市第一醫(yī)院心胸外科行心臟直視手術治療的患者的病例共256例,采用因子分析及聚類分析,初步探討心臟直視手術術后"汗證"的中醫(yī)證候特點,進一步了解心臟直視手術術后"汗證"的分型規(guī)律。結果:心臟直視手術術后"汗證"的中醫(yī)證型分4類,分別為氣虛證,痰濕證,濕熱證,陰虛火旺證。共同癥為:術后汗出。氣虛證主癥為:舌質淡,體倦乏力,神疲,氣短,痰多色黃,身重困倦,周身酸楚,便秘,盜汗,背部汗,午后潮熱,脈弦,口苦。痰濕證主癥為:汗出惡風,蒸蒸汗出,舌質淡,苔白膩,稍勞汗出尤甚,多夢,煩躁,脈弦數(shù),尿黃。濕熱證主癥:體倦乏力,身重困倦,全身汗出,面色晦暗,周身酸楚,煩躁,熱汗,五心煩熱,心悸,苔黃膩,面色不華,口苦。陰虛火旺證主癥:稍勞汗出尤甚,神疲,氣短,發(fā)熱,身重困倦,煩躁,半身汗出,五心煩熱,面赤烘熱,少苔乏津,背部汗,心悸,尿黃,午后潮熱,失眠少寐,口苦。結論:1.心臟直視手術術后"汗證"發(fā)病率高達78.4%,術后汗出跟手術時間,輸血量及呼吸機支持時間無關。2.中醫(yī)辨證術后"汗證"分為4類證型,依次為氣虛證,痰濕證,濕熱證,陰虛火旺證。3.體外循環(huán)與非體外循環(huán)兩種手術方式對于術后的汗出影響無統(tǒng)計學差異。4.4類證型患者性別無統(tǒng)計學差異;年齡主要分布在61-70歲,以氣虛證為主。痰濕證與陰虛火旺證患者年齡有統(tǒng)計學差異,陰虛火旺證患者的年齡較痰濕證大。5、陰虛火旺證和氣虛證兩類證型患者輸血量存在統(tǒng)計學差異,陰虛火旺證秩均值大于氣虛證,因此,大量輸血更易導致或者加重陰虛火旺的癥候。6、濕熱證與氣虛證、陰虛火旺證患者呼吸機支持時間存在統(tǒng)計學差異,濕熱證患者呼吸機支持時間較氣虛證、陰虛火旺證長,因此,長時間使用呼吸機可能導致濕熱證。
[Abstract]:This study mainly adopts the method of collecting cases, carries on the statistical analysis to the related data of TCM four diagnosis information of the patients with "sweating syndrome" after open heart surgery. And then to explore the TCM syndrome differentiation and classification rule of "sweat syndrome" after open heart surgery, to provide TCM differentiation basis for "sweat syndrome", and to guide clinical diagnosis and treatment. Objective: to explore the "sweat syndrome" after open heart surgery. "the law of TCM syndrome differentiation and classification, to provide postoperative" Khan syndrome "TCM syndrome differentiation basis. Methods: from June 2016 to February 2017, we collected cardiothoracic surgery in Jiangsu Provincial traditional Chinese Medicine Hospital. A total of 256 cases were treated with open heart surgery in the Department of Cardiothoracic surgery in the first Hospital of Nanjing. Factor analysis and cluster analysis were used to explore the characteristics of TCM syndromes of "sweating syndrome" after open heart surgery. Results: the TCM syndromes of "sweating syndrome" after open heart surgery were divided into 4 types: Qi deficiency syndrome, phlegm dampness syndrome and damp-heat syndrome. The common symptoms are: sweating after operation. The main symptoms of Qi deficiency syndrome are: light tongue, tired body, tired spirit, short breath, polychromatic phlegm, heavy sleepiness, body acerbity, constipation, night sweat, back sweat, hot tide in the afternoon. The main symptoms of phlegm dampness syndrome are: sweating out bad wind, steam sweating out, tongue light, fur white and greasy, slightly overworked sweat especially, many dreams, fidgety, pulse string number, urine yellow. Damp-heat syndrome main symptom: body fatigue, body heavy sleepiness. The whole body sweats out, the complexion is dark, the whole body is sour, fidgety, hot sweat, five upset heat, palpitation, moss yellow greasy, the complexion is not Hua, the mouth is bitter. Yin deficiency fire prosperous syndrome main symptom: slightly laboriously sweats out especially, the spirit is tired, the breath is short, the fever, the body heavy sleepiness. Fidgety, half body sweats out, five upset heat, the face is red baked heat, little moss is spent, back sweat, palpitation, urine yellow, afternoon hot flashes, insomnia less sleep. Conclusion 1. The incidence of "sweating syndrome" after open heart surgery is as high as 78.4%, and the operative time after operation is as high as 78.4%. The amount of blood transfusion and the time of ventilator support are not. 2.The syndrome of "sweat syndrome" after TCM syndrome differentiation can be divided into 4 types: Qi deficiency syndrome, phlegm dampness syndrome and damp-heat syndrome. There was no significant difference in the effect of cardiopulmonary bypass (CPB) and non-cardiopulmonary bypass (CPB) on postoperative sweating. The main age distribution in 61-70 years old, mainly qi deficiency syndrome. Phlegm-dampness syndrome and Yin deficiency of fire syndrome patients with age difference, Yin deficiency of fire and the age of the syndrome is larger than the phlegm dampness syndrome. There is a statistical difference in blood transfusion volume between the two types of syndrome, and the mean value of the rank of yin deficiency fire is greater than that of qi deficiency. Therefore, a large amount of blood transfusion is more likely to lead to or aggravate the syndrome of yin deficiency fire. 6. There was statistical difference in the time of ventilator support between damp-heat syndrome and qi deficiency syndrome and Yin deficiency fire syndrome. The time of ventilator support in damp and heat syndrome was longer than that in qi deficiency syndrome and Yin deficiency fire syndrome. Prolonged use of ventilators may lead to dampness and heat syndrome.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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