本文關(guān)鍵詞： 動脈粥樣硬化 動脈粥樣硬化性腦梗塞 冠心病 下肢動脈粥樣硬化 用藥規(guī)律　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過對中藥治療冠狀動脈粥樣硬化性心臟病、動脈粥樣硬化性腦梗塞、下肢動脈粥樣硬化性疾病的臨床研究文獻(xiàn)進(jìn)行整理,借鑒不同的研究思路,從多角度對動脈粥樣硬化用藥規(guī)律進(jìn)行研究,初探三者常用方藥以及組方配伍規(guī)律,為中醫(yī)藥治療動脈粥樣硬化性疾病提供選擇用藥依據(jù)。方法:通過計算機(jī)檢索與人工檢索相結(jié)合的方法,收集中國知識資源總庫(CNKI)、萬方數(shù)據(jù)庫中2006-2015年的冠狀動脈粥樣硬化性心臟病、動脈粥樣硬化性腦梗塞、下肢動脈粥樣硬化性疾病中醫(yī)證治研究相關(guān)文獻(xiàn)。根據(jù)嚴(yán)格的文獻(xiàn)納入與排除標(biāo)準(zhǔn)篩選出符合標(biāo)準(zhǔn)的文獻(xiàn),運用中醫(yī)臨床文獻(xiàn)質(zhì)量證據(jù)等級體系將文獻(xiàn)分為4類。將其藥物名稱、藥物歸類等規(guī)范化處理后,在Excel中建立中醫(yī)藥研究數(shù)據(jù)庫并錄入數(shù)據(jù),按照目的計算并確定核心藥物,采用SPSS20.0統(tǒng)計軟件對核心藥物進(jìn)行頻數(shù)描述、聚類分析,最后結(jié)合中醫(yī)學(xué)相關(guān)理論對結(jié)果進(jìn)行討論并得出結(jié)論。結(jié)果:1.經(jīng)篩選共納入符合標(biāo)準(zhǔn)的中藥湯劑治療冠狀動脈粥樣硬化性心臟病文獻(xiàn)516篇,通過文獻(xiàn)質(zhì)量評價,最終得到辨證論治文獻(xiàn)(Ⅰ類)330篇,非嚴(yán)格辨證論治(Ⅱ類)186篇。其中Ⅰa文獻(xiàn)291篇,Ⅰb文獻(xiàn)39篇,Ⅱa文獻(xiàn)178篇,Ⅱb文獻(xiàn)8篇。納入共23870例患者,232味中藥。經(jīng)計算確定核心藥物總頻次7708次,共77味核心藥物。對動脈粥樣硬化性腦梗塞的511篇文獻(xiàn)進(jìn)行質(zhì)量評價,最終得到辨證論治文獻(xiàn)(Ⅰ類)206篇,非嚴(yán)格辨證論治(Ⅱ類)305篇,其中Ⅰa文獻(xiàn)183篇,Ⅰb文獻(xiàn)23篇,Ⅱa文獻(xiàn)269篇,Ⅱb文獻(xiàn)36篇。納入共31323例患者,237味中藥,經(jīng)計算確定核心藥物總頻次7942次,共85味核心藥物。對中藥湯劑治療下肢動脈粥樣硬化性疾病的186篇文獻(xiàn)進(jìn)行質(zhì)量評價,最終得到辨證論治文獻(xiàn)(Ⅰ類)65篇,非嚴(yán)格辨證論治(Ⅱ類)121篇,其中Ⅰa文獻(xiàn)38篇,Ⅰb文獻(xiàn)27篇,Ⅱa文獻(xiàn)91篇,Ⅱb文獻(xiàn)30篇。納入共10959例患者,174味中藥,經(jīng)計算確定核心藥物總頻次2540次,共76味核心藥物。2.核心藥物比較情況:冠心病、腦梗塞、下肢動脈粥樣硬化共同核心藥物共38味,以活血化瘀(31.58%),補益類(28.95%),清熱解毒(13.16%),化痰(10.53%)為主,其中補虛藥以補氣藥(54.55%)為主。經(jīng)卡方檢驗,其中黃芪、川芎、赤芍、白術(shù)、白芍、熟地和何首烏的使用頻率無明顯差異(P0.05);經(jīng)過進(jìn)一步兩兩比較,最終發(fā)現(xiàn)冠心病高頻用藥為丹參、甘草、桂枝、黨參、茯苓、生地、山楂、三七、半夏、陳皮、麥冬、人參、葛根、枳實、郁金、黃連;動脈粥樣硬化性腦梗塞高頻用藥為地龍、紅花、桃仁、水蛭、牡蠣、大黃、丹皮、澤瀉、黃芩、杜仲;下肢動脈粥樣硬化性疾病高頻用藥為:當(dāng)歸、牛膝、地龍、甘草、雞血藤、水蛭、桂枝、附子、玄參、黨參、澤瀉、丹皮。研究三者聚類共同點皆存在益氣活血藥物組合、健脾化痰(濕)藥物組合、化瘀通絡(luò)藥物組合。其中益氣活血組合皆為桃紅四物湯基礎(chǔ)上加用補氣藥,如黃芪、黨參;健脾化痰(濕)組合雖不能組成經(jīng)方,但藥物組合均存在茯苓、白術(shù);化瘀通絡(luò)組合為以水蛭為主的多種蟲類藥的應(yīng)用。經(jīng)統(tǒng)計學(xué)計算,在冠狀動脈粥樣硬化性心臟病、動脈粥樣硬化性腦梗塞、下肢動脈粥樣硬化性疾病的藥物性、味、歸經(jīng)上無差異(P0.05)。結(jié)論:1.文獻(xiàn)研究方面:中醫(yī)治療動脈粥樣硬化研究的文獻(xiàn)量整體呈增長趨勢,說明動脈粥樣硬化的中醫(yī)藥研究愈來愈受到重視,但對該病研究仍處于分部位論治階段,且各個疾病文獻(xiàn)質(zhì)量參差不齊,相比于動脈粥樣硬化性腦梗塞、下肢動脈粥樣硬化,冠心病高質(zhì)量文獻(xiàn)相對較多。2.常用藥物方面:動脈粥樣硬化性心、腦、下肢血管疾病共用高頻核心藥物以補虛扶正、活血化瘀、化痰祛濁、清熱解毒藥物為主。其中補虛藥中以補氣為主。在藥物使用上,黃芪、川芎、赤芍、白術(shù)、白芍、熟地、何首烏為三者共同高頻用藥。丹參、桂枝、茯苓、半夏、陳皮、枳實、郁金等在冠心病中使用較多;地龍、紅花、桃仁、水蛭、大黃等在腦梗塞中使用頻率較高;牛膝、地龍、雞血藤、水蛭、桂枝、附子、玄參等在下肢動脈粥樣硬化中多于其他二者。三者藥性以寒溫平為主,味以苦甘辛為主,主要歸經(jīng)以肝脾心經(jīng)為主。3.聚類方面:均以益氣活血藥物組合、健脾化痰(濕)藥物組合、化瘀通絡(luò)藥物組合為主。動脈粥樣硬化性心、腦、下肢疾病若辨證為氣虛血瘀證,可以選用桃紅四物湯合用黃芪、黨參補氣藥益氣活血治療;若辨證為痰濕內(nèi)阻證,可選用陳皮、茯苓、半夏、白術(shù)為主的藥物組合健脾化痰進(jìn)行加減治療;若辨證為瘀阻脈絡(luò)證,可選用以水蛭為主的蟲類藥進(jìn)行加減。而各自聚類組合又較多,用藥靈活多變。聚類方體現(xiàn)了組方用藥規(guī)律。4.本文從多角度研究用藥規(guī)律,頻數(shù)分析側(cè)重于單味藥的高頻使用情況,為臨床加減用藥提供一定的理論學(xué)參考;聚類分析側(cè)重于探索藥組的總體傾向及藥物間的配伍規(guī)律,為臨床辨證組方用藥提供新思路。
[Abstract]:Objective: Based on the traditional Chinese medicine in the treatment of coronary heart disease, atherosclerotic cerebral infarction, clinical research literature of lower extremity atherosclerotic disease were collected from different research ideas, research on atherosclerosis drug law from different angles, on the three commonly used prescription and compatibility law, provide the basis for the choice of drug treatment of atherosclerosis disease of traditional Chinese medicine. Methods: through the method of computer retrieval combined with manual search, collecting Chinese knowledge resources database (CNKI), coronary heart disease 2006-2015 years of Wanfang database, atherosclerotic cerebral infarction, the research literature on treating lower extremity atherosclerotic disease in TCM. According to the strict inclusion and exclusion criteria of literature selected in accordance with the standards of the literature, the use of traditional Chinese medicine clinical literature quality level of evidence The system will be divided into 4 categories. The drug name, drug classification standardization, establish a database of traditional Chinese medicine in the Excel and input data, in accordance with the objective to calculate and determine the core drugs, frequency description of core drugs by SPSS20.0 statistical software, clustering analysis, finally discussed the related theory of traditional Chinese medicine the results and conclusions: 1.. Results after screening were included in accordance with the standards of the traditional Chinese medicine decoction for treating coronary heart disease and 516 papers, through the literature quality evaluation, finally get the treatment based on syndrome differentiation Literature (class I) 330, non strict differentiation (class II) 186. The effect of a 291 documents I B, 39 articles, 178 articles of a II, B 8 articles. A total of 23870 patients were included, 232 kinds of traditional Chinese medicine. Through calculation to determine the core drug total frequency of 7708 times, a total of 77 core drugs. The taste of atherosclerotic cerebral infarction 511 鏂囩尞榪涜璐ㄩ噺璇勪環(huán),鏈，

本文編號：1521420