腰椎管狭窄症中医证型临床调查分析研究.pdfVIP

目 录 中文摘要 ················································1 英文摘要 ················································2 引 言 ················································4 正 文 ················································7 1.资料方法 ·············································7 1.1 研究对象 ·············································7 1.2 研究方法 ·············································9 2.研究结果 ············································14 3.讨 论 ·············································15 3.1 辩证论治重要性 ···································15 3.2 现代医学对腰椎管狭窄症的认识 ··················17 3.3 腰椎管狭窄症与中医证型的关系 ························23 3.4 腰椎管狭窄症与中医症候的关系 ························24 4.存在的问题和展望 ··································26 结 论 ···············································27 参考文献 ··············································28 附 录 ···············································31 综 述 ···············································36 致 谢 ···············································45 攻读学位期间发表的学术论文目录 ····················46 作者声明 ··············································47 个人简历 ··············································48 中 文 摘 要 目 的：通过对以腰椎管狭窄症入院时的症状和体征进行调查分析归类 找出其中医症候规律及好发中医症型，为规范腰椎管狭窄症的中医证候 诊断标准，优化中医治疗方案提供临床依据。 方 法：通过对广西中医学院第一附属医院广西中医学院附属瑞康医院 和南宁市中医院近三年内以腰椎管狭窄症住院的各120例病历对其入院 时的临床症状体征相关辅助检查一般情况临床证型进行收集，根据《常 见症状中医鉴别诊疗学》200条症状及 《中医病证治法术语〃证候部分》 的标准对采集的症候进行规范化转化，然后进行统计分析, 应用聚类分 析结合中医症候标准总结出好发症状、多发症状及相关的中医临床证型; 通过主成分分析得出各证型的临床主、次症状及临床诊断要点。 结 果：通过360例病例分析，发现腰腿痛、间歇性跛行为腰椎管狭窄症 的主要特征，其中医症候主要集中表现在三类症候群的主次症中，第1类 的主症为腰部冷痛重着、 遇冷加重、得热痛缓;次症为拘急不舒、遇阴 雨天疼痛发作或加重、 静卧时腰痛不减甚或加重、舌苔白腻、 脉沉紧。 第2类的主症为面色少华、神疲无力、腰痛疼痛缠绵;次症为不耐久坐、 下肢麻木、疼痛固定、舌质瘀紫、脉涩。第3类的主症为腰腿酸痛、腿膝 无力、遇劳更甚、手足不温;次症为卧则减轻、形嬴气短、精神倦怠、 面 色晦暗、失眠多寐口燥咽干 、五心烦热、舌苔少、脉虚细弱。 结 论：腰椎管狭窄症的中医临床常见证型有三种: ⒈风寒痹阻型、⒉ 气虚血瘀型、 ⒊肝肾亏虚型。 关键词：腰椎管狭窄症;中医证型;临床调查 1 Lumbar spinal stenosis of TCM cli