急性脑梗死不同中医证型与NIHSS评分时相性演变的相关性研究

摘要

目的 观察急性脑梗死不同中医证型与美国国立卫生研究院卒中量表(NIHSS)评分时相性演变的相关性,为急性脑梗死诊治提供新思路.方法 将符合纳入标准的192例急性脑梗死患者进行辨证分型;采用NIHSS评分量表分别记录各证型患者入院0～1d、3～4 d、7～8 d、13～14 d神经功能缺损程度;采用K-means聚类分析法对各证型患者进行4个时段NIHSS评分聚类分析.结果 1)急性脑梗死中医证型分布:风痰瘀阻证＞风痰火亢证＞痰热腑实证=阴虚动风证＞气虚血瘀证＞风火上扰证＞痰湿蒙神证.2)总NIHSS评分聚类中心点动态演变规律:0～3 d NIHSS聚类中心点变化不明显,在3～4 d之后下降明显,8d之后下降趋势平稳.3)风痰瘀阻证重度NIHSS评分聚类中心点在4～8 d时线形图斜率最大,评分下降速度最快.结论 急性脑梗死不同中医证型与NIHSS评分时相性演变规律密切相关,其结论对针对不同证型脑梗死患者在不同时相的辨证治疗具有一定的指导意义.%Objective:To explore the correlation between TCM syndromes of acute cerebral infarction and NIHSS score.Methods:192 patients with acute cerebral infarction according to the inclusion criteria were divided into syndrome types.Each patients was scored by NIHSS and neurologic impairment was recorded in different days.K-means cluster analysis was used to analyze the NIHSS scores in four periods of each syndrome type.Results:1)TCM syndrome distribution of acute cerebral infarction:wind phlegm stasis syndrome＞wind phlegm fire hyperactivity syndrome＞phlegm heat syndrome=yin deficiency dynamic wind syndrome＞qi deficiency blood stasis syndrome＞syndrome of phlegm-damp clouding orifices.2)NIHSS score dynamic evolution:in 0～3 days,NIHSS clustering center point change was not obvious,but after 3-4 days,it decreased significantly,and after 8 days,the downward trend was stable.3)Wind phlegm stasis syndrome NIHSS score clustering center point in 4～8 days declined fastest.Conclusion:Different TCM syndromes of acute cerebral infarction are closely related to the temporal evolution of NIHSS score.The conclusion is of some significance for different syndromes of patients with different syndromes of cerebral infarction.