| 摘要: | 目的 傳統中醫的最大特色是整體觀和辨證論治。辨證論治是利用望、聞、問、切四種方法蒐集病人的病情資料，綜合分析歸納出證型，然後施予治療，根據我們的認知台灣至今尚未有腦梗塞急性期中醫證型的報告，又證型與臨床嚴重度的關係至今未明，因此木研究的目的是探討腦梗塞急性期的中醫證型及其嚴重度的關係。方法 我們評估162位台灣某醫學中心由急診入院腦梗塞急性期病患，他們都經頭部電腦斷層或磁振造影檢查以及神經科專科醫師診斷確定為腦梗塞，分別填寫腦中風登錄表、modified rankin scale (MRS)、美國國家衛生研究院中風評量表(National Institutes of Health Stroke Scale; NIHSS)、巴氏量表(Bathel Index; BI)和生活功能獨立執行測量表(function independence measure; FIM)。另外，由兩位資深中醫師經中醫望、聞、問、切等四診診察，取得一致性之後，填寫中風病辨證診斷量表，以上工作都需在腦中風發作後72小時之內完成。結果 總共蒐集162位腦梗塞急性期患者，162位中有一個證型，以風證最多140位(87%)，其次為痰證92位(56.7%)，再其次為血瘀證78位(48.1%)，而火熱證、氣虛證和陰虛陽亢證，分別為33位(20.4%)，32位(19.8%)和23位(14.2%)。同時有二個證型，以風痰證77位(47.5%)最多，其次為風血瘀證67(41.4%)，再其次為痰血瘀證44位(27.2%)，而火熱陰虛陽亢證2位(1.2%)。各證型出現的有和無，兩者之間的MRS，NIHSS及FIM分數都相似(all p>005)。結論 台灣腦梗塞急性期的中醫證型以風證、痰證和血瘀證為主，因此風、痰和血瘀是腦梗塞發病的主要表現。證型與臨床嚴重度沒有關係。
Purpose. Western Medicine treats specific diseases, whereas Chinese Medicine (CM) focuses on the whole body and pattern identification. CM utilizes four diagnostic methods including inspection, listening, smelling, and palpation to collect information about the human body. Based on the data from these four diagnostic methods, a Chinese Medicine pattern (CMP) is established. No reports of CMP of acute stage cerebral infarct in Taiwan have been published. The purpose of the present study is to investigate the CMP and clinical severity in acute stage cerebral infarct. Methods. We evaluated 162 acute stage cerebral infarct patients at a medical center in central Taiwan. All of the patients were assessed within 72 hours after stroke onset. Cerebral infarct was confirmed by computed tomography or by magnet resonance imaging. The data of the patients were assessed by a Stroke Registry Chart, Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and Functional Independence Measure (FIM). In addition, the data of the patients were assessed by two CM doctors who used inspection, listening, smelling, inquiry and palpation to examine patients. Results. A total of 162 acute stage cerebral infarct patients were studied. In patients with one CMP, the Wind pattern (n=140, 87%) was most prevalent, followed by Phlegm pattern (n=92, 56.7%), Blood-stasis pattern (n=78, 48.1%), Fire-hot pattern (n=33, 20.4%), Qi-vacuity pattern (n=32, 19.8%) and Yin-Vacuity and Yang-hyperactivity pattern (n=23, 14.2%). In patients with two CMPs, Wind-Phegm pattern was most prevalent (n=77, 47.5%), followed by Wind-Blood stasis (n=67, 41.4%), and Phegm-Blood stasis (n=44, 27.2%); Fire-hot, Yin-vacuity and Yang-hyperactivity pattern were found in only 2 patients (1.2%). In addition, there was no significant difference in MRS, NIHSS, BI and FIM scores between patients with CMP and those without CMP. Conclusions. The predominant CMPs and clinical manifestations in patients with acute stage cerebral infarct are Wind, Phlegm and blood stasis. CMP was not related to the clinical severity of acute stage cerebral infarct. |
