缺血性中风病急性期的病机演变初探

Preliminary study on pathogenesis changes of acute ischemic stroke

关键词:  缺血性中风  病机  证候

Key words:  ischemic stroke  pathogenesis  syndrome

摘要:

[目的]揭示缺血性中风病急性期影响疾病演变的主证,探寻缺血性中风病急性期的病机。[方法]采用前瞻性临床调查的方法,对发病72h内入院患者进行自入院当天至发病14d的连续动态采集临床信息,研究缺血性中风病急性期的病机。[结果]缺血性中风病起病24h内,患者的神经功能缺损主要与痰证相关;痰证与风证、火热证相关;至发病48h时,患者的神经功能缺损主要与痰证和气虚证相关;痰证与火热证、气虚证相关,气虚证与风证、痰证、血瘀证均相关;而至发病72h后,患者的神经功能缺损与痰证、气虚证和火证均相关。[结论]缺血性中风病急性期的病机是风、火挟痰上犯清窍,壅滞脉络,气虚血瘀,气不化津则痰凝,痰瘀互结,致气虚益甚,使疾病不断恶化;或痰郁化热,痰热互结,上蔽神明,阻塞脑府脉络,而加重神机受损。

Abstract:

[Objective] To reveal the principal syndrome which impact on the evolution of acute ischemic stroke and to explore pathogenesis changes of acute ischemic stroke. [Methods] By clinical investigation of the use of forward-looking approach,the information from Patient entered to the hospital less than 72h,was collected continuously for 14 days. The pathogenesis changes of acute ischemic stroke was studied. [Results] In patients who’s onset of ischemic stroke was within 24h,the neurologic impairment was mainly related to phlegm syndrome;phlegm syndrome to wind syndrome and syndrome of fire-heat. Until the time 48 hours after the onset of ischemic stroke,the neurologic impairment in patient was related to phlegm syndrome and syndrome of deficiency of Qi;phlegm syndrome to syndrome of fireheat and syndrome of deficiency of Qi,syndrome of deficiency of Qi to phlegm syndrome,wind syndrome and syndrome of blood stasis;In the period 72 hours after onset of ischemic stroke the neurologic impairment in patient was related to phlegm syndrome,syndrome of deficiency of Qi and syndrome of fire-heat. [Conclusion] The pathogenesis of acute ischemic stroke is that wind or fire combining with phlegm infringed the clear orifice,congested the vessels and networks leading to qi vacuity and blood stasis. Qi can not transform liquid leading to phlegm turbidity congestion. On the one hand,phlegm and stasis binding together can injury the original qi leading to more serious qi vacuity and the deteriorating condition. At the same time phlegm depression is transformed into heat. Phlegm and heat binding together can spirit light. Vessels and networks of brain are obstructed leading to aggravation of spirit injury.