中风证脉图参数变化分析

文章编号:1005-8486(2007)03-0283-04

?论著?

中风证脉图参数变化分析

马　科1,　保　婧2,　江启中3

(11宁夏医学院中医学院中医内科学教研室,银川　750004;　21银川市第一人民医院综合科,银川　750001;

31上海中医药大学附属龙华医院,上海　200032)

摘要:目的　通过观测中风患者脉图参数变化,探讨该病证型脉象变化机理及其客观化。方法　选择75例经

CT 明确诊断的中风住院患者,并以健康老年人20例做对照,采用Z M -III 型智能脉象仪进行脉图检测并对检

测结果进行统计学处理和临床分析。结果　风痰瘀血痹阻脉络和痰热腑实风痰上扰两型脉图参数与对照组之间无统计学意义;而肝阳暴亢风阳上扰、气虚血瘀、阴虚风动和中脏腑四型脉图参数与对照组以及这四型之间均有特征性的变化;其中肝阳暴亢风阳上扰型以h 1、h 3、h 4和A 参数值均非常显著高于其它三型相应参数值;气虚血瘀型和阴虚风动型h 3、h 4和A 则界于肝阳暴亢,风阳上扰型和中脏腑型之间,而h 4/h 1值均显著高于其它两型;气虚血瘀型h 5/h 1值显著小于阴虚风动型的h 5/h 1值;中脏腑型中h 1、h 3、h 4、h 3/h 1、h 4/h 1、A 及PR 均与对照组中相应的参数有明显的差异,而h 3/h 1值显著小于其它三型的h 3/h 1值。结论　中风证脉图参数变化提示老年人群中风发病多见于在肝阳暴亢风阳上扰、气虚血瘀、阴虚风动和中脏腑型上,表明中风的病因病机以“虚”为主。

关键词:中风证;脉图参数;脉诊

中图分类号:R241.1 文献标识码:A

收稿日期:2006-10-11

作者简介:马科(1973-),男(回族),宁夏人,主治医师,博士,主要从事中医药防治恶性肿瘤的临床诊治、教学和科研工作。

脉诊是中医诊法学中重要的诊断方法之一,但传统的切脉全凭医者的经验和主观感觉,缺乏判脉的客观标准。脉象仪的出现使脉诊的客观化研究成了可能,脉象仪主要是观测心血管疾病(病类、证侯)脉图参数的变化,以探求其证型变化的基础

[1-2]

。有关中风脉图参数变化机制的研

究,国内外文献尚未见报告,本研究在这方面进行了一些探索性的研究,现报告如下。

1　资料与方法111　一般资料

75例病人均为上海中医药大学附属龙华医院2000年9月～2001年1月神经内科住院病人。其中男41例,女34

例,年龄最小45岁,最大91岁,平均(70185±9179)岁。所有病例均经CT 明确诊断:其中缺血脑梗死35例,腔隙性梗死28例,出血性梗死3例,脑出血9例。选择20例健康人作为对照组,男12例,女8例,年龄最小68岁,最大77岁,平均(7111±3106)岁,均为上海市老干部大学学员,经近期体格检查无任何器质性病变。

112　主要仪器

Z M -III 型智能脉象仪由上海中医药大学研制。113　辨证、诊断标准及实验分组11311　辨证、诊断标准:

采用《中风中医诊断、疗效评定标准》[3]

进行辨证分型;按全国脑血管病防治研究规划纲要(1990～2000)修定的

《各类脑血管病诊断要点》[4]

进行诊断。

11312　病例分组:(1)风痰瘀血　痹阻脉络型(风痰瘀血组12例):半身

不遂,口舌歪斜,舌强语蹇,偏身麻木,头晕目眩,舌质暗淡,苔薄白或白腻。

(2)痰热腑实　风痰上扰型(痰热腑实组12例):半身

不遂,口舌歪斜,语言蹇涩,便干便秘,头晕目眩,咯痰或痰多,舌质暗红或暗淡,苔黄或黄腻。

(3)肝阳暴亢　风阳上扰型(肝阳暴亢组12例):半身

不遂,口舌歪斜,语言蹇涩,眩晕头痛,面红目赤,口苦咽干,心烦易怒,尿赤便干,舌质红或红绛,苔薄黄。

(4)气虚血瘀型(气虚血瘀组13例):半身不遂,口舌歪

斜,语言蹇涩,面色恍白,气短乏力,自汗出,心悸便溏,舌质暗淡,苔薄白或白腻。

(5)阴虚风动型(阴虚风动组13例):半身不遂,口舌歪

斜,语言蹇涩,眩晕耳鸣,手足心热,舌质红绛或暗红。苔少或无苔。

(6)中脏腑型(中脏腑组13例):神昏或昏愦,鼻鼾痰鸣

或痰涎壅盛,肢体强痉拘急或肢体松懈或手撒肢冷,二便失禁,舌质红绛或暗淡,苔黄腻或干腻或白腻或舌痿软无力。

(7)健康对照组:20例健康对照组老年人经近期体格

检测无任何器质性病变。

114　检测方法及指标

患者呈仰卧位,将脉象仪传感器放置于左手桡骨茎突

内侧桡动脉搏动点处,即寸口脉的关部,嘱患者保持呼吸平稳均匀,安静勿动,然后调节取脉压力,从0～250g ,采集

5～10个压力段下的系列脉图及40s 最佳脉图,并测量同侧

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382?第29卷　3期　2007年6月宁夏医学院学报

Journal of Ningxia Medical College

手臂肱动脉的血压。

对照组对象脉图检测时采用坐位,余法同上。

主要观察的脉图参数有h1(脉力)主波幅度;h3、h3/h1 (张力系数)即重搏前波幅度及其与主波幅度的比值;h4、h4/h1(阻力系数)即降中峡幅度及其与主波幅度的比值;h5、h5/h1即重搏波幅度及其与主波幅度的比值;w/t(主波上1/ 3高度处的宽度值与脉动周期的比值);最佳取脉压P(g)、脉图面积(A)、脉率(PR)等[5]。

115　统计学方法

采用SPSS1010统计软件,计量资料用 x±s表示,组间比较用单因素方差分析。

2　结果

211　中风证各型脉图参数h1、h3、h4、h3/h1、h4/h1变化情况(表1)

表1　中风证各型脉图参数指标变化比较

证型分组n h1(mm)h3(mm)h4(mm)h3/h1h4/h1

风痰瘀血组1223.53±7.9815.31±7.179.09±3.720.64±0.130.38±7.12E-02　痰热腑实组1226.6±7.7616.77±7.468.88±3.350.62±0.130.34±9.97E-02肝阳暴亢组1232.25±5.67△△18.33±5.349.55±3.400.56±9.42E-02△0.29±7.46E-02△△气虚血瘀组1317.48±6.09△△▲▲10.84±3.53△△▲▲ 6.62±2.64△△▲0.66±0.220.41±0.15▲

阴虚风动组1317.22±7.37△△▲▲11.12±5.43△▲▲ 6.92±3.16△▲0.65±0.180.42±0.16▲▲

中脏腑组1318.01±6.20△▲▲8.03±3.58△△▲▲ 4.72±1.99△△▲▲0.44±0.12△△▲☆☆※※0.26±8.73E-02△△☆☆※※对照组2024.32±7.7416.02±5.319.69±3.330.67±0.150.41±8.59E-02

　与对照组比△P<0105,△△P<0101;与肝阳暴亢组比▲P<0105,▲▲P<0101;与气虚血瘀组比☆P<0105,☆☆P<0101;与阴虚风动组比※P<0105,※※P<0105

(1)与对照组比,肝阳暴亢组中h1显著高于对照组,而h3/h1、h4/h1则显著小于对照组相应的参数值;气虚血瘀组和阴虚风动组中h1、h3、h4均显著小于对照组相应的参数值;中脏腑组中h1、h3、h4、h3/h1、h4/h1各参数均显著小于对照组相应的参数值,上述差异均有统计学意义。

(2)与肝阳暴亢组比,气虚血瘀组中h1、h3、h4各参数值均显著低于肝阳暴亢组中相应的参数值,h4/h1显著高于肝阳暴亢组;阴虚风动组中h1、h3、h4各参数均显著低于肝阳暴亢组相应的参数值,h4/h1高于肝阳暴亢组;中脏腑组中h1、h3、h4、A和h3/h1各参数均显著低于肝阳暴亢组相应的参数值,上述差异均有统计学意义。

(3)与气虚血瘀组比,中脏腑组中h3/h1和h4/h1二项参数均显著低于气虚血瘀组。

(4)与阴虚风动组比,中脏腑组中h3/h1、h4/h1各参数值均显著低于阴虚风动组。

212　中风证各型脉图参数h5/h1、w/t、PR、A和最佳取脉压变化情况(表2)

表2　中风证各型脉图参数指标变化比较

证型分组n h5/h1w/t A(mm2)PR(b/min)最佳压力(g)风痰瘀血组12-4.67E-02±8.25E-020.23±2.51E-027.62±2.9868.43±8.76122.57±34.89痰热腑实组12-1.75±7.88E-020.23±2.68E-027.58±2.5878.82±15.93144.75±36.67肝阳暴亢组12-5.83E-03±5.45E-020.20±2.84E-028.64±2.3074.7±12.17143.1±45.33气虚血瘀组13-0.10±0.10▲0.24±5.25E-02 5.73±1.89△▲▲69.64±8.32146.52±40.80阴虚风动组13-2.54E-02±0.14☆0.26±0.12▲ 5.72±2.39△▲▲70.63±7.65143.94±47.28中脏腑组13 3.08E-03±9.69E-02☆☆0.21±4.19E-02※ 4.28±1.37▲▲82.35±17.84△☆☆※133.57±48.04对照组20-4.90E-02±8.56E-020.24±3.29E-027.69±2.5973.44±9.59129.44±21.47

　与正常组比△P<0105,△△P<0101;与肝阳暴亢组比▲P<0105,▲▲P<0101;与气虚血瘀组比☆P<0105,☆☆P<0101;与阴虚风动组比※P<0105,※※P<0105

(1)与对照组比,气虚血瘀组和阴虚风动组中A值均显著小于对照组;中脏腑组中PR则显著高于对照组。

(2)与肝阳暴亢组比,气虚血瘀组中A参数值显著低于肝阳暴亢组,h5/h1则显著高于肝阳暴亢组;阴虚风动组中A参数显著低于肝阳暴亢组,w/t显著高于肝阳暴亢组;中脏腑组中A参数显著低于肝阳暴亢组。

(3)与气虚血瘀组比,阴虚风动组仅h5/h1值显著高于气虚血瘀组;中脏腑组h5/h1和PR二项参数则显著高于气虚血瘀组。

(4)与阴虚风动组比,中脏腑组中w/t参数值显著低于阴虚风动组,而PR显著高于阴虚风动组。

3　讨论

对中风六个证型中肝阳暴亢风阳上扰、气虚血瘀、阴虚风动和中脏腑四型的观察发现,肝阳暴亢风阳上扰型的h1、h3、h4以及A各脉图参数值均显著高于其它三型,h3/h1、h4/h1则小于气虚血瘀和阴虚风动两型而大于中脏腑型,从各参数值的生理病理意义可以看出,肝阳暴亢风阳上扰型中风其脉力h1显著增大,而动脉血管张力、外周阻力却相应降低。上述血管动力学病理改变表明,肝阳暴亢风阳上扰型中风者血液循环呈高动力、低张力和低阻力的病理状态,一定程度上反映了该型本虚标实的病理特征,并且由于心室长期代偿而可能导致一系列的改变,如心室的肥厚或不同程度的扩张[6],表明长期的高血压和许多心脏病是中风发病的最重要因素;(2)在气虚血瘀和阴虚风动型中二者的h1、h3、h4和A均低于肝阳暴亢风阳上扰型相应的参数值,仅有h4/h1参数值显著高于其它二型的h4/h1值,因此气虚血瘀和阴虚风动的病理改变小于肝阳暴亢风阳上扰型

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?宁夏医学院学报29卷

和中脏腑型的中风,故在肝阳暴亢风阳上扰型和后二型的诊断上脉图h 1、h 3、h 4、A 及h 4/h 1值的改变可作为其特征性的参数;(3)在气虚血瘀和阴虚风动两型之间脉图改变不是很明显,仅有气虚血瘀型h 5/h 1值较阴虚风动型h 5/h 1更低且二者的h 5/h 1值均为负数,表明气虚血瘀型和阴虚风动型的中风患者由于长期的血管改变极有可能导致大动脉器质性的改变和心脏瓣膜的病变,提示在病理改变方面气虚血瘀型中风和阴虚风动型中风比较接近;(4)在中脏腑型中风中h 1、h 3、h 4、h 3/h 1、h 4/h 1等参数均显著或非常显著低于对照组,与其它三型相比具有特征性的参数表现在h 3/h 1值显著低于其它三型的h 3/h 1的值,h 4/h 1显著低于气虚血瘀和阴虚风动型,且有低于肝阳暴亢型的趋势,同时呈现脉力h 1界于肝阳暴亢,风阳上扰型与气虚血瘀型、阴虚风动型之间、脉图面积A 小于其它三型、脉率快于其它三型的趋势,从而表明中脏腑型中风发病多比较急猝,病理改变明显,具有脉力中等,动脉张力、阻力偏低的趋势。说明中脏腑型中风主要是由长期的心血管血液动力学的病理改变,机体因此已失去了代偿功能而呈现低动力、低张力和低阻力亦即可能低循环的血管动力状态,在此病理改变基础上则突受内外因素诱而发病。

由以上结论可以看出,老年人群中风发病多见于在肝阳暴亢风阳上扰、气虚血瘀、阴虚风动和中脏腑型上,在脉势表现上后三型均呈现“低平虚”的病理改变,而肝阳暴亢组中h 3/h 1、h 4/h 1值显著低于对照组,表明肝阳暴亢型中风呈明显的本虚标实的病理改变。由此不难看出中风的病因

病机侧重点在“虚”上。肝阳暴亢,风阳上扰型是在原有的肝肾阴虚、水不涵木基础上而风自内动;气虚血瘀型和阴虚风动型则是长期的气血两虚致阴血亏虚,气虚无力而致瘀血,所谓因虚致瘀,正如《医林改错》所云:“元气既虚,必不能达于血管,血管无气,必停留而瘀”;中脏腑型脉图参数变化也表明病变是由于长期的肝肾亏虚、气血不足,正不胜邪诱而发病,所谓邪之所凑、其气必虚,这说明中风发病的基础依然是因为长期的“虚”而致。参考文献:

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(责任编辑:路锦绣)

St u dy on t he Cha nges of Puls e ogra m Pa ra met e r a n d t he

Rele va nce t o TCM i n Ap op le xy

MA K e ,BAO J ing ,J IANG Qi -zhong

(The School of Tradition Medicine College ,Ningxia Med.Coll.,Y inchuan 750004)

A bst ract :Objective To study the objectivity of the pulse variations in the diagnosis of this syndrome ,the significance of the changes of pulseogram parameter to the clinical treatment of this disease ,the relevance of apoplexy to the cerebral CT and the physiological changes of age in the light of pulseogram.M et hods 75pa 2tients with apoplexy confirmed by CT were compared with 20health old people.The pulseogram of all subjects was examined by ZM 2III Intellectual Pulse Instrument ,and the results was analyzed by statistics and clinical methods.Res ults There was no statistical significance in the pulseogram parameters (in the types of blockage of the collaterals due to wind 2phlegm and blood stasis as well as retention of phlegm 2heat in the Fu 2organs and upward disturbance of wind 2phlegm )between cases and controls ;while there was specific changes in the parame 2ters of the types of acute exuberance of liver yang ,upward disturbance of wind 2yang ,blood stasis due to qi as 2thenia ,endogenous wind due to yin asthenia and attack of viscera as well as the control group ;the h 1,h 3,h 4and A parameter in the types of acute exuberance of liver yang and upward disturbance of wind 2yang were signifi 2cantly higher than that in the other three types ;the level of h 3,h 4and A parameter in the types of blood stasis due to qi asthenia and endogenous wind due to yin asthenia were between that of the types of acute exuberance of liver yang and upward disturbance of wind 2yang as well as attack of viscera ,but the value of h 4\h 1were lower than that of the other two types ;the value of h 5/h 1were significantly lower than that in the type of endogenous

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582?3期马科,等.中风证脉图参数变化分析

wind due to yin asthenia ;changes of h 1,h 3,h 4,h 3/h 1,h 4/h 1,A and PR in the type of visceral attack and that in the control group were significantly ,but h 3/h 1were lower than that in the other three types.Concl usion

　The changes of the pulseogram parameters in apoplexy indicated that such changes have further confirmed that

pathogenesis of apoplexy is asthenia ;so supplementing therapy should be used to treat this syndrome.Ke y wor ds :apoplexy ;pulseogram parameter ;pulse diagnosis

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A n A nalysis on The Economic Ris k of Dis e as es i n New R ural Coop e rat e M e dical Syst e m Exp e ri me nt al Cou nt ry i n Ni ngxia

W ANG Gang ,GUO Zhong 2qin ,XUE Sai 2feng ,RUAN Y ue 2sheng (The School of Public Health ,Ningxia Medical College ,Y inchuan 750004)

A bst ract :Objective To explore the economic loan of diseases in farmers of experimental county.M et hods

　The cluster sampling and the random sampling conjuctive were used.Three towns were selected in each county which economic conditions was high ,Middle and low.Then three villages were selected in each town which eco 2nomic conditions was high ,Middle and low.20to 40households were selected in every village at last.Res ults Two 2week prevalence and the prevalence of chronic diseases in lower income family were higer than that the better income family.2.42%households were the extremly risk households.The economic risk of in city 2level hospitals is 3.28times as the town 2level hospitals.Concl usion The new cooperative medical system is a tenta 2

tive way to bring down the economic loan of diseases in farmers.

Ke y wor ds :Ningxia ;new rural cooperate medical system ;economic risk

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Relations hip B etwe e n Se r u m A ntioxi da nts a n d t he Exp ression of

Bcl 22、B a x Ap op t osis Prot ei n of Place nt al Tiss ues wit h

Pre gna ncy 2i n d uce d Hyp e rt e nsion Syn drome

J IAN Y i 2deng 1

,ZHANG Hui 2ping 2

,ZHANG Ming 2hao 1

,et al

(1.School of Basic Medicine ,Ningxia Medical College ,Y inchuan 750004;

2.City Health Care Hospital for Women and Children ,Y inchuan 750001)

A bst ract :Objective To explore the relationship between superoxide dismutase (SOD ),glutathione peroxi 2dase (GSH 2px )and malondialdehyde (MDA )in peripheral venous blood of patients and the expression of Bcl 22、Bax apoptosis protein of placental tissues with pregnancy 2induced hypertension syndrome (PIH ).M et hods The activity of SOD ,GSH 2px and content of MDA in the serum of peripheral blood of nonpregnant women ,normal pregnant women and PIH women were measured and the expression of Bcl 22,Bax were assessed by immunol 2is 2tochemical detection.Res ults The ratio of GSH 2px/MDA 、SOD/MDA 、Bcl 22/Bax in normal pregnant women was significantly lower than those in nonpregnant women (P <0.05),apoptosis index (AI )and the expression of Bax in normal pregnant women were significantly higher than those in nonpregnant women (P <0.05);there were significantly positive correlation in the ratio between GSH 2px/MDA 、SOD/MDAand Bcl 22/Bax 、apoptosis index (P <0.05).Concl usion The mechanism of PIH is associated with the disequilibrium of oxidation ,anti oxidation and apoptosis overexpression of placental tissues induced by it.

Ke y wor ds :pregnancy 2induced hypertension ;disequilibrium of oxidation and antioxidation ;Bax ;P 53

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682?宁夏医学院学报29卷