CAJ | 학술논문

目的探讨急性心肌梗死(AMI)的发病节气与其中医证型之间的关系.方法选择2003年2月4日(立春)至2008年2月3日(立春)在佛山市中医院住院的430例AMI患者病历资料,将发病节气化为角度坐标进行圆形分布统计,分析AMI不同证型的发病节气特点.结果 430例AMI患者中气滞血瘀型134例,痰浊闭塞型188例,阴血虚型29例,阳气虚型79例;其中以实证(气滞血瘀型+痰浊闭塞型)为主,占74.9%.圆形分布统计法分析结果显示,AMI患者总体发病节气高峰为立春时节[集中向量(r)=0.127 4,P＜0.01],标准差(s)=116.300 6°,发病节气高峰期处于冬、春两季.气滞血瘀型发病节气高峰为冬至末至小寒前(r=0.200 5,P＜0.01),高峰期集中于冬季;痰浊闭塞型发病节气高峰为春分时节(r=0.147 0,P＜0.05),高峰期集中于春季,但两节气发病高峰都比较平缓;而阴血虚型、阳气虚型未发现特定的发病节气高峰期(均P＞0.05).结论 AMI发病节气存在集中趋势,提示治疗AMI应以豁痰泄浊、活血化瘀、通脉止痛为基本大法,冬季以活血化瘀、温阳通脉法为主,春季以通阳泄浊、豁痰开结为基本治法.
목적 탐토급성심기경사(AMI)적발병절기여기중의증형지간적관계.방법 선택2003년2월4일(립춘)지2008년2월3일(립춘)재불산시중의원주원적430례AMI환자병력자료,장발병절기화위각도좌표진행원형분포통계,분석AMI불동증형적발병절기특점.결과 430례AMI환자중기체혈어형134례,담탁폐새형188례,음혈허형29례,양기허형79례;기중이실증(기체혈어형+담탁폐새형)위주,점74.9%.원형분포통계법분석결과현시,AMI환자총체발병절기고봉위립춘시절[집중향량(r)=0.127 4,P＜0.01],표준차(s)=116.300 6°,발병절기고봉기처우동、춘량계.기체혈어형발병절기고봉위동지말지소한전(r=0.200 5,P＜0.01),고봉기집중우동계;담탁폐새형발병절기고봉위춘분시절(r=0.147 0,P＜0.05),고봉기집중우춘계,단량절기발병고봉도비교평완;이음혈허형、양기허형미발현특정적발병절기고봉기(균P＞0.05).결론 AMI발병절기존재집중추세,제시치료AMI응이활담설탁、활혈화어、통맥지통위기본대법,동계이활혈화어、온양통맥법위주,춘계이통양설탁、활담개결위기본치법.
Objective To study the relationship between the solar term of onset of acute myocardial infarction (AMI) and its syndrome types in traditional Chinese medicine (TCM).Methods The clinical data about 430 patients with AMI hospitalized in Foshan Hospital of TCM from February 4th 2003 (Beginning of Spring) to February 3rd 2008 (Beginning of Spring) were collected, and the solar term of onset as angle coordinate was regarded, then the peak phase of the onset solar term in each syndrome type of AMI was calculated by circular statistical analysis.Results Among 430 patients with AMI, 134 patients were considered to have qi stagnancy and blood stasis syndrome (气滞血瘀型), 188 patients showed the syndrome of turbid sputum obstruction (痰浊闭塞型), 29 of them showed deficiency of yin-blood (阴血虚型), and 79 showed deficiency of yang qi (阳气虚型 ).The clinical manifestation of AMI was mainly sthenia syndrome (实证, qi stagnancy and blood stasis +turbid sputum obstruction,74.9%).According to the circular statistical analysis,the peak of the solar terms of AMI onset occurred at the Beginning of Spring in all cases (r=0.127 4, P＜0.01), and standard deviation (s)=116.300 6°, showed it mainly occurred in winter and spring.As the peak of the onset of qi stagnancy and blood stasis occurred at Winter Solstice and Lesser Cold (r=0.200 5, P＜0.01), its peak occurred in winter； the turbid sputum obstruction syndrome occurred at Spring Equinox (r=0.147 0, P＜0.05), mainly in spring, yet the symptoms of above two peaks were generally mild.Besides, there was no significant difference in onset of the solar term in regard to onset of deficiency of yin-blood and deficiency of yang qi (both P＞0.05).Conclusion There is a close relationship between periodicity of the solar terms and onset of AMI.The main treatment for AMI is to expel turbid sputum, activate blood to resolve stasis and promote blood circulation to relieve pain； also the method of activating blood to resolve stasis is frequently contemplated in winter, and the method of expelling turbid sputum is the main strategy in spring.