梗塞型腦中風急性期患者中醫證型與其預後關係之探討

謝慶良
中國醫藥大學針灸研究所
我們先前研究162位梗塞型腦中風急性期患者的中醫證型，結果發現風證140位（87％）、痰證92位（56.7％）、血瘀證78（48.1％)、火熱證33位（20.4％）、氣虛證32位（19.8％）和陰虛陽亢證23位（14.2％），因此台灣地區梗塞型腦中風急性期的中醫證型以風、痰和血瘀證為主，風、痰和瘀是台灣梗塞型腦中風的主要病因。又我們研究148位出血型腦中風急性期患者中醫證型，結果顯示風證141位（95.3％）、痰證60位（40.5％）、火熱證43位（29.1％）、血瘀證39位(26.4％)、氣虛證7位（4.7％）和陰虛陽亢證3位（2.0％），因此台灣地區出血型腦中風急性期的中醫證型以風、痰和火熱證為主，風、痰和火熱是台灣出血型腦中風的主要病因。腦中風急性期中醫證型與其預後關係之探討，根據我們所知至今尚未有研究報告，因此本研究的目的是探討梗塞型腦中風急性期中醫證型與其預後之關係。我們預計二年蒐集160位梗塞型腦中風急性期患者，每年80位。他們都是第一次腦中風患者，於發病後72小時內分別完成填寫Glasgow Coma Scale （GCS）、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（Barthel Index，BI）和生活功能獨立執行測量表（Functional Independence Measure，FIM）。另外，由兩位資深中醫師取得一致後填寫中風病辨證量表，並確定其中醫證型。12週（12週±3天）後再分別填寫GCS、MRS、NIHSS、BI和FIM表。最後統計分析梗塞型腦中風急性期患者中醫證型與其預後之關係。
我們預期本研究結果可以提供梗塞型腦中風中醫證型與其預後關係之客觀科學性研究，如此對中醫的發展將做出貢獻。
關鍵字：梗塞型腦中風，急性期、中醫證型、預後

The study on the relationship between Chinese Medicine pattern and its prognosis in patient with acute stage of cerebral infarct

Ching-Liang Hsieh
Graduate Institute of Acupuncture Science, China Medical University
Our previous results indicated that Wind pattern is 140 (87%), Phlegm pattern 92 (56.7%), Blood-stasis pattern 78 (48.1%), Fire-hot pattern 33 (20.4%), Qi-vacuity 32 (19.8%) and Yin-Vacuity pattern 23 (14.2%) in the Chinese Medicine pattern (CMP) of 162 patients with acute stage of cerebral infarct. The main CMP is Wind pattern, Phlegm pattern and Blood-stasis pattern, suggesting the etiology of cerebral infarct mainly results from Wind, Phegm and blood stasis. In addition, Wind pattern is 141 (95.3%), Phlegm pattern 60 (40.5%), Fire-hot pattern 43 (29.1%), Blood-stasis pattern 39 (26.4%), Qi-vacuity pattern 7 (4.7%), Yin-Vacuity 3 (2.0%) and Yang-hyperactivity pattern 3 (2.0%) in the CMP of 148 patients with acute stage of cerebral hemorrhage. The main CMP is Wind pattern, Phlegm pattern and Fire-hot pattern, suggesting the etiology of cerebral hemorrhage mainly results from Wind, Phegm and Fire-hot. The study is about the relationship between CMP and its prognosis, according to our knowledge until now not yet. Therefore, the purpose of the present study was to investigate the relationship between CMP and its prognosis, we collect 160 patients with acute stage of cerebral infarct among two years, one year is 80 patients. All of them, the stroke is first attack, and the G Glasgow Coma Scale (GCS), Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and Functional Independence Measure (FIM) were finished within 72 h after onset of stroke. In addition, the CMP was confirmed by two experience Chinese Medicine doctors and finished the CMP chart of stoke. The scales of GCS, MRS, NIHSS, BI and FIM were wrote again after 12 weeks (12 week±3 days). Finally, we analysis statistically the relationship of CMP and its prognosis in patients within acute stage of cerebral infarct.
We expect the results of the present study may provide objective scientific evidence about the relationship between the CMP and its prognosis, thus, the results will be a contribution to the development of Chinese Medicine.
關鍵字：Cerebral infarct; Acute stage; Chinese Medicine Pattern; Prognosis