中風神昏病人閉脫陰陽辨證與疾病嚴重度的臨床觀察

THE CLINICAL OBSERVATIONS OF BLOCK-DESERTION, YIN-YANG PATTERN IDENTIFICATIONS AND SEVERITY IN STROKE PATIENTS WITH CONSCIOUS DISTURBANCE

目的：經由中風神昏病人的臨床觀察，歸納提出閉證和脫證在現代可用的診斷指標，並將該診斷指標和西醫一些疾病嚴重度評分系統作比較。方法：橫斷面觀察型研究。亞東紀念醫院內科加護病房及神經內科病房診為中風併有意識障礙且告以病危通知的病患，發病一週以內者，共 人。同時記錄中醫辨證（閉脫辨證和腦部陰陽辨證）及西醫疾病嚴重度（LOD、APACHE II、APACHE III），統計分析中醫辨證及西醫疾病嚴重度的相關性。結果：閉脫辨證的疾病嚴重度分數由小到大依序為閉證、閉脫混合、脫證， 與LOD評分的相關係數最高，其中以神經系統最有相關。閉證和脫證以腦部陰陽辨證分偏陽證、陰陽混合、偏陰證，和疾病嚴重度沒有統計相關。結論：中風神昏病人使用閉脫辨證，疾病嚴重度由輕到重依序為閉證、閉脫混合、脫證，和神經系統最有相關。閉脫辨證之後，還可以使用腦部陰陽辨證將閉證區分為偏陽閉、偏陰閉，將脫證區分為偏陽證、偏陰證。由於樣本數不夠多、代表性不足，陰陽辨證的疾病嚴重度尚未有定論。Objective: to propose a modern diagnostic criteria of block and desertion patterns for stroke patients with conscious disturbance and compare them with the severity scoring systems. Design: A cross-sectional observation study. Setting: The medical intensive care unit and neurological ward of Far Eastern memorial hospital. Patients: Fifty-five critical stroke patients with conscious disturbance and having onset within week. Measurements: The pattern identifications (block-desertion and yinyang) and severity scoring systems (LOD, APACHE II, and APACHE III). Results and Conclusions: The severity scores of the block-desertion patterns from small to large are block, block-desertion mixed, and desertion pattern. The block-desertion patterns are more relevant with the neurological system. The yin-yang pattern identifications of block or desertion pattern are not correlated with the severity scores due to the small sample size.