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台灣出血型腦中風急性期中醫證型之研究

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(1)42. 1,2. 1,3. 1,4. 5. 1. 6. 7,8. 5 2. 7. 3. 4. 8. 6. 148 Modified Rankin Scale (MRS). (national institute of. neurological disorders and stroke. NIHSS). 7 148 (29.05%). 141 39. (26.35%). 59 (25.68%). 7. 19. 40. (40.54%). 1. 38 (0.68%). NIHSS 79.49%. 75.18%. 85.71%. 100%. (5.4%). 3. (66.7%). 2006;11:42-9. (. ). [1] [4] [2,3] [5-7] 404. [8,9]. 2. 2005. 7. 14. 2005. 9. 21. 43. (2.03%). (27.03%). (12.84%). 71.67%. 8. 60. 3. (39.86%). MRS 86.05%. (95.27%) (4.73%). 2005. 8. 22. 2.

(2) 43. (N = 148). [10,11]. ( 21 31 41 51 61 71 81. [12]. [13] 162 [14]. n (%). ). 30 40 50 60 70 80 90. 0 5 6 10 21 18 5. 1 2 16 25 16 17 6. 1 (0.68) 7 (4.73) 22 (14.86) 35 (23.65) 37 (25.00) 35 (23.65) 11 (7.43). [15] MRI 5) [16] 1). [17,18]. 7. 2). 3). [19] [20]. FIM MRS. NIHSS. BI. 7 7 (functional independence measure. FIM) [21]. (1994. ) [15]. Modified Rankin Scale (MRS) [22] (national institute of neurological disorders and stroke (Barthel index. 30. NIHSS) [23-25]. 7-14. BI) [26]. 7 15-22. 23. (. 3. 7. 3. ). ). ( (. 2. 5. 0. 8. 7. 3. ( 2. (. 1. 2. ( (CT). (MRI). 5 4. ). 2. ). (. 4. 0. 3 (. ) 1). ( ). 3). ) 7. 2). (3. ( 4). CT. 1. ) ). ). ( (. ). (. 5. (. 2. 2. 2. 2 0. 8 6. ). (. 0. ) 1. 2. 6. ). 3. ). ). ) 1. ) (. (. 0 1. 4. ( (. ( (. ). ) (. ). ). 2. 6. 8. 3. ). ) (. (. 4. 0 9.

(3) 44. (N = 148) (%). (%). =. =. 7 (4.73) 105 (70.95) 88 (59.46) 109 (73.65) 141 (95.27) 145 (97.97) ( 7-14. 141 (95.27) 43 (29.05) 60 (40.54) 39 (26.35) 7 (4.73) 3 (2.03) ) ( 15-22. (%). (%) 2 (1.35) 3 (2.03) 12 (8.11) 4 (2.7) 0 (0) 0 (0). 139 (93.92) 40 (27.03) 47 (31.76) 35 (23.65) 7 (4.73) 3 (2.03) ). (. 23. (%) 0 (0) 0 (0) 1 (0.68) 0 (0) 0 (0) 0 (0). ). (N = 148) n (%) 40 (27.03) 59 (39.86) 38 (25.68) 7 (4.73) 3 (2.03) 19 (12.84) 13 (8.78) 2 (1.35) 2 (1.35) 20 (13.51) 6 (4.05) 1 (0.68) 3 (2.03) 3 (2.03) 1 (0.68) 19 (12.84) 13 (8.78) 2 (1.35) 2 (1.35) 7 (4.73) 2 (1.35) 1 (0.68) 3 (2.03) 1 (0.68) 1 (0.68) 19 (12.84) 6 (4.05) 1 (0.68) 3 (2.03) 3 (2.03). n (%) 1 (0.68) 1 (0.68) 2 (1.35) 1 (0.68) 1 (0.68) 7 (4.7) 2 (1.35) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 3 (2.03) 1 (0.68) 1 (0.68) 1 (0.68) 2 (1.35) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 1 (0.68) 0 (0).

(4) 45. (N = 148) BI 0-100. NIHSS 0-42. MRS 0-6. FIM 0-126. 22.71. 14.68. 11.43. 26.10. 4.71. 0.76. 37.14. 37.00. 21.68. 12.71. 18.12. 27.51. 4.48. 0.76. 43.62. 34.90. 22.78. 12.54. 15.71. 25.57. 4.56. 0.69. 40.29. 32.83. 19.16. 13.04. 22.91. 31.15. 4.30. 0.89*. 50.70. 38.90. 23.48. 12.65. 13.58. 24.50. 4.63. 0.65. 38.63. 32.21. 19.17. 12.57. 24.00. 30.32. 4.28. 0.87*. 50.18. 37.71. 23.44. 12.92. 15.60. 27.20. 4.58. 0.75. 39.56. 33.87. 16.95. 11.07. 23.97. 27.34. 4.23. 0.74. 53.38. 36.00. 22.36. 12.68. 16.70. 27.27. 4.52. 0.76. 41.86. 34.71. 9.00. 5.72*. 40.00. 20.82. 3.86. 0.38. 72.52. 25.62. 21.90. 12.81. 17.76. 27.59. 4.49. 0.76. 43.24. 35.11. 20.00 18.03 4.33 0.58 46.67 26.76 5.51 = = NIHSS = national institute of neurological disorders and 42 ) BI = Barthel index (0 100 ) MRS = Modified Rankin Scale (1 6 ) FIM = stroke (1 126 ) *p < 0.05 vs functional independence measure (1 13.33. 2. & & &. ). &. ( (. (N = 148) n (%) 112 (75.68) 13 (8.78) 1 (0.68) 12 (8.11) 13 (8.78) 12 (8.11) 2 (1.35). 5. 2. 7 5. ). (. ). ( (. (. 1 4. 4. ). ). 5. (. ( (. ( (2. ). ) 1. 3 7. ) (. 3. ). 2. 66.8 (. 1. 3. ). 3. 9. ). 3. ). (2. 83. 13.1. ) (. (1. (. 26-90 51-80. ). 80 141. ) (. ). 68. 3. ( ). 61-70. 1. 1. ( 1. 2. 65. ). (. 0. ). ). ). ). (. t. 6. 5 4. 4. ( 0. 1 3. 2. 2. 5. ) ). 0. (95.27%). 60. (40.54%). 43.

(5) 46. (N = 148) 106 (75.18). 13 (9.22). 1 (0.71). 12 (8.51). 37 (86.05). 3 (6.98). 1 (2.33). 4 (9.30). 43 (71.67). 6 (10.00). 1 (1.67). 8 (13.33). (%). 31 (79.49). 4 (10.26). 1 (2.56). 7 (17.95). (%). 6 (85.71). 0 (0.00). 0 (0.00). 1 (14.29). 3 (100.00). 0 (0.00). 0 (0.00). 1 (33.33). (%) (%) (%). (%). (N = 148) ( ). (%) 2 (66.7). (3). 3 (2.1). (141). 112. (75.68%). 1. (0.68%). 1 (2.3). (43). 0. (0) (0). 0. (0). 0. ). 13. (8.78%). 12. 75.18%. 71.67%. (8.11%) (. 86.05%. 79.49%. 85.71%. 100%. (0). 0. (59). 1 (1.7). (. ). 1 (5.3). (19). 8. (5.4%) 3. (29.05%). 39. (26.35%). (4.73%). 3. 2. 7. (2.03%). (. ). 40. (27.03%). 19. (66.7%) 1. (5.3%) (. ). 59 (39.86%) 38. (25.68%). 148. 19. 51-80. (12.84%) 1. (0.68%). (. 65. ) [2]. 19 13 (4.7%) (. 148 141. (12.84%). (8.78%) (. (40.54%). ). (26.35%) 7. 61-70. ). (95.27%). 43 7. (4.73%). ). 148. [27] (1996. (2.03%). 148 MRS NIHSS. ) [6]. ) 3. (. ). [17,18]. 148. 39 3. (2.03%) (. (. 60. (29.05%).

(6) 47. 68 CCMP93-RD-012 148 59 (39.86%). 40 38. (27.03%). (25.68%). 19. 1.. 93. (12.84%). http://www.doh.gov.tw/statistic/data/. 1. /93.htn. (0.68%) 19 13. (12.84%). /93. 2. Rowland LP. Merritt's Neurology. Lippincott Williams & Wilkins Piladelphia, 2000:217-71.. (8.78%). 3. Samuels MA. Manual of neurologic therapeutics.. 7. Boston New York Toronto London: Little, Brown and. (4.7%). Company, 1995:207-23. 4.. [18]. 1994:131-51 5. CT. 1994;15:38-. 40. (. ). 6.. [28] 148. 1996;19:53-4. MRS. 7.. CT 1998;20:21-3. NIHSS 8. CT. 1995;20:554-6 9.. 148 112 1. (75.68%) (0.68%). 13 12. (8.78%). CT. 10.. (8.11%) [2]. 315 2001;21:30-1. 1994:37784. 11.. 100%. 1993:817. 3. 12.. 148 8. 1993:6986. 13.. (5.4%). 1999;18:26-8. 3 2. (66.7%) 1. 19. 14. 92. (5.3%) 15. 1995;4:85-8 16. (. ). 1994;17:64-6. 17. 1994;17:41-3 18. 1995;4:75-8.

(7) 48. 19. 1996; 10:118-9 20. 1996;13:274-5 21.Functional Independence Measure (FIMTM) Instrument. 1997 Uniform Data system for medical rehabilitation, a division of UB foundation activities, Inc. Reprinted with the permission of UDSMR, University at Buffalo. 22. van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7. 23. Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination. scale. Stroke 1989;20:864-70. 24. Lyden P, Brott T, Tilley B, et al. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke 1994;25:2220-6. 25.Wityk RJ, Pessin MS, Kaplan RF, et al. Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 1994;25:362-5. 26. Wade DT, Skilbeck CE, Hewer RL. Predicting Barthel ADL score at 6 months after an acute stroke. Arch Phys Med Rehabil 1983;64:24-8. 27. 1999;31:412 28. 2004;27:83-5.

(8) 49. Study of Chinese Medicine Pattern of Acute Stage Hemorrhagic-type Stroke in Taiwan 1,2. 1,3. 1,4. 5. Nou-Ying Tang, Chung-Hsiang Liu , Wei-Kung Chen , Der-Yang Cho , Tsai-Chung Li , 6. Yu-Hsien Peng , Ching-Liang Hsieh. 7,8. 1. 5. School of Chinese Medicine, School of Medicine , Graduate institute of Chinese Medical Science , Graduate institute of 7. Integration Chinese and Western Medicine , China Medical University, Taichung, Taiwan, R.O.C. 2. 3. 4. Department of Neurology , Department of Emergency , Department of Neurosurgery , 8. Department of Chinese Medicine , China Medical University Hospital Clinical Department of Integration Chinese and Western Medicine, 6. Chung Shan Medical University Hospital , Taichung, Taiwan, R.O.C.. Purpose. Chinese Medicine (CM) uses pattern identification to determine the method of treatment. The effective treatment is closely related to the Chinese Medicine pattern (CMP) identification. Therefore, the purpose of the present study is to investigate the CMP in patients with acute stage hemorrhagic-type stroke. M e t h o d s . We collected 148 acute stage hemorrhagic-type stroke patients from the emergency department of a medical center in central Taiwan. All patients were studied within 7 days after stroke onset. Hemorrhagic-type stroke was confirmed by cranial computer tomography or by magnet resonance image, and a neurological specialist. Patient data was retrieved from Stroke Registry charts, Functional Independence measurements, Modified Rankin Scale (MRS), national institute of neurological disorders and stroke (NIHSS), and Barthel Index. In addition, CMP data of the patients were assessed by two CM doctors who used the four examinations including inspection, listening and smelling, inquiry and palpitation. Results. A total of 148 acute stage hemorrhagic-type stroke patients were studied in the present study. In patients with one CMP, the Wind pattern (WP) 141 (95.27%) was most prevalent, followed by Phlegm pattern (PP) 60 (40.54%), Fire-hot pattern (FHP) 43 (29.05%), Blood-stasis pattern (BSP) 39 (26.35%), Qi-vacuity pattern (QVP) 7 (4.73%), Yin-Vacuity and Yang-hyperactivity pattern (YV-YHP) 3 (2.03%). In patients with two CMP, Wind-Phegm pattern most prevalent 59 (39.86%), followed by Wind-Fire-hot pattern 40 (27.03%), Wind- Blood-stasis pattern 38 (25.68%), Fire-hot-Phegm pattern 19 (12.84%). Phegm-Yin-vacuity and Yang-hyperactivity pattern 1 (0.68%), Qi-vacuity-Yin-vacuity and Yang-hyperactivity pattern 1 (0.68%). The MRS score was lower in patients with FHP than those without FHP. Similarly, patients with PP had lower MRS score than those without PP. The NIHSS score was lower in patients with QVP than those without QVP. Hypertension in patients with WP was 75.18%, FHP was 86.05%, PP was 71.67%, BSP was 79.49%, QVP was 85.17%, and YV and YHP was 100%. A total of 8 patients (5.4%) die in 148 acute stage hemorrhagic-type stroke patients. 2 patients (66.7%) die in 3 patients who without WP, PP, FHP, BSP, QVP or YV and YHP. Conclusions. CMP in patients with acute stage hemorrhagic-type stroke comprises WP, PP, FHP and BSP. The main clinical manifestations of acute stage hemorrhagic-type stroke are Wind, Phegm, Firehot and blood stasis. The clinical manifestations were milder in patients with the FHP, PP and QVP than in patients without FHP, PP and QVP. The CMP is closely related to the CMP of hypertension. The prognosis is poor in acute stage hemorrhagic-type patients that did not have comprising WP, PP, FHP, BSP, QVP or YV and YHP. ( Mid Taiwan J Med 2006;11:42-9 ). Key words acute stage hemorrhagic-type stroke, Chinese Medicine Pattern Received : 14 July 2005.. Revised: 22 August 2005.. Accepted : 21 September 2005. Address reprint requests to : Shih-Wei Lai, Department of Family Medicine, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan..

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