摘要
目的总结中医药治疗冠心病房颤患者的用药规律。方法通过医院信息系统(HIS),提取山东中医药大学附属医院心病科2014年1月1日—2016年1月31日收治的住院患者信息。将提取的患者基本信息和诊断信息导入EXCEL表并合并,从合并后的诊断中筛选同时包含"冠心病"和"房颤"的患者;完成筛选,得到结果。依据患者ID提取使用药物情况,分别导入EXCEL表。选用SPSS17.0统计分析软件进行频数统计,利用EXCEL辅助作图,采用Liquorice软件进行复杂网络分析和点式互信息分析,寻找冠心病房颤核心处方以及两两药物之间的强相关性。结果466例冠心病房颤住院患者中,男231例(49.57%),女235例(50.43%);年龄30~95岁,中位数为74岁,男患者中位数为75岁,女患者中位数为73岁;女性在60~74岁年龄段时住院例数较男性多,男性在75~89年龄段住院人数略多于女性;住院天数1~72 d,中位数为17 d,住院天数以15~28 d最多,2014年—2015年住院天数变化不明显,医保报销比例明显高于自费比例。高频药物为黄连、黄芪、麦冬、川芎等;通过复杂网络分析,得到治疗本病的核心处方为黄连、黄芪、麦冬、川芎、茯苓、当归、党参、清半夏、炒酸枣仁、甘草;利用点式互信息分析,除了发现麦冬-制五味子、黄连-黄芪、黄连-党参、党参-麦冬、川芎-黄连、当归-川芎、生地黄-炒酸枣仁、虎杖-紫石英等冠心病房颤常用药物之间配伍的关联强度较高之外,焦山楂-麸神曲、玉竹-天花粉、红参-煅牡蛎、桂枝-麦冬、醋延胡索-麦冬、炙甘草-黄连等特有的配伍关联强度也很高,同时发现这些配伍中焦山楂-麸神曲关联系数最大(10.38439),高于其他特有药对的关联系数。结论冠心病房颤患者男女比例相当,老年人居多,住院天数>15 d者居多,住院费别为医保支付比例明显多于自费比例;中医药治疗以益气养阴、活血化瘀为主,随证佐以理气、化痰、温阳、清热、利水等法。
Objective To summarize the rule of traditional Chinese medicine in the treatment of patients with coronary heart disease and atrial fibrillation. Methods Through the hospital information system( HIS),the information of inpatients admitted to the Department of Cardiology,Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 1,2014 to January 31,2016 was extracted. The extracted basic information and diagnosis information of patients were imported into excel table and the patients with " coronary heart disease" and " atrial fibrillation" were screened from the combined diagnosis.The results were obtained after the screening. According to the patient ID,the drugs were extracted and imported into the excel table. SPSS17. 0 statistical analysis software was used for frequency statistics,excel was used for auxiliary mapping,and liquorice software was used for complex network analysis and point type mutual information analysis to find out the core prescription of coronary heart disease atrial fibrillation and the strong correlation between the two drugs. Results Of the 466 inpatients,231 were male( 49. 57%) and 235 were female( 50. 43%). The median age was 74 years old( 30-95 years old),75 years old( male) and 73 years old( female). The number of inpatients in the age group of 60-74 years old was more than that in the age group of 75-89,and the number of inpatients in the age group of 75-89 was slightly more than that in the age group of 60-74. The number of inpatient days was 17 days,the most of which was 15-28 days. The change of inpatient days from 2014 to 2015 was not obvious,and the proportion of medical insurance reimbursement was significantly higher than that of self expense. High frequency drugs were Huanglian( Coptis),Huangqi( Astragalus),Maidong( Ophiopogon japonicus),Chuanxiong( Ligusticum chuanxiong),etc. Through complex network analysis,the core prescriptions for the treatment of this disease were Huanglian( Coptis),Huangqi( Astragalus),Maidong( Ophiopogon japonicus),Chuanxiong( Ligusticum chuanxiong),Fuling( Poria cocos),Danggui( angelica),Dangshen( Codonopsis pilosula),Banxia( Pinellia ternate),Chao Suanzaoren( fried jujube kernel),Gancao( Liquorice). Using point mutual information analysis,in addition to the high correlation among the commonly used drugs for atrial fibrillation of coronary heart disease,including Maidiong( Ophiopogon japonicus)-Zhi Wuweizi( processed Schisandra),Huangqi( Astragalus)-Huanglian( Coptis),Huanglian( Coptis)-Dangshen( Codonopsis pilosula),Dangshen( Codonopsis pilosula)-Maidiong( Ophiopogon japonicus),Chuanxiong( Ligusticum chuanxiong)-Huanglian( Coptis),Danggui-Chuanxiong( Ligusticum chuanxiong),Shengdi( Rehmannia glutinosa)-Chao Suanzaoren( fried jujube kernel) and Huzhang( Polygonum cuspidatum)-Zishiying( Amethyst incident),the drug pairs including Jiaoshanzha( Crataegus pinnatifida)-Fushenqu( medicated leaven),Yuzhu( Polygonatum odoratum)-Tianhuafen( trichosanthes roots),Hongshen( red ginseng)-Duanmuli( calcined oyster shell),Guizhi( cassia twig)-Maidong( Ophiopogon japonicus),vinegar-processed Yanhusuo( Corydalis)-Maidong( Ophiopogon japonicus) and Gancao( Liquorice)-Huanglian( Coptis) had highcompatibility. The correlation coefficient of Jiaoshanzha( Crataegus pinnatifida)-Fushenqu( medicated leaven) was the highest( 10. 38439),which was higher than that of other specific drug pairs. Conclusion The proportion of male and female patients with atrial fibrillation of coronary heart disease is the same. The elderly are the majority,the number of hospitalization days is more than 15 days,and the proportion of hospitalization expenses paid by medical insurance is significantly more than the proportion of self paid. The treatment of traditional Chinese medicine is mainly to invigorate Qi and Yin,promote blood circulation and remove blood stasis,and the methods of regulating Qi,resolving phlegm,warming Yang,clearing heatand promoting water are used along with the syndrome.
作者
李晓春
戴国华
LI Xiaochun;DAI Guohua(Chifeng Songshan Traditional Mongolian Chinese Medicine Hospital,Chifeng 024000,Inner Mongolia,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011,Shandong,China)
出处
《实用中医内科杂志》
2020年第8期63-68,I0002,共7页
Journal of Practical Traditional Chinese Internal Medicine
基金
山东省中医药科技计划(2015-299)。
关键词
HIS
中医药
冠心病房颤
频数统计
复杂网络分析
点式互信息
HIS
traditional Chinese medicine
atrial fibrillation of coronary heart disease
frequency statistic
complex network analysis
point mutual information
