| Object ivesTo obtain the opinions and suggestions of the experts on the diagnostic criteria of the revised stroke by expert questionnaire and the Delphi method (Delphi), and provide the basis for the development of diagnostic criteria for acute stage of ischemic stroke, and combined with the application of statistical methods to analyze the clinical information by four physical examinations, and explore the effective method of screening stroke diagnosis entry by combining with the expert experience and clinical information.MethodThis study is part of the ischemic stroke diagnostic criteria (Industry standards) of the National Eleventh Five-Year Technology Support Program subject (subject ID:2006BAI21B00). Study is divided into three main parts, the first part is amendment stroke diagnostic criteria based on literature research;the second part, revising ischemic stroke name, illness diagnosis, staging criteria, the syndrome diagnosis criteria through expert consultation; third part is based on the database of the National Eleventh Five-Year Technology Support Program subject which contains information of ischemic stroke, and it is large sample, multiple time points,mutilple center.Then we analyse four clinical consultation information by cluster analysis, chi-square test, logistic regression, and combined with expert experience in screening, optimization of ischemic stroke inmeridian syndrome diagnostic entries.Results1. Developed diagnosis of ischemic stroke disease, illness diagnosis, staging syndrome type based on expert advice.(1) Disease:stroke is divided into ischemic stroke, hemorrhagic stroke, and apoplexyapoplectoid stroke. ①Ischemic stroke:ischemic stroke is due to deficiency of Qi and blood. Concerned overstrain, anxiety and rage, intemperance of taking food, causing the imbalance of yin and yang in zang-fu, Qi can not reach the brain, brain lost filling, or blood stasislag cerebral vessels;manifesting suddenly faint servant, hemiplegia, facial paralysis, difficult to speech, aphasia, hemianesthesia;or face stiff, mouth drooling, sudden dizziness, or, as diplopia, alalia, or did not know things and loved ones, or gait disturbance, or side of the body pain, or limb shaking than as the main performance of a group of diseases.②Apoplexyapoplectoid stroke:manifesting sudden dizziness, or diplopia, alalia, or did not know things and loved ones, or gait disturbance, or side of the body pain, or limb shaking;rather than a suddenfaint servant, hemiplegia, facial paralysis, speech harmful astringent or without a word, hemianesthesia five symptoms as the main performance;and see which one or two symptoms, but lesser, known as the apoplexyapoplectoid stroke.(2) Illness diagnosis①In meridians and collaterals:ischemic stroke and normal mind.②In Zang-fu:ischemic stroke associated with unconsciousness.(3) Staging criteria①Super acute phase:onset within6hours.②Acute phase:within2weeks of onset, patients in coma may be extended to4weeks of onset.③Recovery period:2weeks to6months of onset.④Sequelae:6months after the onset.(4) In Meridian illness syndrome type①Interfered by pathogenic wind-fire②Excess syndrome in FU-organ caused by Phlegm-heat③Obstruction of collateral caused by wind-phlegm④Stirring of wind due to YIN deficiency⑤Obstruction of collateral caused by Qi deficiency, phlegm and stasis2. Based on the diagnosis of the syndrome in the meridian of the clinical screening of ischemic stroke disease entry(1) The entries of Interfered by pathogenic wind-fire:usually irritable, impatient and restless,dizziness, headache, dryness in both eyes, insomnia, morbid forgetfulness, tinnitus, dry mouth and thirst,bitter mouth, dry and red lips, terribly upset and testiness, night sweat, red tongue,yellow and thin fur, string,thin and fast in the right pulse.(2) The entries of excess syndrome in FU-organ caused by Phlegm-heat:headache, dizziness, flushing,bitter mouth, sticky sputum difficult to cough, abdominal fullness, physically relax longitudinal income, yellow urine, then dry, red tongue, yellow and thick moss, left pulse string.(3) The entries of Obstruction of collateral caused by wind-phlegm:dizziness, blurred vision,sticky sputum difficult to cough, limb numbness, pale tongue, white coating, thin fur, string and slippery in right pulse.(4)The entries of Stirring of wind due to Yin deficiency:emaciation,red face, dry throat,dry mouth, terribly upset and testiness, dizziness, tinnitus, and more sleep,dry stool,red and thin tongue, less moss, string thin and fast in the right pulse.(5)The entries of Obstruction of collateral caused by Qi deficiency, phlegm and stasis:lassitude and languid, pale in the face, headache, palpitations, chest tightness, spontaneous perspiration,cold extremities, black eyelid, mouth drooling, loose stools, fat tongue with teeth marks,white and thick moss, context tortuous bruising, left pulse is thready and thin.Conclusion1.This study comprises systematic collecting literature, analyzing ischemic stroke TCM syndromes. Then finding the ischemic stroke Syndromes research trends, with provide the basis for the development of ischemic stroke diagnostic criteria.2.Using the Delphi method in this study, access to expertise, qualitative study used in the field of TCM syndrome, preliminarily shows the applicability of the Delphi in the process of developing Chinese medicine diagnosis scheme, providing thought for future standardization, standardization of TCM diagnosis and treatment.3.Preliminary structural integrity of the clinical diagnosis and treatment elements of complete disease and syndrome diagnostic criteria.4. Studies have shown that, supported by clinical data using multivariate statistical analysis to combine the expertise of the method of screening the entry of the diagnosis of ischemic stroke disease syndrome is more objective, it is worth further clinical validation, amendments and promotion. |
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