Yang Wei, Li Ming-Quan, Li Yang, Sun Lei-Lei, Xie Yan-Ming, Guo Chong-Hui, Zhuang Yan
The Affiliated Hospital of Changchun University of Chinese Medicine， Changchun 130021， China.
Institute of Basic Research in Clinical Medicine， China Academy of Chinese Medical Sciences， Beijing 100700， China.
Zhongguo Zhong Yao Za Zhi. 2018 Feb;43(3):618-626. doi: 10.19540/j.cnki.cjcmm.20171211.001.
Under the theoretical guidance of "combination of disease and syndrome， correspondence between syndrome and prescription， and dynamic space-time"， 11 135 acute ischemic stroke patients were collected from hospital information system(HIS) of many 3A grade hospitals of traditional Chinese medicine. Complex network analysis was adopted to obtain the core syndrome elements in different periods of acute ischemic stroke patients， and it was found that the core syndrome elements were blood stasis syndrome， phlegm， endogenous wind， Yin deficiency， Qi deficiency， heat， hyperactivity of liver Yang， liver， and kidney of patients in hospital for the first day， and during 8-14 d in hospitalization， the core syndrome elements were blood stasis， phlegm， Yin deficiency， Qi deficiency， endogenous wind， hyperactivity of liver Yang， liver， and kidney. The data with "improved" and "cured" treatment outcomes were adopted for complex network analysis and correlation analysis to identify the Chinese and Western medicine group modules in patients with different disease conditions in different phases after hospitalization. It was found that the Chinese and Western medicine modules within 14 d after hospitalization mainly included "blood-activating and stasis-dissolving module "consisted by "anti-platelet drug + circulation-improving medicine(or anticoagulant drug and anti-fibrinogen drug， et al) + blood-activating and stasis-dissolving drugs"， as well as "stasis-dissolving and phlegm-reducing module" consisted by "anti-platelet drugs + circulation-improving medicine(or anticoagulant drug and anti-fibrinogen drug， et al) + phlegm refreshing drug". The core Chinese and Western medicine modules in patients with urgent and general conditions within 7 d after hospitalization mainly used "blood-activating and stasis-dissolving module" and "stasis-dissolving and phlegm-reducing module". Three or more Chinese medicine and Western medicines module with more than 1% utilization rate was not found in the patients with critical disease condition in admission. The urgent， general and critically ill patients in admission mainly used "blood-activating and stasis-dissolving module" in 8-14 d. From the real world medical big data research， it was found that the combined use of Chinese and Western medicines were consistent with "combination of disease and syndrome， correspondence between syndrome and prescription， and dynamic space-time" theory， and multiple multidimensional dynamic Chinese medicine and Western medicine group modules of "patient-syndrome-drug-time-effective" at the acute ischemic stroke stage were dug out， forming the method of Chinese and Western medicine combination research based on electrical medical big data.
在“病证结合、方证相应、动态时空”理论指导下，从多家三级甲等中医医院信息系统（HIS）中收集11135例急性缺血性脑卒中患者。采用复杂网络分析方法获取急性缺血性脑卒中患者不同时期的核心证候要素，发现入院第1天患者的核心证候要素为血瘀证、痰、内风、阴虚、气虚、热、肝阳上亢、肝、肾；住院8～14 d时，核心证候要素为血瘀、痰、阴虚、气虚、内风、肝阳上亢、肝、肾。采用治疗转归为“好转”和“治愈”的数据进行复杂网络分析及关联分析，识别住院后不同阶段不同病情患者的中西医组方模块。发现住院14 d内的中西医模块主要包括由“抗血小板药物+改善循环药物（或抗凝药物及抗纤维蛋白原药物等）+活血化瘀药物”组成的“活血化瘀模块”，以及由“抗血小板药物+改善循环药物（或抗凝药物及抗纤维蛋白原药物等）+豁痰药物”组成的“化痰祛瘀模块”。住院7 d内急重症和普通症患者的核心中西医模块主要使用“活血化瘀模块”和“化痰祛瘀模块”。入院时危重症患者未发现使用率超过1%的3种及以上中西药模块。入院时急、普通、危重症患者在8～14 d主要使用“活血化瘀模块”。从真实世界医学大数据研究中发现，中西医联合用药符合“病证结合、方证相应、动态时空”理论，挖掘出急性缺血性脑卒中阶段“患者-证候-药物-时间-疗效”的多维多动态中西医组方模块，形成基于电子医学大数据的中西医结合研究方法。
