脓毒症急性胃肠损伤中医证候评分量表的初步探讨  

A preliminary study on traditional Chinese medicine syndrome rating scale for acute gastrointestinal injury in sepsis

作　　者：廖吕钊 李闪闪 邢茜[2] 王希 周建明 李雯静 潘思旭 江荣林[2] Liao Lyuzhao;Li Shanshan;Xing Qian;Wang Xi;Zhou Jianming;Li Wenjing;Pan Sixu;Jiang Ronglin(Department of Emergency Intensive Care Unit (ICU), Zhejiang Hospital, Hangzhou 310007, Zhejiang, China;Department of ICU, the First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou 310006,Zhejiang, China;First Clinical Medicine College, Zhejiang Chinese Medicine University, Hangzhou 310053, Zhejiang, China)

机构地区：[1]浙江医院急诊科ICU,浙江杭州310007 [2]浙江中医药大学附属第一医院ICU,浙江杭州310006 [3]浙江中医药大学第一临床医学院,浙江杭州310053

出　　处：《中国中西医结合急救杂志》2018年第6期625-630,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金(8177140461);浙江省科技计划项目(2018C35014);浙江省中医药防治重大疾病攻关计划项目(2012ZGG001).

摘　　要：目的研制脓毒症急性胃肠损伤(AGI)中医证候评分量表,并进行信效度分析和临床初步应用。方法①根据重症加强治疗病房(ICU)患者特点,结合中医对病因病机和体征的认识及文献检索构建评分系统的初步框架进行本量表评分。②对取得的量表及数据进行分半信度(用a、b两组的Guttman分半信度表示)、重测信度、内部一致性信度(用克朗巴赫系数α表示)分析,以及结构效度、效标效度分析。③按28d生存和死亡分组,比较两组患者AGI中医证候评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、多器官功能障碍综合征(MODS)评分的差异,确定最佳截断点、进行生存分析。结果①制备脓毒症AGI中医证候评分量表初稿,中医证候指标包括:腹胀、便秘/腹泻、饮食、呕吐/胃潴留、舌质、舌苔、脉象、嗳气、体温、兼证,按0~6分分为正常(0分)、轻度(2分)、中度(4分)、重度(6分)。②共有88例患者纳入最终统计。本量表重测相关系数R=0.974(>0.85),Guttman分半信度为0.793(>0.7);克朗巴赫系数α均>0.7。本量表适合因子分析,经旋转后确定3个因子,分别命名为中医辨证、相关体征、胃肠容受。建模后验证性因子分析显示,模型近似误差均方根(RMSEA)为0.07(<0.08),拟合优度指数(CFI)=0.90;效标APACHEⅡ、SOFA、MODS评分与本量表中医评分1和中医评分2之间Pearson相关性分析显示,r值分别为0.802和0.752、0.524和0.519、0.619和0.590,均P<0.01。③生存组中医评分(分:33.73±5.95比37.28±5.26,t=2.945,P=0.004)、APACHEⅡ评分(分:19.90±4.4比22.28±5.79,t=2.069,P=0.043)、SOFA评分(分:8.73±1.11比9.64±1.38,t=3.329,P=0.020)均明显低于死亡组;MODS评分较死亡组有降低趋势(分:6.65±1.22比7.28±1.60),但两组比较差异无统计学意义(t=2.078,P=0.050)。以35分为截断点进行生存分析,Cox回归分析显示,中医评分≥35分患者的28d生存率�Objective To develop a traditional Chinese medicine (TCM) syndrome score scale for acute gastrointestinal injury (AGI) in sepsis, and to carry out its reliability and validity analyses and its clinical preliminary application. Methods ① According to the characteristics of intensive care unit (ICU) patients, combined with the understanding of etiology, pathogenesis and physical signs of TCM and literature search, a preliminary framework of scoring system for TCM syndromes of AGI in sepsis was constructed to carry out the scoring by this scale. ② After the scale and data were obtained, the analyses of split-half reliability (indicated by Guttman's split-half reliability of the a and b groups), test-retest reliability and the internal consistency reliability (expressed by the Cronbach's coefficient α) were carried out, and the structural validity and criterion validity were also analyzed. ③ The AGI patients were divided into two groups according to the 28-day survival and death conditions, and the AGI TCM syndrome score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, and multiple organ dysfunction syndrome (MODS) score were compared between the two groups to determine the best cutoff point for survival analysis. Results ① The first draft of the septic AGI TCM syndrome rating scale was prepared, The TCM syndrome indicators include: abdominal distension, constipation/diarrhea, diet situation, vomiting/stomach retention, tongue proper, tongue coating, pulse manifestation, belching, body temperature, and accompanied syndrome, there were 6 points for scoring, 0 - 6 points, and they were divided into normal (0 points), mild (2 points), moderate (4 points), and severe (6 points) in severity. ② Eighty-eight patients with septic AGI were included in the final statistics. The retest of correlation coefficient of this scale was R = 0.974 (> 0.85), Guttman's split-half reliability was 0.793(> 0.7) and the Cronbach's coefficient α was > 0.7. Th

关 键 词：脓毒症 胃肠损伤 急性 中医药 证候 评分 量表 

分 类 号：R449[医药卫生—诊断学]