急诊脓毒症中医证型分布特点的研究  

A study on distribution characteristics of traditional Chinese medical syndromes of emergency sepsis

作　　者：丁黎敏[1] 张颖[2] 郑兰芝[1] 周晶晶[3] 张卓一[1] 黄小民[1] Ding Limin;Zhang Ying;Zheng Lanzhi;Zhou Jingjing;Zhang Zhuoyi;Huang Xiaomin(Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006,Zhejiang, China;Department of Information Evaluation Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China;Clinical Practric Teaching Center, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China)

机构地区：[1]浙江中医药大学附属第一医院急诊科,浙江杭州310006 [2]浙江中医药大学附属第一医院信息评价中心,浙江杭州310006 [3]浙江中医药大学临床实践教学中心,浙江杭州310053

出　　处：《中国中西医结合急救杂志》2018年第6期631-635,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省中医药科技计划项目(2015ZA089).

摘　　要：目的通过分析本院急诊科脓毒症患者临床资料和中医四诊信息,探讨急诊脓毒症患者的中医证型分布特点及规律,为脓毒症的中医规范化诊治提供依据。方法选择2016年7月至2017年10月浙江中医药大学附属第一医院急诊科和急诊重症加强治疗病房(EICU)收治脓毒症患者135例,其中脓毒症组110例,脓毒性休克组25例。制定统一的调查表,收集患者入院确诊当天的一般资料、感染部位、采集患者中医临床四诊信息(中医证候、舌苔、脉象等)进行辨证分型,于确诊24h内完成相关实验室检查,并计算快速序贯器官衰竭评分(qSOFA)及序贯器官衰竭评分(SOFA)。结果135例脓毒症患者以肺部感染为主(占51.9%),其次为腹腔感染(占25.9%)。中医证型分布:脓毒症组以毒热证为主(占61.8%);脓毒性休克组以急性虚证为主(占68.0%),两组比较差异有统计学意义(P<0.001)。脓毒症组与脓毒性休克组间以及脓毒症不同中医证型之间感染相关指标,如白细胞计数(WBC)、中性粒细胞比例及绝对值、C-反应蛋白(CRP)、降钙素原(PCT)的比较差异均无统计学意义(均P>0.05);而急性虚证患者乳酸(Lac)较毒热证、腑气不通证、血瘀证明显升高〔mmol/L:2.8(1.5,4.2)比1.3(1.0,1.8)、1.6(1.3,3.8)、1.6(1.2,2.9),P<0.001〕,脓毒性休克组较脓毒症组显著升高〔mmol/L:4.0(2.7,5.7)比1.4(1.1,1.9),P=0.000〕。qSOFA≥2分患者在脓毒症组为25.5%(28/110),在脓毒性休克组为80.0%(20/25),差异有统计学意义(P<0.001);而急性虚证qSOFA≥2分患者为69.4%(25/36),气不通证为42.1%(8/19),毒热证为19.1%(13/68),血瘀证为16.7%(2/12),差异亦有统计学意义(P<0.001)。脓毒性休克组〔7.0(5.0,10.0)分〕和急性虚证患者〔6.0(4.0,9.0)分〕SOFA评分显著升高,与脓毒症组〔3.0(2.0,4.0)分〕和其他证型患者〔毒热证为3.0(2.0,4.0)分,腑气不通证为4.0(2.0,6.0)分,血瘀证为4.5(3.0,5.0)分〕比较差异均有统计学意义(均P<0.001)�Objective To explore the distribution characteristics and regularity of traditional Chinese medical (TCM) syndromes in patients with sepsis in Department of Emergency of our hospital by enalyzed their clinical data and TCM four clinical diagnostic information so as to provide the basis for TCM standardized diagnosis and treatment of sepsis. Methods From July 2016 to October 2017, 135 patients with sepsis were admitted to the Department of Emergency and Department of Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Zhejiang Chinese Medical University, 110 cases in sepsis group, 25 cases in sepsis shock group. An unified questionnaire was developed to collect the patients' general data, infection site and TCM four clinical diagnostic information (TCM syndromes, tongue coating, pulse signs, etc.) for dialectical typing on the day of admission with definite diagnosis, the relevant laboratory examinations were completed within 24 hours after the confirmative diagnosis was made, and the quick sequential organ failure assessment (qSOFA) and SOFA scores were calculated. Results In 135 cases of sepsis, pulmonary infection (51.9%) was the main one, followed by abdominal infection (25.9%). The distribution of TCM syndromes: the toxic heat syndrome was the main syndrome in sepsis group (61.8%) and acute deficiency syndrome was the main syndrome in sepsis shock group (68.0%), the difference between the two groups being statistically significant (P < 0.001). There were no statistical significant differences in comparisons of infection related indicators between sepsis and septic shock groups, different TCM syndromes of sepsis (all P > 0.05), such as white blood cell count (WBC), percentage and absolute value of neutraphils, C-rative poucin (CRP)_ proraleitonin (PCr). the lactic acid in patients oK the arute deficiencysyndone was xignifieantly higher than those in patients of the toxic hrat syndrome, the stoppage of the qi of the bxowelssyndrome and blond stanis syndrome [mmo/Lz 28(15, 4.2)vm.13(10, 1.8)

关 键 词：脓毒症 中医证型 分布 

分 类 号：R259.631[医药卫生—中西医结合]