内科危重症患者中医“虚实”特点的临床研究  

Clinical Study on the Characteristics of Critically Ill Patients Guided by TCM Syndrome Identification

作　　者：石筝筝[1] 刘清泉[1,2] 吴彦青[1] 范圣凯[1] 姚卫海[1] 徐向东 郭玉红[1] 

机构地区：[1]首都医科大学附属北京中医医院,北京100010 [2]中医感染性疾病基础研究北京市重点实验室,北京100010

出　　处：《中国中医急症》2017年第5期789-793,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：北京市医院管理局重点医学专业发展计划专项(ZYLX201611);北京中医药科技发展资金青年项目(QN2014-15);北京中医药科技发展资金一般规划项目(JJ2014-24);首都医科大学附属北京中医医院院级课题(2014YM-06)

摘　　要：目的从中医"虚实"辨证观点,结合客观指标研究内科危重症患者特点,以期发现中医虚实病机在危重症患者诊治中的内在规律。方法对本院2015年1月至2016年1月ICU收治的内科危重患者进行前瞻性调查,符合标准入选60例,评价中医虚实辨证、患者危重程度和转归等。结果危重症患者虚证组和实证组60 d死亡率比较存在显著差异(P<0.05);经ICU治疗7 d后APACHEⅡ评分下降(P<0.05);虚证组和实证组的APACHEⅡ评分无统计学差异,但虚证组的平均分较实证组高,提示虚证组患者危重程度高。血清前白蛋白水平可反映患者疾病危重程度并预测其转归(P<0.05),但虚证组和实证组之间的血清前白蛋白水平差异无统计学意义。结论本次调查研究启示笔者建立以中医"虚实"为"纲",具体客观指标(如APACHEⅡ评分、血清前白蛋白)为"目"的危重症评分体系更能全面准确把握病情演变和评价治疗效果。虚实证候和血清前白蛋白的测定相结合可能给危重症患者的营养支持提供理论依据。同时探索客观量化指标反映"虚实"动态演变过程是今后研究方向。Objective： To analyze the characteristics of critically ill patients by using Chinese basic theory-syn- drome identification as well as the objective indicators. Methods： Based on the perspective analysis of the critically ill patients due to internal diseases in the ICU of Beijing Hospital of Traditional Chinese Medicine from Jan- uary 2015 to January 2016,60 cases were selected. Their TCM syndrome differentiation of excess and deficiency, critical degree ,prognosis and so on were recorded and evaluated in order to find its internal laws. Results： There was significant difference between the TCM deficient syndrome group and the sthenia syndrome group on the 60 d mortality rate （P〈 0.05）. After treatment for 7 days in ICU,APACHE II score decreased in both groups （P 〈 0.05） and there was no statistical difference between the two groups on APACHE II score. But the average score in the deficient syndrome group was higher than that in the sthenia syndrome group which indicated that the patients in the deficient syndrome group were in a higher critical ill state. The serum prealbumin level could tell the critical degree of the patients and predict the prognosis（P〈 0.05）, but there was no statistical difference between the TCM deficient syndrome group and the sthenia syndrome group on the serum prealbumin level. Conclusion- This anal- ysis shows that a comprehensive critical disease scoring system should be built on both TCM syndrome identifica- tion and objective indicators such as APACHE II scores and serum prealbumin level. It can reflect the status of critically ill patients and analyze the therapeutic effect comprehensively. The measurement of both TCM syndrome identification and serum prealbumin level may provide theoretical evidence to the nutrition support to critically ill patients. Meanwhile,the physiochemical index of the sthenia and deficient syndrome is the future research direction.

关 键 词：危重症 虚实 转归 

分 类 号：R278[医药卫生—中医学]