虚实辨证对肺源性脓毒症患者预后评估  

Prognostic Evaluation of Patients with Pulmonary Sepsis Based on Deficiency-Excess Differentiation

作　　者：夏非[1] 杨思雯[1] 朱玉菡 郭玉红 王烁 徐霄龙[1] 宋麦芬[1] XIA Fei;YANG Siwen;ZHU Yuhan;GUO Yuhong;WANG Shuo;XU Xiaolong;SONG Maifen(Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Medical Affairs Office,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院,北京100010 [2]北京市医院管理中心医疗护理处,北京100010

出　　处：《辽宁中医杂志》2024年第8期5-8,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81973608)。

摘　　要：目的探索肺源性脓毒症患者的中医虚实证素特点,分析其对疾病预后的影响。方法统计该院ICU 2018年1月—2020年1月间的168例肺源性脓毒症患者,根据中医虚实辨证分为虚、实两组,比较虚证组与实证组患者休克发生率、28 d病死率、白细胞计数、降钙素原(procalcitonin,PCT)、血乳酸以及病原学结果等指标。结果168例患者中虚证组65例,实证组103例。虚证组休克发生率(23/42 vs.17/86,χ^(2)=7.830,P=0.005)及28 d病死率(23.3%vs.41.5%,χ^(2)=6.270,P=0.012)显著高于实证组。虚证组G+感染率显著低于实证组(24/37 vs.24/64),G-感染显著高于实症组(31/37 vs.40/64),两组间差异有统计学意义(χ^(2)=5.087,P=0.024)。虚证组白细胞计数[(9.76±4.28)×10^(9)/L vs.(12.85±10.50)×10^(9)/L,t=-2.257,P=0.025]及血乳酸[1.90(1.59,2.63)vs.2.27(1.77,2.98),Z=1.382,P=0.044]均显著低于实证组。结论肺源性脓毒症虚证型者休克发生率、病死率均明显高于实证型者。扶正治疗应贯穿脓毒症整个治疗过程。Objective To explore the characteristics of deficiency-excess syndrome elements of traditional Chinese medicine in patients with pulmonary sepsis,and analyze its impact on the prognosis of the disease.Methods A total of 128 patients with pulmonary sepsis in ICU of the hospital from 2018 Jan.to 2020 Jan.were involved in the research.According to the syndrome differentiation,they were divided into the deficiency and excess groups.The incidence of shock,28-day mortality,white blood cell count,procalcitonin(PCT),blood lactic acid and etiological results were compared between the two groups.Results There were 65 cases in the deficiency syndrome group and 103 cases in the excess syndrome group.The incidence of shock(23/42 vs.17/86,χ^(2)=7.830,P=0.005)and 28-day mortality(23.3%vs.41.5%,χ^(2)=6.270,P=0.012)in the deficiency group were significantly higher than those in the excess group.In the deficiency group,G+infection was lower than that in the excess group(24/37 vs.24/64),whereas G-infection(31/37 vs.40/64)was higher than that in the excess group,and the significant difference was found between the two groups(χ^(2)=5.087,P=0.024).The white blood cell count[(9.76±4.28×10^(9))/L vs.(12.85±10.50×10^(9))/L,t=-2.257,P=0.025]and blood lactic acid[1.90(1.59,2.63)vs.2.27(1.77,2.98),Z=1.382,P=0.044]in the deficiency group were significantly lower than those in the excess group.Conclusion The incidence of shock and mortality in the patients with deficiency syndrome of pulmonary sepsis were significantly higher than those in the patients with excess syndrome.Reinforcing healthy Qi therapy should be run through the whole process of sepsis treatment.

关 键 词：肺源性脓毒症 虚实理论 预后 

分 类 号：R256.13[医药卫生—中医内科学]