中医腹诊在脓毒症中的应用研究  

Study on Application of Chinese Medicine Abdominal Diagnosis for Sepsis

作　　者：丘富程 吴智鑫 刘芬芳 苏懿 贾静静 谢东平[1,2] QIU Fucheng;WU Zhixin;LIU Fenfang;SU Yi;JIA Jingjing;XIE Dongping(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou Guangdong 510120,China;Intensive Care Unit,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou Guangdong 510120,China;Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Foshan Guangdong 528000,China;Acupuncture and Moxibustion Rehabilitation Department,Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine,Guangzhou Guangdong 510310,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510120 [2]广东省中医院重症医学科,广东广州510120 [3]广州中医药大学附属佛山中医院,广东佛山528000 [4]南方医科大学中西医结合医院针灸康复科,广东广州510310

出　　处：《新中医》2024年第23期53-58,共6页New Chinese Medicine

基　　金：国家自然科学基金项目(82374216);广东省中医药局科研项目(20241307)。

摘　　要：目的:通过观察脓毒症患者中医腹诊情况,总结规律,为中医腹诊在脓毒症患者中的应用提供初步思路和临床依据。方法:通过文献回顾总结整理出中医腹诊阴阳分型及6项腹诊重点体征(腹形、腹部压痛、腹温、腹力、肠鸣音、腹围)的标准。然后纳入52例脓毒症患者,根据腹诊信息和大便情况分为腹阴证组和腹阳证组,比较腹部阴阳分型与腹诊信息、大便的相关性,并比较胃肠功能障碍评分(GIF评分)、脓毒症相关序贯器官衰竭(SOFA)评分、白细胞计数(WBC)、C-反应蛋白(CRP)和降钙素原(PCT)水平。结果:腹阴阳分型与性别、年龄、腹形、腹部压痛、大便无相关性(P>0.05);与腹温、腹力均呈正相关关系(P<0.05)。腹阳证组GIF评分、腹围高于腹阴证组(P<0.05)。腹阴证组WBC略高于腹阳证组,腹阳证组SOFA评分较腹阴证组高,但差异均无统计学意义(P>0.05)。腹阳证患者CRP、PCT水平均高于腹阴证组(P<0.05)。结论:根据中医腹诊可初步预测脓毒症患者的危重情况及整体预后。Objective:To observe the situation of Chinese medicine abdominal diagnosis in sepsis patients,and to summarize the rules to provide preliminary ideas and clinical basis for the application of Chinese medicine abdominal diagnosis in sepsis patients.Methods:The criteria for the yin-yang classification of Chinese medicine abdominal diagnosis and six key signs of abdominal diagnosis(abdominal shape,abdominal tenderness,abdominal temperature,abdominal strength,bowel sounds,abdominal circumference)were summarized and organized through literature review.Then,a total of 52 sepsis patients were included and divided into the abdominal yin syndrome group and the abdominal yang syndrome group based on abdominal diagnosis information and stool condition.The correlation between abdominal yin-yang classification and abdominal diagnosis information and stool was compared,and the Gastrointestinal Failure(GIF)scores,Sequential Organ Failure Assessment(SOFA)scores,white blood cell(WBC),C-reactive protein(CRP),and procalcitonin(PCT)were compared.Results:There was no correlation between the abdominal yin-yang classification and gender,age,abdominal shape,abdominal tenderness,and stool(P>0.05);there is a positive correlation between abdominal temperature and abdominal force(P<0.05).The GIF scores and abdominal circumference in the abdominal yang syndrome group were higher than those in the abdominal yin syndrome group(P<0.05).The WBC count in the abdominal yin syndrome group was slightly higher than that in the abdominal yang syndrome group,and the SOFA score in the abdominal yang syndrome group was higher than that in the abdominal yin syndrome group,but there was no significant difference(P>0.05).The levels of CRP and PCT in patients with abdominal yang syndrome were higher than those in the abdominal yin syndrome group(P<0.05).Conclusion:Chinese medicine abdominal diagnosis can preliminarily predict the critical condition and overall prognosis of sepsis patients.

关 键 词：脓毒症 胃肠功能障碍 中医腹诊 胃肠功能障碍评分 脓毒症相关序贯器官衰竭评分 炎症因子 

分 类 号：R631[医药卫生—外科学]