脓毒症血分证的理论辨析与临床应用  

Theoretical analysis and clinical application of"blood syndrome of sepsis"

作　　者：马林沁 刘艺 张惠 刘峻溪 吴彩军 Ma Linqin;Liu Yi;Zhang Hui;Liu Junxi;Wu Caijun(Department of Emergency Medicine,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Iinstitute of Sepsis,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Cardiovascular Disease,Qingdao Fifth People's Hospital,Qingdao 266002,Shandong,China)

机构地区：[1]北京中医药大学东直门医院急诊科,北京100700 [2]北京中医药大学脓毒症研究所,北京100700 [3]青岛市第五人民医院心血管病科,山东青岛266002

出　　处：《中国中西医结合急救杂志》2024年第6期751-755,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家中医药管理局科技司中医药防治新型冠状病毒感染应急研究专项课题(2023ZYLCYJ02-1)。

摘　　要：脓毒症以其高发病率和高病死率给人类健康带来重大威胁,目前对于脓毒症的综合干预方案仍有局限性。特别是当脓毒症进展至脓毒性休克阶段、出现多器官功能障碍综合征(MODS)或弥散性血管内凝血(DIC)等危重情况时,则更无有效的特异性治疗手段,使脓毒症成为公认的疑难重症。而中医药以其整体观念、辨证论治等理论优势,在参与干预及治疗脓毒症方面有特殊的优势。故本团队基于脓毒症中医辨证理论体系及临床经验总结,提出以“脓毒症血分证”的概念概括脓毒症危重阶段的中医证候特点,并从脓毒症血分证的发生机制、基础研究等角度归纳了其现代研究进展,总结其临床主要证候,从概念辨析角度探讨其诊断和鉴别诊断,并概述和讨论本证的有效治则治法、常用中药及成药。值得注意的是,血管内皮损伤在脓毒症血分证的客观发生机制中扮演着重要的角色,以凉血活血为核心治则的中医药治疗可能通过血管内皮功能保护产生对本证的治疗效应,并遏制脓毒症进展为休克、MODS、DIC等危重情况的趋势,最终改善脓毒症患者的疗效及预后。希望通过本次思辨和论述能为脓毒症危重阶段中医辨证的早期识别和早期治疗提供思路和借鉴。Sepsis poses a major threat to human health due to its high morbidity and mortality.At present,there are still limitations to the comprehensive intervention plan for sepsis.Especially when sepsis progresses to the stage of septic shock,multiple organ dysfunction syndrome(MODS)or disseminated intravascular coagulation(DIC)and other critical conditions,there are no effective specific treatment methods,which makes sepsis a more severe syndrome.Traditional Chinese medicine has special advantages in participating in intervention and treatment of sepsis due to its holistic concept,syndrome differentiation and other treatment theories.Therefore,our team proposed to summarize the characteristics of traditional Chinese medicine syndrome in the critical stage of sepsis with the concept of"blood syndrome of sepsis",based on traditional Chinese medicine syndrome differentiation theoretical system and clinical experience summary.In this article,we summarized the modern research progress of the blood syndrome of sepsis from the perspectives of its pathogenesis and basic research.And we summarized its main clinical symptoms,explored its diagnosis and differential diagnosis from the perspective of conceptual analysis,and outlined and discussed the effective treatment principles and commonly used traditional Chinese medicine for this syndrome.It should be noted that endothelial injury plays an important role in the objective mechanism of blood syndrome of sepsis.The traditional Chinese medicine treatment with cooling blood and promoting blood circulation as the core principle may have a therapeutic effect on blood syndrome of sepsis through the protection of vascular endothelial function,and curb the trend of sepsis progressing to critical conditions such as shock,MODS,and DIC,ultimately improving the efficacy and prognosis of sepsis patients.We hope that our thinking and discussion could provide reference for the early identification and early treatment in the critical stage of sepsis,based on the theory of traditional Chinese m

关 键 词：脓毒症 血分证 理论探讨 血管内皮损伤 

分 类 号：R47[医药卫生—护理学]