冠脉搭桥术术前中医证型分布与术后肺部并发症的关系

Preoperative Distributive Characteristics of TCM Syndrome and the Relation to the Postoperative Pulmonary Complication in Patients Undergoing Coronary Artery Bypass Grafting

目的:探讨冠脉搭桥术患者术前中医证型分布特点及与术后肺部并发症的关系。方法:通过整理196份冠脉搭桥术病历,搜集术前中医证型和肺部并发症方面的资料,并将病例按有无肺部并发症分为两组,进行回顾性对照研究。比较两组间各因素有无差异。结果:冠脉搭桥术病人术前中医证型构成方面,基本证型包括心气虚、心阴虚、心阳虚、气滞、痰浊、血瘀,6个基本证型相互组合成为13个临床证型。血瘀89.79%;痰浊57.65%;心气虚仅47.45%;心阴虚仅29.59%。总体特点:以虚实夹杂,夹杂实邪多见,虚以心气虚、心阴虚为主;实以痰浊、血瘀为主。痰浊型发生术后肺部感染的几率较大;心阳虚型,发生术后肺间质水肿可能性较大。

Objective： To summarize the preoperative distributive characteristics about the syndrome of Traditional Chinese Medicine （TCM） in patients undergoing coronary arteries bypass grafting （ CABG）, and find the relation between syndrome of TCM and postoperative pulmonary complication （PPC） in these cases. In the end, try to alleviate these complications. Methods： Through having read the 196 cases medical recorders, we had gathered the data about the individual characteristics and preoperative TCM syndrome. Then, divided these cases into tow groups, one PPC and another non - PPC, we compared the data. There is some variation between them which be analyzed by statistical method, e.g. the numerical variable by t test, the count variable by X^2 test, respectively. The whole data were dealt with in computer by the SPSS 12.0 software. Eventually, we obtained the distribution of TCM syndrome and get the relationship between syndrome and PPC. Results ： Preoperative TCM syndrome in this study consists of Deficiency of Heart - Qi, Deficiency of Heart - Yin, Deficiency of Heart - Yang, Deficiency of Heart - Qi - Yin, Blood Stasis, Stagnation of Phlegm, and Stagnation of Qi. In actual clinical, these kinds of syndrome always assembled together, one by one, or one by two. Preoperative syndrome of TCM in patients undergoing CABG is characterized by Deficiency in the Root and Excess in the Branch, Deficiency mingling with Excess, but Excess in the Branch is more frequent and predominant. For incidence, the syndrome of Blood Stasis accounted for 89.79% of all cases, and the syndrome of Phlegm Stasis accounted for 57.65%. But, the syndrome of Deficiency of Xin - Qi only occupied 47.45% in all patients, and the syndrome of Deficiency of Xin - Yin occupied 29.59%. In addi- tion, another common syndrome, Stagnation of Cold in heart meridian, is hardly present in our study. It is considered that this may be related with the climate conditions of the south. Among these syndromes, preoperative Stagnation of Phlegm has some link with the incidence of pneumonia, and Deficiency of Xin - Yang relate to the pulmonary edema. Conclusions ： The Stagnation of Phlegm has higher probability in the incidence of pneumonia. The Deficiency of Xin - Yang has higher risk in the incidence of pulmonary edema. The treatment to Stagnation of Phlegm and Deficiency of Xin - Yang based on the Differential Diagnosis of TCM may have help for the protection to these complications.