慢性阻塞性肺疾病稳定期中医脏腑辨证与营养状态、血气分析的变化

Visceral syndrome differentiation in traditional Chinese medicine and the changes of nutrition status or blood gas analysis in patients with chronic obstructive pulmonary disease

观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者中医脏腑辨证与营养状态、血气分析的关系。方法:将60例COPD稳定期患者按中医脏腑辨证分为肺气虚型(n=20)、肺脾气虚型(n=16)和肺脾肾气虚型(n=24)。运用胃电图基本电节律、胃动过缓百分率、实际体质量(actual body weight,ABW)与理想体质量(ideal body weight,IBW)的百分比以及血清白蛋白等指标来评估患者的营养状态,同时进行血气分析。结果:肺气虚型、肺脾气虚型和肺脾肾气虚型患者胃电图基本电节律分别为(56.20±13.24)%、(47.38±10.24)%、(41.35±10.01)%,肺脾气虚型和肺脾肾气虚型较肺气虚型明显降低(P<0.05);胃动过缓百分率分别为(45.18±18.13)%、(46.31±15.83)%、(49.90±17.54)%,3组比较差异无统计学意义(P>0.05)。肺气虚型、肺脾气虚型、肺脾肾气虚型ABW/IBW<90%的发生率分别为50%、75%、54.17%,3组比较差异无统计学意义(P>0.05);血清白蛋白<35g/L的发生率分别为20%、37.5%、54.17%,3组比较差异亦无统计学意义(P>0.05)。肺气虚型、肺脾气虚型、肺脾肾气虚型的动脉血氧分压分别为(78.15±16.63)mmHg、(63.56±15.06)mmHg、(63.17±19.05)mmHg,肺脾气虚型和肺脾肾气虚型的氧分压均较肺气虚型明显降低(P<0.05);动脉血二氧化碳分压分别为(42.25±12.46)mmHg、(48.60±17.60)mmHg、(49.97±13.43)mmHg,3组比较差异无统计学意义(P>0.05)。结论:随着病情程度和低氧、二氧化碳潴留的加重,累及脏腑数目亦相应增加,胃肠道功能障碍和营养不良的发生也有一致性的结果。

Objective： To investigate the relationship between visceral syndrome differentiation in traditional Chinese medicine （TCM） and the changes of nutrition status or blood gas analysis in patients with chronic obstructive pulmonary disease （CQPD）. Methods： Sixty patients with COPD in stable phase were divided into dysfunction of lung （DL, n=20） group, dysfunction of lung and spleen （DLS, n=16） group and dysfunction of lung, spleen and kidney （DLSK, n= 24） group according to syndrome differentiation of TCM. Moreover, the basic electric rhythm, percentage of bradygastria in electrogastrogram （EGG）, ratio of actual body weight （ABW） to ideal body weight （IBW） and serum albumin level were determined to evaluate the nutrition status of the patients with COPD. Blood gas analysis was made too. Results： The basic electric rhythm values in the DL, DLS and DLSK groups were （56. 20±13. 24）%, （47.38±10.24）% and （41.35±10.01）%, respectively. Compared with the DL group, the basic electric rhythm values in the DLS and DLSK groups decreased obviously （P〈0.05）. The percentages of bradygastria in the DL, DLS and DLSK groups were （45. 18±18.13）%, （46. 31±15.83）% and （49. 90±17.54）%, respectively, and there were no differences among the three groups （P〉0.05）. The incidence rates of ABW/IBW〈90% in the DL, DLS and DLSK groups were 50%, 75% and 54.17%, respectively, and there were no differences among the three groups （P〉0.05）. The incidence rates of serum albumin less than 35 g/L were 20%, 37.5% and 54.17%, respectively, and there were no differences among the three groups （P〉0.05）. PO2 in the DLS group [（63. 56±15.06） mmHg] and DLSK group [（63.17±19.05） mmHg] were decreased as compared with the DL group [-（78.15±16.63） mmHg] （P〈0.05）. PCO2 in the DL, DLS and DLSKgroups were （42. 25± 12. 46） mmHg, （48. 60± 17. 60） mmHg and （49. 97± 13. 43） mmHg respectively, and there were no differences among the three groups （P〉0.05）. Conclusion; Several dysfunction organs described in TCM were involved in COPD followed by the increased severity, hypoxemia and PCOz. Dysfunction of gastrointestinal tract and malnourishment took place accord- ingly.