以舌诊为主的辨证治疗对脓毒性休克微循环的影响

Effects of Syndrome Differentiation and Treatment on Basis of Tongue Diagnosis on Microcirculation of Septic Shock Patients

目的观察舌质舌苔辨证诊疗对脓毒性休克患者微循环的影响。方法对脓毒性休克患者进行舌质舌苔辨证,对同证候患者随机分组,并对治疗组应用中药辨证治疗,分别在确诊时、第24小时、第72小时测定患者的心率、平均动脉压、血乳酸、可溶性细胞间黏附分子-1(sICAM-1)、内皮素-1(ET-1)。结果根据患者舌质、舌苔结合脓毒症病机辨证为阳气暴脱证、毒热内盛证、瘀血阻滞证;对阳气暴脱证应用参附汤治疗,治疗组第24小时平均动脉压显著高于对照组(P<0.01),心率、血乳酸低于对照组(P<0.05),第72小时治疗组平均动脉压高于对照组(P<0.05),心率、血乳酸、血清sICAM-1、ET-1含量低于对照组(P<0.05);对毒热内盛证应用清营汤合生脉散治疗,治疗组第24小时血清sICAM-1、ET-1含量低于对照组(P<0.05),治疗组第72小时平均动脉压高于对照组(P<0.05),心率、血乳酸、血清sICAM-1、ET-1含量均低于对照组(P<0.05);对瘀血阻滞证应用桃红四物汤加味治疗,治疗组第24小时血乳酸、血清sICAM-1、ET-1含量低于对照组(P<0.05),第72小时平均动脉压高于对照组(P<0.05),心率、血乳酸、血清sICAM-1、ET-1含量低于对照组(P<0.05)。结论应用舌质舌苔辨证治疗可以改善脓毒性休克患者的微循环,其作用机制可能与降低血管内皮细胞ICAM-1表达,减轻内皮损伤有关。

Objective：To study effects of syndrome differentiation and treatment on the basis of tongue diagnosis on microcirculation of patients with septic shock.Methods：Patients with septic shock checked in ICU from January 2012 to June 2013 were differentiated on the basis of tongue nature and fur.Same syndrome patients were randomly divided into 2 groups.Treatment group was given herbal decoction.Survey and record heart rate （HR）,mean arterial pressure （MAP）,lactate（Lac）,soluble intercellular adhersion molecule-1 （sICAM-1） and endothelin-1 （ET-1） at the time of diagnosis,24th hour and 72th hour.Results：（1）Red or crimson tongue with yellow or without fur （32/91）,pale tongue with very little fur （23/91）,dark and purplish tongue with white or yellowish fur （19/91） were common,corresponding syndromes of which were intense toxic heat,sudden yang collapse,and blood stasis.（2）After treating patients of sudden yang collapse syndrome with Shenfu Decoction,MAP of treatment group was significant higher （P＜0.01） while HR and Lac were lower than those of control group at the time of 24 h（P＜0.05）.MAP was higher and HR,Lac,sICAM-1 and ET-1 were lower than those of control group （P＜0.05）.（3）After treating patients of intense toxic heat syndrome with Qingying Decoction and Shenmai Powder,sICAM-1 and ET-1 were lower than those of control group （P＜0.05） at the time of 24 h;MAP was higher and HR,Lac,sICAM-1 and ET-1 were lower than those of control group（P＜0.05） at the time of 72 h.（4）After treating patients of blood stasis syndrome,Lac,sICAM-1and ET-1 of treatment group were lower than those of control group （P＜0.05） at the time of 24h.MAP was higher and HR,Lac,sICAM-1 and ET-1 were lower than those of control group （P＜0.05）.Conclusion：Syndrome differentiation and treatment on basis of tongue nature and fur can improve microcirculation of patients with septic shock.The mechanism of that could reduce ICAM-1 expression and endothelial injury.