脓毒症休克患者早期中医证候要素与PiCCO监测指标的关系研究

Relationship of Traditional Chinese Medical Syndrome Elements of Early Septic Shock Patients with Pulse-indicated Continuous Cardiac Output Indicators

【目的】探讨脓毒症休克患者脉搏指数连续心排量(PiCCO)监测指标与早期中医证候要素的关系。【方法】采用回顾性调查方法,收集78例脓毒症休克患者PiCCO监测指标和中医证候要素等资料,进行PiCCO监测指标与早期中医证素的单因素分析,PiCCO监测指标包括心脏指数(CI)、全心舒张末期容积指数(GEDI)、血管外肺水指数(EVLWI)、体循环阻力指数(SVRI)。【结果】脓毒症早期中医证素分布以气虚证(84.62%)、痰浊证(66.67%)、血瘀证(43.59%)最为常见。证素频次依次为:气虚证>痰浊证>血瘀证>水停证>火热证、阴虚证。采用单因素方差分析比较CI、GEDI、EVLWI、SVRI在不同证素之间的差异,结果提示各组差异均无统计学意义(P>0.05);组间的两两比较结果显示,血瘀证与火热证的EVLWI差异有统计学意义(P<0.05)。采用独立样本t检验比较,血瘀兼证组与非血瘀证组的CI、GEDI、SVRI差异无统计学意义(P>0.05),EVLWI差异有统计学意义(P<0.05)。【结论】脓毒症早期伴火热证在出现脓毒症休克时EVLWI较血瘀证升高。脓毒症早期血瘀兼证组在出现脓毒症休克时EVLWI低于非血瘀证组。将PiCCO监测指标与脓毒症的中医辨证有机结合,采取直中病机的主要治法,将有助于进一步完善脓毒症休克中医治疗方案的制定。

Objective To investigate the relationship of traditional Chinese medical syndrome elements of early septic shock patients with pulse-indicated continuous cardiac output （PiCCO） indicators. Methods A retrospective study was carried out in 78 early septic shock patients. We collected the data of traditional Chinese medical syndrome elements and PiCCO indicators such as cardiac index （CI）, global end diastolic volume index （GEDI）, extravascular lung water index （EVLWI） and systemic vascular resistance index （SVRI）, and then performed one-factor analysis of variance. Results In early septic shock patients, qi deficiency syndrome, phlegm turbidity syndrome and blood stasis syndrome were predominant, accounting for 84.62%, 66.67%, 43.59% respectively. Decreasing sequence was shown in the frequency of syndrome elements of qi deficiency syndrome, phlegm turbidity syndrome, blood stasis syndrome, fluid retention syndrome, and fire heat syndrome （yin deficiency syndrome）. The results of one-factor analysis of variance showed that no significant difference was found in CI, GEDI, EVLWI and SVRI among various groups（P〉0.05）. The results of inter-group pair-wise comparison showed that the difference of EVLWI between blood stasis syndrome and fire heat syndrome was significant （P〈0.05）. The results of independent-sample T test showed that the differences of CI, GEDI and SVRI between blood stasis syndrome and non-blood stasis syndrome were insignificant （P〉0.05）, but the difference of EVLWI was significant （P〈0.05）. Conclusion Increased EVLWI at septic shock stage shows up earlier in early sepsis patients with fire heat syndrome than those with blood stasis syndrome, and EVLWI at septic shock stage is lower in early sepsis patients with blood stasis syndrome than that in patients with non-blood stasis syndrome. The combined consideration of PiCCO indicators and syndrome differentiation will be helpful for the establishment of pathogenesis-targeted traditional Chinese medical regimen for septic shock.