重症监护病房危重病患者腹泻的中医证型分布

Study on the distribution of TCM syndrome type in critical patients with diarrhea in Intensive Care Unit

目的探讨危重病患者腹泻中医证型分布特点,为危重病患者腹泻辨证施治提供依据。方法采用观察性研究方法 ,观察2012年1月~2013年1月入住中国中医科学院广安门医院重症监护病房且出现腹泻并符合纳入标准的患者,收集一般情况、24 h后APACHEⅡ评分、腹泻发生时间、持续时间、腹泻相关因素、中医证型、腹泻发生当天便常规及其预后转归等内容。结果共观察70例患者,其中,男44例,女26例;寒热错杂、清浊相混证41例,占58.6%;脾肾阳虚证16例,占22.8%;脾胃湿热证13例,占18.6%。脾肾阳虚证中APACHEⅡ评分≥20分者11例,占68.8%,病死9例,为病死率最高的证型,占56.2%。结论寒热错杂、清浊相混证为危重病患者腹泻的主要证型,治疗上应补泄兼施,寒热并调。脾肾阳虚证病情严重程度较重,病死率较高。

Objective To study the distribution of TCM syndrome type in critical patients with diarrhea, so as to provide evidence for syndrome differentiation and treatment. Methods Critically ill patients with diarrhea in ICU from January 2012 to January 2013 were observed, and those who were in accordance with the inclusion criteria were included. The diarrhea patients＇ general information, APACHE Ⅱ score within the first 24 hours after admission, the diarrhea occurrence time, the duration of diarrhea, the relative factors in diarrhea, TCM syndrome type, dejecta RT and the prognosis were collected. Results A total of 70 patients with 44 male and 26 female were included in this study.The distribution of TCM syndrome types were as follow： the percentage of cold-syndrome associated with heat-syndrome was 58.6% with 41 cases, the yang deficiency of spleen and kidney was 22.8% with 16 cases, and the spleen stomach damp heat syndrome was 18.6% with 13 cases. 11 cases of the patients with yang deficiency of spleen and kidney were found with APACHE Ⅱ≥20 scores, occupying the highest ratio within the three syndrome types, about68.8%. The mortality rate of the yang deficiency of spleen and kidney type also topped in the three, with 9 cases, about56.2%. Conclusion This study shows that the most common TCM syndrome type in critically ill patients with diarrhea is cold-syndrome associated with heat-syndrome, which indicates that the treatment should include both reinforcing and discharging methods, and regulating cold and heat. The yang deficiency of spleen and kidney type may closely relate to a poorer prognosis and higher mortality rate than other types.