不同舌色脓毒症休克患者血流动力学差异研究

Differences in Hemodynamics between Septic Shock Patients with Different Tongue Colors

目的观察不同舌色的脓毒症休克患者血流动力学差异,为脓毒症休克患者中医舌诊提供理论依据。方法采用前瞻性研究方法,纳入符合入选标准的67例脓毒症休克患者,根据舌色将其分为白舌组22例、紫舌组25例及红舌组20例。采用脉搏指示连续心输出量方法测定各组患者平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心排血指数(cardiac output index,CI)、总舒张末期容量指数(general end-diastolic volume index,GEDVI)、胸腔内总血容量指数(intrathoracic blood volume index,ITBVI)、体循环血管阻力指数(systemic vascular resistance index,SVRI)、血管外肺水指数(extravascular lung water index,EVLWI)等,并记录急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、重症监护病房(intensive care unit,ICU)留置天数及28d病死率。结果 3组患者CVP、MAP差异无统计学意义(P>0.05);与红舌及白舌组比较,紫舌组CI明显降低(P<0.05),GEDVI、ITBVI、EVLWI明显升高(P<0.05)。3组APACHEⅡ评分比较,差异无统计学意义(P>0.05);3组ICU留置时间比较,差异具有统计学意义(P<0.05),其中紫舌组ICU留置时间明显多于红舌组(P<0.05),白舌组和红舌组ICU留置时间的差异无统计学意义(P>0.05)。结论脓毒症休克患者舌色与血流动力学改变密切相关,可用于判断病情严重程度,对指导预后有一定意义。

Objective To investigate the differences in hemodynamics between septic shock patients with different tongue colors, and to provide a theoretical basis for traditional Chinese medicine （TCM） tongue diagnosis of patients with septic shock. Methods A prospective study was performed, and a total of 67 patients with septic shock who met the inclusion criteria were enrolled. According to the tongue color, these patients were divided into white tongue group with 22 patients, purple tongue group with 25 patients, and red tongue group with 20 patients. The pulse-indicated continuous cardiac output was used to measure mean arterial pressure （MAP）, central venous pressure （CVP）, cardiac output index （CI）, gen- eral end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, systemic vascular resistance index （SVRI）, and extravascular lung water index （EVLWI）, and the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ ） score, number of days in the intensive care unit （ICU）, and 28-day mortality rate were recorded. Results There were no significant differences in CVP and MAP between the three groups （P〉0.05）. Compared with the red tongue group and the white tongue group, the purple tongue group had a significant reduction in CI （P〈0. 05） and significant increases in GEDVI, ITBVI,and EVLWI （P〈0.05）. There were no significant differences in the APACHE Ⅱ score or number of days in the ICU between the three groups （P〉0. 05）. The purple tongue group had a significantly higher number of days in the ICU than the red tongue group （P〈0. 05）, while there was no significant difference between the white tongue group and the red tongue group （P〉0.05）. Conclusion In patients with septic shock, tongue color is closely associated with hemodynamic changes and can be used to judge the severity of patients＇ conditions and their prognosis.