急性呼吸窘迫综合征的临床及中医证候特点分析

Clinical and traditional Chinese medicine syndromes features of patients with acute respiratory distress syndrome

目的分析急性呼吸窘迫综合征(ARDS)患者的特点和中医证候分布,为临床进一步研究ARDS提供参考.方法回顾性分析2017年11月至2019年2月入住成都中医药大学附属医院重症医学科(ICU) ARDS患者的临床资料.收集患者一般资料(年龄、性别)、发病诱因、临床表现、ICU住院时间、总住院时间、ICU结局、随访28 d结局及中医证候等资料,分析不同程度ARDS组患者临床表现及中医证候分布特点.结果共入选ARDS患者110例,轻度ARDS组仅有2例,中度ARDS组33例,重度ARDS组75例;在ARDS的病因分析中,以感染为最常见,其中肺部感染46例(41.8%),脓毒症27例(24.5%),腹腔感染4例(3.6%),尿路感染2例(1.9%),有手术史13例(11.8%),ICU住院时间9.00 (3.00,18.00) d,总住院时间18.00 (10.00,30.00) d.而ICU内病死率为32.7%(36/110),随访28 d病死率为60.0%(66/110).中、重度ARDS患者临床症状以呼吸困难、咳嗽、发热、咯痰、胸闷、心悸为主,分别占75.0%(81/108)、43.5%(47/108)、28.7%(31/108)、26.9% (29/108)、22.2%(24/108)、25.9%(28/108).重度ARDS组呼吸困难、咳嗽、心悸患者比例均较中度ARDS组明显增加〔分别为80.0%(60/75)比63.6%(21/33)、50.7%(38/75)比27.3%(9/33),33.3%(25/75)比9.1%(3/33),均P<0.05〕.中医证候以阳虚欲脱、热毒炽盛、风热犯肺为主,分别占53.7%(58/108)、28.7%(31/108)、25.0% (27/108).重度ARDS组热毒炽盛证患者比例较中度ARDS组明显增加〔34.7%(26/75)比15.2%(5/33),P<0.05〕,而中度ARDS组风热犯肺证患者比例较重度ARDS组明显增加〔42.4%(14/33)比17.3%(13/75),P<0.05〕.结论ARDS病情危重、病死率高,临床症状复杂多样,中医证候以阳虚欲脱、热毒炽盛、风热犯肺为主,虚实夹杂且易成脱证.

Objective To analyze the distribution of traditional Chinese medicine(TCM)syndromes and characteristics of patients with acute respiratory distress syndrome(ARDS),and to provide reference for further clinical study of ARDS.Methods The clinical data of ARDS patients admitted to the Department of Critical Care Medicine of Affiliated Hospital of Chengdu University of TCM from November 2017 to February 2019 were retrospectively analyzed.The general data(gender and age)and inducing cause of disease,clinical manifestations,intensive care unit(ICU)stay time,total hospitalization time,outcome in ICU,outcome in 28-day follow-up and TCM syndromes were recorded.The different degrees of disease severity,the clinical manifestations and distribution characteristics of TCM syndromes were analyzed.Results A total of 110 patients with ARDS were enrolled,including 2 patients in mild ARDS group,33 patients in moderate ARDS group and 75 patients in severe ARDS group.In the etiology analysis of ARDS,infection was the commonest cause,including 46 cases of pulmonary infection(41.8%),27 cases of sepsis(24.5%),4 cases of abdominal cavity infection(3.6%),2 case of urinary tract infection(1.9%),and 13 cases had surgical histories(11.8%).The stay in ICU was 9.00(3.00,18.00)days and the total hospital stay was 18.00(10.00,30.00)days.The mortality in ICU was 32.7%(36/110),and that in 28-day follow-up was 60.0%(66/110).The clinical symptoms of the patients in moderate and severe groups ARDS were mainly dyspnea,cough,fever,sputum,chest tightness,and palpitations,accounting for 75.0%(81/108),43.5%(47/108),28.1%(31/108),26.9%(29/108),22.2%(24/108)and 25.9%(28/108),respectively.Compared with the ARDS moderate group,the proportions of patients with dyspnea,cough and palpitation in severe ARDS group were significantly higher[80.0%(60/75)vs.63.6%(21/33),50.7%(38/75)vs.27.3%(9/33),33.3%(25/75)vs.9.1%(3/33),respectively,all P<0.05].The main TCM syndromes were yang deficiency,exuberant heat-toxin,and wind-heat invading lung,accounting for 53.7%(58/108),28.7%(31/108),and 25.0%(27/108)respectively.The proportion of patients with exuberant heat-toxin syndrome in severe ARDS group was obviously higher than that in the moderate ARDS group[34.7%(26/75)vs.15.2%(5/33),P<0.05],while the proportion of patients with wind-heat invading lung syndrome in moderate ARDS group was more than that in the severe ARDS group[42.4%(14/33)vs.17.3%(13/75),P<0.05].Conclusion ARDS is a critical illness with high mortality and various complicated clinical symptoms,the TCM syndromes of ARDS are mainly yang deficiency,exuberant heat-toxin,wind-heat invading lung,and intermingling of deficiency and excess easily leading to collapse syndrome.