脓毒症不同时期水肿的中医辨证治法

TCM treatment based on pattern identification for edema in different stages of sepsis

水肿是脓毒症期和脓毒症休克期、多脏器功能障碍期常见症状。蛋白是维持血管内外胶体渗透压平衡的主要物质,脓毒症炎性反应消耗大量蛋白,同时毒素损伤血管内皮细胞使其通透性增加蛋白泄漏至组织间隙,血管内外压力失衡液体分布失常是脓毒症水肿发生的主要原因。脓毒症期水肿伴高热持续不退、便秘、少尿或无尿,舌质红绛或有瘀斑,舌苔黄腻或燥,脉滑数等症状,表现为实热证的水肿属于阳水,治以清热解毒活血通络为主,又出现急性虚证,当兼顾益气。休克期或多脏器功能障碍期正虚邪恋,正气耗损严重,遍身水肿,肿处皮肤松弛按之如泥,大便溏,小便少,为虚证或寒证,属阴水,需治以益气温阳,佐以清热解毒活血通络。

Edema is a common symptom in the shock stage of sepsis and multiple organ dysfunction syndrome.Protein is the main substance that maintains the balance of colloidal osmotic pressure inside and outside blood vessels.Inflammatory response in sepsis consumes a lot of protein.Meanwhile,due to damage to vascular endothelial cells,their permeability is increased.As a result,protein leaks into the interstitial space.This abnormal fluid distribution as well as pressure imbalance inside and outside blood vessels are the chief reasons for toxic edema.The symptoms included persistent high fever,constipations,oliguria or absence of urination,redness of the tongue or with stasis,yellow slimy or dry tongue coating,slippery pulse.For edema with heat pattern,which is considered as yang water in TCM,the treatment approach is to clear away heat,detoxify and promote blood circulation.If acute deficiency pattern is present,replenishing qi should be taken into consideration.In the shock stage of sepsis or during multiple organ dysfunction period,it is the defeciency pattern or cold pattern,which is considered as yin water in TCM.In this stage,healthy qi is insufficient and pathogenic qi lingers.Healthy qi is greatly damaged.And edema all over the body is present.The skin around the swollen area is loose as if touching mud.Loose stools,little urination are also present.The main treatment approach is to replenish qi to warm yang so as to clear away heat,detoxify,promote blood circulation and dredge collaterals.