ICU重症肺炎的中医证候分布特征研究

Study on the distribution characteristics of traditional Chinese medicine syndromes of severe pneumonia in ICU

目的总结ICU重症肺炎患者的中医证型及证候要素分布特点,对ICU重症肺炎患者开展中医药方面的治疗提供依据。方法收集2015年1月~2019年9月安徽省中医院ICU收治的重症肺炎患者病例,采用描述性统计学方法计算证候及症状的频数和构成比,总结分析其中医辨证分型及证候要素的分布特征。结果纳入研究患者158例,中医证型分布包括痰热壅肺证、肺胃热盛证、气阴两虚证、风热犯肺证、热闭心包证。其中实证120例,占总体的75.95%;虚证38例,占总体的24.05%。证候要素分布中,实性证素包括痰、热、瘀、湿、风,虚性证素包括气虚、阴虚、阳虚、血虚。预后情况方面,痰热壅肺证死亡10例,肺胃热盛证死亡6例,气阴两虚证死亡4例,热闭心包证死亡4例,风热犯肺证死亡0例。结论重症肺炎的中医证型以实证为主,其中痰热壅肺证是主要证型,气阴两虚证也不可忽视;在治疗中应主要采用清热化痰药物,还要注意益气养阴药物的使用。在预后方面,热闭心包证死亡率最高,在治疗中应未病先防、既病防变,防止毒邪入里。

Objective To summarize the distribution characteristics of traditional Chinese medicine(TCM)syndrome types and syndrome elements distribution in ICU patients with severe pneumonia,to provide basis for the treatment of TCM in ICU patients with severe pneumonia.Methods Cases of severe pneumonia in ICU of Hospital of TCM of Anhui Province from January 2015 to September 2019 were collected.The frequency and proportion of syndromes and symptoms were calculated by using descriptive statistical methods.The TCM syndrome differentiation and the distribution features of syndrome elements were summarized and analyzed.Results A total of 158 patients were included in this study.The syndromes of TCM included phlegm-heat obstructing the lung syndrome,exuberant heat in the lung and stomach syndrome,dual deficiency of qi and yin syndrome,wind-heat invading the lung syndrome,syndrome of heat sink pericardium.In all of TCM syndromes,excess syndrome accounted for 75.95%(120 patients),deficiency syndrome accounted for 24.05%(38 patients).The elements of excess syndrome included phlegm,heat,blood stasis,damp,wind.And deficiency syndromes were composed of qi deficiency,yin deficiency,yang deficiency,blood deficiency.In terms of prognosis,10 cases died of phlegm-heat obstructing the lung syndrome,6 cases died of exuberant heat in the lung and stomach syndrome,4 cases died of dual deficiency of qi and yin syndrome,4 cases died of syndrome of heat sink pericardium,0 case died of wind-heat invading the lung syndrome.Conclusion The excess syndromes is the main syndrome in TCM syndromes,the phlegm-heat obstructing the lung syndrome is the main syndrome type.The dual deficiency of qi and yin syndrome should not be ignored.In the treatment of TCM,the drugs and methods mainly are heat-clearing and phlegm-dispelling.In the treatment should mainly use heat clearing and phlegm resolving drugs,but also pay attention to the use of Yiqi Yangyin drugs.In the aspect of prognosis,the mortality of syndrome of heat sink pericardium is the highest.So it′s necessary to prevent before the disease arises and prevent disease from exacerbating in case of pathogenic factors toward the interior.