脓毒症患者中医证候分析

Analysis of TCM syndromes in patients with sepsis

目的:探讨脓毒症的中医证候分型规律,为中西医结合治疗脓毒症提供依据。方法:回顾性分析2017年1月至2018年8月于成都中医药大学附属医院重症医学科诊断为脓毒症122例患者的一般资料、临床表现、中医四诊资料得出中医证候,并对感染标志物与中医证型关系进行分析。结果:脓毒症患者纯虚证19例(15.6%),虚实夹杂证72例(59.0%),纯实证31例(25.4%),其中存在阳虚患者58例(47.5%)。白细胞计数在纯实证与纯虚证间、C反应蛋白在纯实证与虚实夹杂证、降钙素原在纯实证与纯虚证、纯实证与虚实夹杂证间比较,差异有统计学意义(P<0.05)。结论:脓毒症患者临床以虚实夹杂多见;虚证方面以阳虚、气虚多见,实证又有热、痰、湿的不同;而尤以阳虚患者多见;实证患者可能在感染指标上较虚证患者更高。

Objective:To explore the TCM syndromes classification rules of sepsis,and to provide evidence for the treatment of sepsis with integrated traditional Chinese medicine and western medicine.Methods:The general date,clinical manifestations and four diagnostic data of TCM of patients who were diagnosed with sepsis in the ICU of Teaching Hospital of Chengdu University of TCM from January 2017 to August 2018 were retrospectively analyzed to established the relationship of infection markers and TCM syndromes.Results:There were 19 cases(15.6%)with pure deficiency syndrome,72 cases(59.0%)with syndrome of intermingled deficiency and excess,31 cases(25.4%)with pure excess syndrome,including 58 cases(47.5%)with yang deficiency.Comparing the white blood cell count between pure positive syndrome and pure deficiency syndrome,C-reactive protein between pure positive syndrome and syndrome of intermingled deficiency and excess,procalcitonin between pure positive syndrome and pure deficiency syndrome with pure positive syndrome and syndrome of intermingled deficiency and excess,the differences were statistically significant(P<0.05).Conclusion:Patients with sepsis are more likely to have syndrome of intermingled deficiency and excess,yang deficiency and qi deficiency are more common in deficiency syndrome,and excess heat,phlegm,dampness are more common in excess syndrome.Yang deficiency patients are more common in all patients,the treatment of’warming yang and subsiding yang’is better for patients with yang deficiency.Patients with excess syndrome may have higher infection indicators than patients with deficiency syndrome.