基于脓毒症的五段论认识来论治脓毒症——一个小样本的病例回顾性研究

Treating sepsis based on five segments understanding of sepsis:a retrospective study of a small sample of cases

目的基于脓毒症的五段论,探讨中医药联合常规西医治疗脓毒症的临床疗效,为临床诊治脓毒症提供新的思路和理论依据。方法选择成都中医药大学附属医院重症监护病房(ICU)2021年11月至2022年1月收治的45例脓毒症患者,按治疗方法分为中西医结合组(基于脓毒症的五段论给予相应的辨证论治)和常规西医组。收集两组患者的一般临床资料、基础疾病、治疗前后实验室检查结果和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、中医症状评分等信息,比较两组的临床疗效。结果中西医结合组治疗后白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)较治疗前下降;常规西医组治疗后血红蛋白(Hb)较治疗前下降;对比两组治疗后各项指标,其中WBC、hs-CRP、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、PCT差异有统计学意义(均P<0.05)。中西医结合组平均ICU住院时间、平均机械通气时间均较常规西医组明显缩短(d:11.33±5.07比15.97±7.87,9.20±4.44比13.17±6.79,均P<0.05);中西医结合组治疗后APACHEⅡ评分和中医症状评分均较治疗前明显下降(分:17.00±3.20比25.00±4.83,7.47±1.30比12.27±1.16,均P<0.05),中西医结合组疗效明显优于常规西医组。中西医结合组28 d病死率显著低于常规西医组(33.7%比66.7%,P<0.05)。结论基于脓毒症的五段论,通过辨证论治,运用中医药联合常规西医治疗ICU脓毒症患者,能有效减轻炎症反应,改善肝功能,缩短ICU住院时间和机械通气时间,降低APACHEⅡ评分及中医症状评分,减轻患者中医症状,从而降低患者28 d病死率。

Objective Based on the five segments of sepsis,to discuss the clinical efficacy of sepsis treatment combining traditional Chinese medicine(TCM)with conventional Western medicine(WM),and provide new ideas and theoretical basis for clinical diagnosis and treatment of sepsis.Methods A total of 45 patients with sepsis admitted to the intensive care unit(ICU)of the Affiliated Hospital of Chengdu University of TCM from November 2021 to January 2022 were selected and divided into two groups by different treatment methods,namely an integrated TCM and WM group(corresponding syndrome differentiation and treatment based on the five segments of sepsis)and a conventional WM treatment group.The information was collected from the two groups of patients,including the general clinical data,underlying diseases,laboratory test results before and after treatment,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and TCM symptom scores,to compare the clinical efficacy of those two groups.Results After treatment,the levels of white blood cell count(WBC),high sensitivity C-reactive protein(hs-CRP)and procalcitonin(PCT)were decreased in the integrated TCM and WM group;the hemoglobin(Hb)was declined in the conventional WM group;there were statistically significant differences in WBC,hs-CRP,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and PCT between the two groups after treatment(all P<0.05).The average ICU stay time and average mechanical ventilation time in the integrated TCM and WM group were significantly lower than those in the conventional WM group(days:11.33±5.07 vs.15.97±7.87,9.20±4.44 vs.13.17±6.79,both P<0.05).After treatment,the APACHEⅡscore and TCM symptom score in the integrated TCM and WM group were significantly lower than those before treatment(17.00±3.20 vs.25.00±4.83,7.47±1.30 vs.12.27±1.16,both P<0.05),better than the conventional WM group.The 28-day mortality in the integrated TCM and WM group was significantly lower than that in the conventional WM group(33.7%vs.66.7%,P<0.05).Conclusion Based on the five segments of sepsis,through syndrome differentiation and treatment of TCM,the combining TCM with conventional WM for treatment of ICU sepsis patients can effectively reduce the inflammatory reaction,improve liver functions,shorten ICU hospital stay and mechanical ventilation times,decrease APACHEⅡand TCM symptoms scores,and relieve TCM symptoms,so as to reduce 28-day mortality.