基于数据挖掘探析从热毒论治脓毒症肺损伤

Analysis on Treatment of Sepsis-Induced Lung Injury from Heat Toxicity Based on Data Mining

目的:介绍热毒理论指导下的解毒法在脓毒症肺损伤中的运用,并通过数据挖掘法进一步总结和验证。方法:选取2018年1月至2020年6月山东中医药大学附属医院(西院区)重症医学科脓毒症肺损伤住院患者,将其中药原始处方录入Microsoft Excel软件,对中药频次、性味、归经、功效情况进行一般描述性分析,使用IBM SPSS Medeler 18.0的Apriori算法进行高频药物关联规则分析,使用IBM SPSS statistics 26.0进行高频药物聚类分析。结果:得到使用频率≥15%的高频药物共31味,如生地黄、炙甘草、连翘、石膏、栀子、黄芪等;通过关联规则分析得到常用药对,如金银花-连翘、栀子-黄芩等,三联药物组合如麸炒白术-党参-茯苓、黄芩-金银花-栀子等;通过聚类分析得到5首常用方。结论:解毒法贯穿脓毒症肺损伤治疗始终。发病初期,热毒之邪在肺卫,治以宣肺解毒;加重期,正邪交争,气分火毒炽盛,治以泻火解毒,若肺之热毒合并阳明腑实,治以通腑解毒;恢复期,若以正气亏虚为主,治以扶正解毒,若以阴亏津伤为主,则治以养阴解毒。

Objective:To introduce the application of detoxification method based on the heat toxin theory in sepsis-induced lung injury,and further summarize and verify it by data mining method.Methods:Inpatients with lung injury due to sepsis in Intensive Care Department of The Affiliated Hospital of Shandong University of traditional Chinese Medicine(western district)from January 2018 to June 2020 were selected and their original traditional Chinese medicine prescriptions were input into Microsoft Excel software to conduct general descriptive analysis on frequency,property,taste,meridian tropism,and efficacy of Chinese medicinals.The Apriori algorithm of IBM SPSS Medeler 18.0 was used for association rule analysis on high-frequency medicinals,and IBM SPSS statistics 26.0 was used for cluster analysis on high-frequency medicinals.Results:A total of 31 high-frequency drugs with a frequency higher than or equal to 15%were obtained,such as Shengdihuang(Rehmanniae Radix),Zhigancao(Glycyrrhizae Radix Et Rhizoma),Lianqiao(Forsythiae Fructus),Shigao(Gypsum Fibrosum),Zhizi(Gardeniae Fructus),Huangqi(Astragali Radix),etc..Through association rule analysis,commonly used drug pairs and triple-drug combinations were obtained,including Jinyinhua(Lonicerae Japonicae Flos)-Lianqiao(Forsythia Fructus),Zhizi(Gardeniae Fructus)-Huangqin(Scutellariae Radix),bran-fried Baizhu(Attractylodis Macroceohalae Rhizoma)-Dangshen(ChangII Radix)-Fuling(Poria),Huangqin(Scutellariae Radix)-Jinyinhua(Lonicerae Japonicae Flos)-Zhizi(Gardeniae Fructus),etc..By cluster analysis,five commonly used prescriptions were obtained.Conclusions:The detoxification method runs through the treatment of sepsis-induced lung injury.In the early stage of the disease,the heat toxin is in the lung-defense aspect,which should be treated with the method of ventilating lung and removing toxin.In the aggravating stage,the healthy qi is struggling with the pathogenic qi,with excessive heat toxin accumulated in qi aspect,which should be treated with the method of purging fire and removing toxin.If the heat toxin of lung is complicated with Fu-organ excess of Yangming meridian,the treatment should aimed at dredging Fu-organ and removing toxin.During the recovery period,if the symptoms are dominated by deficiency of healthy qi,the method of reinforcing healthy qi and removing toxin is recommended for treatment.However,if yin deficiency and body fluid injury is the main pathogenesis,the method of nourishing yin and removing toxin is more suitable for treatment.