基于营血辨证总结药源性脓毒性休克一例

Summarizing one case of drug-induced septic shock based on nutrient-blood syndrome differentiation

叶桂(字天士)作为温病学派的奠基人,其创立的卫气营血辨证理论是温热时邪外感疾病在不同阶段采取不同辨证方法的重要依据。重症药疹是由药物引起的一种皮疹分布广泛,病情发展迅速,常伴有全身中毒症状及内脏损害,易出现脓毒症等严重并发症的疾病。外来药物引起的脓毒症、脓毒症性休克,其病因和卫气营血辨证理论具有高度一致性。中医根据药源性脓毒性休克的症状,把其归于“厥脱证”范畴。重庆市中医院重症医学科收治1例重症药疹引起的脓毒症、脓毒性休克以及多器官功能障碍综合征患者。文章主要叙述其病情变化及病程演变过程中抗生素、血管活性药物的选择、连续性肾脏替代治疗(Continuous Renal Replacement Therapy,CRRT)的使用、中医的辨证思路及处方用药等,同时指出药源性脓毒症的病因是药物,病机是正虚毒损、络脉瘀滞,阐述药源性脓毒症和肺在体合皮、营分证阶段透热养阴的治疗原则、透热转气与CRRT工作原理的关系,以及血分证广泛出血的原因,希望对典型案例进行分析,得出中西医结合治疗药源性脓毒症的经验,探讨中医营血辨证体系和药源性脓毒症病程演变过程的相似性,为营血辨证指导药源性脓毒症的治疗提供有益参考。

As the founder of the School of Febrile Diseases,YE Gui established the theory of syndrome differentiation of Wei-Qi-Ying-Xue(卫气营血)(defense-Qi-nutrient-blood syndrome differentiation),which is an important basis for adopting different syndrome differentiation methods in different stages of febrile diseases.Severe drug eruption induced sepsis is a kind of widely distributed rash caused by drugs,it is a disease with rapid development,which is often accompanied by systemic poisoning symptoms and internal damage,sepsis and other serious complications are easy to appear.The etiology of sepsis and septic shock caused by foreign drugs is highly consistent with the theory of syndrome differentiation of Wei-Qi-Ying-Xue.In TCM,drug-induced septic shock belongs to the category of Juetuo syndrome.Department of Critical Care Medicine of Chongqing Hospital of Traditional Chinese Medicine received and cured one case of severe drug eruption induced sepsis,septic shock,and multiple organ dysfunction syndrome.The paper mainly describes the selection of antibiotics,vasoactive drugs,the use of continuous renal replacement therapy(CRRT),and the syndrome differentiation of traditional Chinese medicine in the course of its evolution.At the same time,it points out that the etiology of drug-induced sepsis is drugs,and the pathogenesis is positive Qi deficiency and toxic damage,and collateral stasis.Then it expounds drug-induced sepsis and the teeatment principle of the lungs are related to the skin in the body,expelling heat and nourishing Yin(阴)in the stage of Ying,the relationship between expelling heat and Qi transforming and the working principle of CRRT and the cause of extensive bleeding in the stage of blood syndrome.It is prospected that by analyzing typical cases,the experience of the integrative medicine in the treatment of drug-induced sepsis is obtained,and the similarities between TCM Wei-Qi-Ying-Xue syndrome differentiation system and the course evolution of drug-induced sepsis are discussed,so as to provide useful reference for the treatment of drug-induced sepsis guided by syndrome differentiation of Wei-Qi-Ying-Xue.