135例脓毒症急性肺损伤患者证候分布规律与中医诊疗理论认识思考

Syndrome Distribution Pattern of 135 Cases of Sepsis-induced Acute Lung Injury and Understanding of Traditional Chinese Medicine Diagnosis and Treatment Theory

目的探讨脓毒症急性肺损伤患者的中医证候分布规律与特征,为临床提供辨证论治依据。方法采用回顾性研究方法,收集山东中医药大学附属医院2017年1月至2020年12月脓毒症急性肺损伤患者临床资料,设计中医证候调查表,建立数据库,运用SPSS26.0软件统计分析。结果共收集135例患者病历,平均年龄(64.38±17.61)岁,61~80岁年龄段患者最多。28 d生存患者占比61%,平均年龄(57.78±17.86)岁;死亡患者占比39%,平均年龄(70.98±17.37)岁。主要基础疾病以高血压病、心脑血管疾病、糖尿病居多。单一证候例数:热毒证>痰热证>血瘀证>腑实证>气虚证>痰浊证>阳虚证>阴虚证。复合证候例数:两种证候复合>3种证候复合>1种证候。两种证候复合以热毒证+腑实证最多,3种证候复合以热毒证+痰热证+腑实证最多,1种证候以热毒证最多。证候虚实例数:实证>虚实夹杂证>虚证,生存率相反。结论基本病机为邪实正虚,肺失宣降。病理性质总属标实本虚。病理因素包括热毒、痰、瘀。证型以热毒、痰浊、血瘀、腑实等实证为主,以复合证候多见,虚实夹杂证尤其是虚证多预后不良。脓毒证急性肺损伤治疗应以清热、化痰、活血、通腑为主,辅以益气、温阳、养阴,年老患者尤其需要扶助正气。本病病情复杂,应从整体出发,进一步把握疾病全过程证候演变规律,丰富完善辨证体系。

Objective:To explore the distribution patterns and characteristics of traditional Chinese medicine syndromes in patients with sepsis-induced acute lung injury,and to provide a basis for clinical diagnosis and treatment based on syndrome differentiation.Methods:A retrospective study method was used to collect clinical data of patients with sepsis-induced acute lung injury from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2017 to December 2020.A traditional Chinese medicine(TCM)syndrome questionnaire was designed,a database was established,and SPSS 26.0 software was used for statistical analysis.Results:The medical records of a total of 135 patients were collected,with an average age of(64.38±17.61)years,and the highest number of patients in the 61~80 age group;61%of the patients survived 28 days,with an average age of(57.78±17.86)years;the patients who died accounted for 39%,with an average age of(70.98±17.37)years.The main basic diseases were hypertension,cardiovascular and cerebrovascular diseases,and diabetes.The number of cases with a single syndrome:heat toxin syndrome>phlegm heat syndrome>blood stasis syndrome>fushi syndrome>qi deficiency syndrome>phlegm turbidity syndrome>yang deficiency syndrome>yin deficiency syndrome.The number of cases with composite syndrome:two types of composite syndrome>three types of composite syndrome>one type of composite syndrome.The most common combination of two syndromes was heat toxin syndrome+visceral syndrome,the most common combination of three syndromes was heat toxin syndrome+phlegm heat syndrome+visceral syndrome,and the most common one type was heat toxin syndrome.The number of cases of deficiency and excess syndrome:excess syndrome>mixed deficiency and excess syndrome>deficiency syndrome,while the survival rate was in the opposite order.Conclusion:The basic pathogenesis is pathogenic excess,positive deficiency,and lung dysfunction.The pathological nature always belongs to the syndrome of excess in symptoms and deficiency in origin.Pathological factors include heat toxicity,phlegm,and blood stasis.The syndrome types are mainly characterized by heat toxicity,phlegm turbidity,blood stasis,and visceral excess,with complex syndromes being common.The prognosis is poor due to the combination of deficiency and excess,especially the deficiency syndrome.The treatment should mainly focus on clearing heat,resolving phlegm,promoting blood circulation,and clearing the internal organs,supplemented by tonifying qi,warming yang,and nourishing yin.Elderly patients especially need to support the healthy qi.The condition is complex,and we should start from the overall perspective,further grasp the evolution law of the entire process of the disease syndrome,and enrich and improve the syndrome differentiation system.