严重创伤后急性肾损伤中医证型、证素的临床探析

Clinical Analysis on TCM Syndrome Patterns and Syndrome Elements of Acute Kidney Injury after Severe Trauma

目的通过临床调查与回顾性研究相结合的方法,归纳总结86例严重创伤后出现急性肾损伤患者的中医证型、证素的分布规律,以期为严重创伤后出现急性肾损伤患者的中医诊断、治疗提供可靠依据。方法收集山东省文登整骨医院2023年1月至2023年12月急诊创伤科、重症医学科、内科住院患者中符合严重创伤后急性肾损伤的病例107例,符合纳入标准共计86例,应用传统中医辨证分型,并对其病位、病性证素进行统计分型,分析其临床特点。结果86例严重创伤后急性肾损伤患者中医辨证分型,总体归属于血瘀气滞证、脾肾阳虚水停证、瘀结水留证、热毒炽盛证、脾肾气虚血瘀证、肝肾气血两虚证及痰湿中阻证;病位证素10个,尤以肾、脾、胃、肝、膀胱比较多见;病性证素12个,尤以血瘀、毒、阳虚、水停、气虚、血虚、气滞、湿、闭等比较常见。结论86例严重创伤后急性肾损伤患者的病位证素、病性证素与传统中医辨证分型相符合,辨证素更明确地揭示了疾病发生的病位、病性及病理因素,更能形成统一的辨证分型及论治用药。故而当临床中可采用证素辨证来避免医者主观判断所造成的偏差。

Objective:To provide a reliable basis for the traditional Chinese medicine(TCM)diagnosis and treatment of patients with acute kidney injury(AKI)following severe trauma by summarizing and generalizing the TCM syndrome patterns and syndrome elements in 86 cases through a combination of clinical investigation and retrospective research.Methods:A total of 107 cases of patients with AKI following severe trauma from the Emergency Trauma Department,Intensive Care Unit,And Internal Medicine Department of Wendeng Osteopathic Hospital in Shandong Province were collected from January to December 2023.Among them,86 cases met the inclusion criteria.TCM syndrome differentiation was applied,and statistical classification of the disease location and nature syndrome elements was conducted to analyze their clinical characteristics.Results:Among the 86 cases of AKI following severe trauma,the TCM syndrome differentiation mainly included stasis and qi stagnation type,spleenkidney yang deficiency with water retention type,stasis with water retention type,exuberant heat-toxin type,spleen-kidney qi deficiency with blood stasis type,liver-kidney qi-blood deficiency type,and dampness-phlegm blocking middle energizer type.Ten disease location syndrome elements were identified,most commonly involving the kidney,spleen,stomach,liver,and bladder.Twelve disease nature of syndrome elements were recognized,notably including blood stasis,toxicity,yang deficiency,water retention,qi deficiency,blood deficiency,qi stagnation,dampness,and obstruction.Conclusion:The disease location and nature syndrome elements in the 86 cases of AKI following severe trauma align with traditional TCM syndrome differentiation.Syndrome element differentiation more clearly reveals the disease location,nature,and pathogenic factors,facilitating the formulation of unified syndrome differentiation and therapeutic approaches.Thus,in clinical practice,syndrome element differentiation can be adopted to reduce the bias caused by subjective judgment of medical practitioners.