重症加强护理病房患者谵妄分型与中医证候规律初探

Preliminary Study on the Law of Classification of Delirium and TCM Syndromes of Patients in Intensive Care Unit

目的:探索重症加强护理病房(intensive care unit,ICU)患者谵妄各亚型及中医证候分布规律。方法:收集87例ICU谵妄患者的基线资料及中医四诊信息,行亚型分类、急性生理与慢性健康(APACHEII)评分及中医辨证,确定中医证型及证候要素。结果:谵妄发生率为20.14%,活动减少型、活动增多型及混合型分别占49.4%、18.4%和32.2%。谵妄中医病位主要在心、脾、肝、肾;病性以实证和虚实夹杂证为主,虚证较少;实证以痰、热、瘀多见,虚证多为气虚、阴虚;实证及虚实夹杂证患者的APECHEII评分较虚证者高,且差异具有统计学意义(P<0.05)。结论:ICU谵妄发生率高,多表现为活动减少型,痰、热、瘀、虚是其主要病机,中医辨证与APACHEII评分相结合可以初步反映疾病的严重程度,有助于准确评估病情及判断预后。

Objective:To explore the law of classification of Delirium and TCM syndromes of patients in intensive care unit(ICU).Methods:78 delirium patients' baseline data and four diagnostic information were recorded,then the subtype classification,APACHE scoring and TCM syndrome differentiation were made to explore the law of syndrome characteristics and syndrome factors.Results:The incidence of ICU delirium was 20.14%,in which the hypoactive delirium,hyperative one and mixed type were49.4%,18.4% and 32.2% respectively.The disease is mainly located in Heart,Spleen,Liver and Kidney and it is mainly manifested as excess syndrome or the combination of deficiency and excess syndrome.The excess syndrome is mainly related to Phlegm,Heat and Blood Stasis,while the deficiency syndrome is mainly related to Qi and Yin deficiency.The APECHE scores of the excess syndrome as well as the combination of deficiency and excess syndrome were higher than that of the deficiency syndrome.Conclusion:There is a high incidence of ICU delirium,which is usually characterized by decreased activity of patients and the main pathogenesis includes Phlegm,Heat,Blood Stasis and deficiency conditions.Syndrome differentiation of TCM combined with APACHE can reflect the severity of the disease in preliminary level,which can help with the accurate assessment of disease and the prognosis determination.