脓毒症不同中医证型与临床预后的相关性研究
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摘要
目的:探讨脓毒症不同中医证型与临床预后的相关性。方法:采用前瞻性研究方法,选择318例脓毒症患者作为研究对象,收集入选患者的临床资料和实验室检测数据。将入选患者按就诊时不同中医证型分为毒热证组(73例)、腑气不通证组(82例)、血瘀证组(97例)、急性虚证组(66例),比较不同中医证型之间28 d病死率、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的差异;按28 d临床预后分为存活组(244例)和死亡组(74例),比较两组各临床相关指标的差异,并对影响预后的相关因素作logistic回归分析。结果:不同中医证型28 d病死率从高到低依次为急性虚证组(40.9%)、血瘀证组(20.6%)、毒热证组(17.8%)、腑气不通证组(17.1%),4组互为比较,急性虚证组与毒热证组、腑气不通证组、血瘀证组有显著差异,而毒热证组、腑气不通证组、血瘀证组互为比较差异没有统计学意义;不同中医证型APACHEⅡ评分分值从高到低依次为急性虚证组(24.25±7.67)、血瘀证组(16.85±6.34)、毒热证组(15.64±4.43)、腑气不通证组(14.97±5.23),4组互为比较,急性虚证组与毒热证组、腑气不通证组、血瘀证组有显著差异,而毒热证组、腑气不通证组、血瘀证组互为比较差异没有统计学意义。logistic回归分析显示,APACHEⅡ评分、中医证型、降钙素原、D-二聚体、心肌肌钙蛋白I是脓毒症患者临床预后的影响因素。结论:脓毒症不同中医证型与患者临床预后以及病情严重程度具有相关性,是影响临床预后的因素之一。
Objective: To investigate the correlation between different TCM syndromes and clinical prognosis of sepsis. Methods: The prospective study method was conducted and 318 patients with sepsis were enrolled as the research objects. The clinical data and laboratory test data were collected for this patients. The selected patients were divided into toxic-heat syndrome group(73 cases),Fuqi-impassability group(82 cases),blood-stasis group(97 cases) and acute-deficiency syndrome group(66 cases) according to different TCM syndromes. The differences of 28 d mortality rates,acute physiology and chronic health evaluation II(APACHE II) scores between different TCM syndromes were compared. The selected patients were divided into survival group(244 cases) and death group(74 cases) according to the clinical prognosis of 28 d. Comparing the difference between the two groups of the clinically relevant indicators and logistic regression analysis was performed on the related factors affecting the prognosis.Results: The 28 d mortality rates of different TCM syndromes from high to low were the acute-deficiency syndrome group(40.9%),blood-stasis syndrome group(20.6%),toxic-heat syndrome group(17.8%) and Fuqi-impassability syndrome group(17.1%). The four groups were compared with each other. The acute-deficiency syndrome group had significant differences compared with the toxic-heat syndrome group,the Fuqi-impassability syndrome group and the blood-stasis syndrome group. However,the toxic-heat syndrome group,the Fuqi-impassability syndrome group and the blood-stasis syndrome group were not statistically significant when comparing to each other. The APACHE II scores of different TCM syndromes from high to low were the acute-deficiency syndrome group 24.25±7.67),blood-stasis syndrome group(16.85±6.34),toxic-heat syndrome group(15.64±4.43) and Fuqi-impassability syndrome group(14.97±5.23). The acute-deficiency syndrome group had significant differences compared with the toxic-heat syndrome group,the Fuqi-impassability syndrome group and the blood-stasis syndrome group. However,the toxic-heat syndrome group,the fuqi-impassability syndrome group and the blood-stasis syndrome group were not statistically significant when comparing to each other. Logistic regression analysis showed that the APACHE Ⅱ score,TCM syndrome,procalcitonin,D-dimer and cardiac troponin I are the factors affecting the clinical prognosis of patients with sepsis. Conclusion: The different TCM syndromes of sepsis is related to the patients' clinical prognosis and the severity of the patients' conditions,which is one of the factors affecting the clinical prognosis.
Objective: To investigate the correlation between different TCM syndromes and clinical prognosis of sepsis. Methods: The prospective study method was conducted and 318 patients with sepsis were enrolled as the research objects. The clinical data and laboratory test data were collected for this patients. The selected patients were divided into toxic-heat syndrome group(73 cases),Fuqi-impassability group(82 cases),blood-stasis group(97 cases) and acute-deficiency syndrome group(66 cases) according to different TCM syndromes. The differences of 28 d mortality rates,acute physiology and chronic health evaluation II(APACHE II) scores between different TCM syndromes were compared. The selected patients were divided into survival group(244 cases) and death group(74 cases) according to the clinical prognosis of 28 d. Comparing the difference between the two groups of the clinically relevant indicators and logistic regression analysis was performed on the related factors affecting the prognosis.Results: The 28 d mortality rates of different TCM syndromes from high to low were the acute-deficiency syndrome group(40.9%),blood-stasis syndrome group(20.6%),toxic-heat syndrome group(17.8%) and Fuqi-impassability syndrome group(17.1%). The four groups were compared with each other. The acute-deficiency syndrome group had significant differences compared with the toxic-heat syndrome group,the Fuqi-impassability syndrome group and the blood-stasis syndrome group. However,the toxic-heat syndrome group,the Fuqi-impassability syndrome group and the blood-stasis syndrome group were not statistically significant when comparing to each other. The APACHE II scores of different TCM syndromes from high to low were the acute-deficiency syndrome group 24.25±7.67),blood-stasis syndrome group(16.85±6.34),toxic-heat syndrome group(15.64±4.43) and Fuqi-impassability syndrome group(14.97±5.23). The acute-deficiency syndrome group had significant differences compared with the toxic-heat syndrome group,the Fuqi-impassability syndrome group and the blood-stasis syndrome group. However,the toxic-heat syndrome group,the fuqi-impassability syndrome group and the blood-stasis syndrome group were not statistically significant when comparing to each other. Logistic regression analysis showed that the APACHE Ⅱ score,TCM syndrome,procalcitonin,D-dimer and cardiac troponin I are the factors affecting the clinical prognosis of patients with sepsis. Conclusion: The different TCM syndromes of sepsis is related to the patients' clinical prognosis and the severity of the patients' conditions,which is one of the factors affecting the clinical prognosis.
引文
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[8] 中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[S].中华危重病急救医学,2013,25(4):194.
[9] 张默,李敏珠,鲁俊,等.犀角地黄汤治疗老年脓毒症患者的临床研究[J].中国中西医结合急救杂志,2017,24(4):362.
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[12] 蔡国龙,杨敏春,严静,等.脓毒症患者不同中医证型T淋巴细胞亚群及活化淋巴细胞的变化[J].中华中医药学刊,2013,31(8):1608-1610.
[13] 肖莹莹,周仙仕,唐光华.脓毒症患者中医证候与预后的关系[J].中医杂志,2016,57(3):224-226.
[14] Al Tehewy M,El Houssinie M,El Ezz NA,et al.Developing severity adjusted quality measures for intensive care units[J].Int J Health Care Qual Assur,2010,23(3):277-286.
[15] Naved SA,Siddiqui S,Khan FH.APACHE II score correlation with mortality and length of stay in an intensive care unit[J].J Coll Physicians Surg Pak,2011,21(1):4-8.
[16] Stevens V,Lodise TP,Tsuji B,et al.The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia[J].Infect Control Hosp Epidemiol,2012,33(6):558-564.
[17] 曾文美,毛璞,黄勇波,等.脓毒症预后影响因素分析及预后价值评估[J].中国中西医结合急救杂志,2015,2(2):118-123.
[18] 王盛标,李涛,李云峰,等.4种评分系统对脓毒症患者预后的评估价值:附311例回顾性分析[J].中华危重病急救医学,2017,29(2):133-137.
[19] Qiu QM,Li ZW,Tang LM,et al.Expression of high mobility group protein B1 in the lungs of rats with sepsis[J].World J Emerg Med,2011,2(4):302-306.
[20] 张强,赵良,许永华,等.急性生理学与慢性健康状况评分系统Ⅱ评分及凝血指标对老年脓毒症患者预后的评估作用[J].中国危重病急救医学,2008,20(8):493-494.
[21] 邢豫宾,戴路明,赵芝焕,等.血清降钙素原和常用炎症指标结合SOFA评分对脓毒症早期诊断和预后价值的评价[J].中国危重病急救医学,2008,20(1):23-28.
[2] 周仙仕,叶烨,唐光华.从外感病证的内伤基础辨治脓毒症[J].中华中医药学刊,2016,34(8):1877-1879.
[3] 陈中腾,张远怀,崔可,等.中医辨证治疗脓毒症的临床疗效[J].中华中医药学刊,2018,36(3):726-728.
[4] 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014) [J].中华危重病急救医学,2015,27(6):416.
[5] Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [J].JAMA,2016,315(8):801-810.
[6] Dknaus WA,Draper EA,Wagner DP,et al.APACHE II:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.
[7] 薄禄龙,卞金俊,邓小明.2016年脓毒症最新定义与诊断标准:回归本质重新出发[J].中华麻醉学杂志,2016,36(3):259-261.
[8] 中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[S].中华危重病急救医学,2013,25(4):194.
[9] 张默,李敏珠,鲁俊,等.犀角地黄汤治疗老年脓毒症患者的临床研究[J].中国中西医结合急救杂志,2017,24(4):362.
[10] 王今达,李志军,李银平.从“三证三法”辨证论治脓毒症[J].中国危重病急救医学,2006,18(4):643-644.
[11] 徐顺娟,芮庆林,奚肇庆.脓毒症中医辨证分型的研究进展[J].中国中医急诊,2016,25(2):286-288.
[12] 蔡国龙,杨敏春,严静,等.脓毒症患者不同中医证型T淋巴细胞亚群及活化淋巴细胞的变化[J].中华中医药学刊,2013,31(8):1608-1610.
[13] 肖莹莹,周仙仕,唐光华.脓毒症患者中医证候与预后的关系[J].中医杂志,2016,57(3):224-226.
[14] Al Tehewy M,El Houssinie M,El Ezz NA,et al.Developing severity adjusted quality measures for intensive care units[J].Int J Health Care Qual Assur,2010,23(3):277-286.
[15] Naved SA,Siddiqui S,Khan FH.APACHE II score correlation with mortality and length of stay in an intensive care unit[J].J Coll Physicians Surg Pak,2011,21(1):4-8.
[16] Stevens V,Lodise TP,Tsuji B,et al.The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia[J].Infect Control Hosp Epidemiol,2012,33(6):558-564.
[17] 曾文美,毛璞,黄勇波,等.脓毒症预后影响因素分析及预后价值评估[J].中国中西医结合急救杂志,2015,2(2):118-123.
[18] 王盛标,李涛,李云峰,等.4种评分系统对脓毒症患者预后的评估价值:附311例回顾性分析[J].中华危重病急救医学,2017,29(2):133-137.
[19] Qiu QM,Li ZW,Tang LM,et al.Expression of high mobility group protein B1 in the lungs of rats with sepsis[J].World J Emerg Med,2011,2(4):302-306.
[20] 张强,赵良,许永华,等.急性生理学与慢性健康状况评分系统Ⅱ评分及凝血指标对老年脓毒症患者预后的评估作用[J].中国危重病急救医学,2008,20(8):493-494.
[21] 邢豫宾,戴路明,赵芝焕,等.血清降钙素原和常用炎症指标结合SOFA评分对脓毒症早期诊断和预后价值的评价[J].中国危重病急救医学,2008,20(1):23-28.